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The Canadian Nurse
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MISS JE STOCK
608-l11 wURJEMBu
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OTTAriA 2 ONI
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WHITE SISTER
The Timeless Look
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WHITE
SISTER
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8
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A. Style No. 46463
Sizes 3-15
Royale Corded Tricot
White, Pink . . . . . . . about $26.00
(
)
I
I """ITE
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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
.
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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
,
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$16.99
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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
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Eaeh is distincti\l'h sh'led and features
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Cushioned insoles \\ ith arch support. Fle\.ihle
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Set' the l'ntÌl'e ,election of Bata RE\l TY 0'\
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tolla\. at tIlt-' Bata ston' nearest \tHl.
Then tr
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A world of comfort at your feet
\t
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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
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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."
\'
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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
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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.re<lthe dressing
may be changed 10 a nOf'Hmpregnated one The amount of
.Jludete should de.ermlne the frequency 01 dressing c"anges
Pre(; ...ÖO....
In most cases abSOfpt!on 01 tI'Ie antlbtotlc IS so Slight that It can
be discounted W"ere very large body areas are Invotved (eg
301iit Of more bOdy burn) ltIe possfbd,1')' of Ok>tOXlC1ty 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?"
.
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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
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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
,
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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.
"
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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.
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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. ."
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A. S StyI. No. 467
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Izes 3-15
Royale Di
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Sugg. Retail $28.00
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B. S S!y1e No. 46214
Izes 5-15
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Polyester Te
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Kni
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White, Mint
Sugg. Retail $30.00
C. S S!y1e No. 6256
Izes 8-16
Royale Wicke
Polyester Te
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Knit ured Warp
White
Sugg. Retail $25.00
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.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.
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CNA has added another example of
local craftsmanship to its display of
gifts from member-provinces. A
distinctIve pewter wall hanging,
entitled "Fiddlehead Sunrise," was
given to the Association by the New
Brunswick Association of Registered
Nurses.
The three-dimensional plaque
was designed and executed by
Carole Cronkhite, a Fredericton artist.
It depicts the sun rising in the east,
Canadian Diabetic
Association Sponsors
Bursaries
One of the two Ames Bursaries for
1975 has been won by Mavis
Verronneau, diabetic teaching nurse
at the Montreal General Hospital In
Montreal. Her project involves
preparation of a diabetic teaching
manual in both English and French.
Two bursaries of up to $1,000
each are offered annually by the Ames
Company, a division of Miles
Laboratories Limited. Application
forms are available from the Canadian
Diabetic Association, 1491 Yonge
Street. Toronto. Ontario. Deadline for
submission of protocols to this
Association is March 1, 1976.
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along with a fiddlehead motif.
(Fiddleheads are an early growth of
Ostrich Fern considered a gourmet
delicacy.) The wall hanging shown
above with NBARN executive
secretary Jean Anderson (right) and
CNA president Huguette Labelle,
IS on display in the main entrance
lobby of CNA House. A ceramic
planter that was a recent gift from the
Alberta Association of Registered
Nurses is also suspended nearby.
Association Offers
Legal Aid to B.C. Nurses
British Columbia nurses not covered
by collective agreements can now
apply for RNABC legal aid to help
resolve serious disputes with their
employers.
Under a system approved
recently by the association s board of
directors. members excluded from
bargaining units may obtain loans to
retain lawyers, if legal action is
considered necessary to settle
disputes
I...UW ........ y"u W
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Both sizes of Sofra- Tulle
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mesh is wide enough to permit
good drainage of exudate, thus
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u
I ne (;8naalan Nurse January 1976
ttThe more you
want from nursing, the
more reason
you should be
Medox:'
Virginia Flintoft, R.N., Staff Supervisor
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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?
. retire from nursing, but not completely?
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.
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 it
is to keep growing in your job-to
avoid that awful feeling of being
stuck in the same rut. Certainly
what you're doing is tremendously
worth-while. and heaven knows
there is a desparate shortage of
nun.es But your job must be
worthwhile to YOII. or else you"!1
eventually want to drop out"'.
"That's wh} 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 "orking
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 Hintoft,
R.N.. Staff Supervisor. Medox, 55
Bloor St. W.. Toronto, Ontario, or
call the local Medox office"
[M.:noXl
a DRAKE INTER
ATlONAl company
If you care for people,
you're Medox.
Cale,ll(ll1I e
February 5-6, 1976
"Nursing and the Adolescent" to be in
Vancouver. Contact" Continuing
Education in Health SCiences,
University of British Columbia,
Vancouver, B.C., V6T 1W5. Phone:
228-3055.
February 27-28, 1976
Conference for Recovery Room
Nurses, In Vancouver. Contact"
Continuing Education in Health
SCiences, University of British
Columbia, Vancouver. B.C., V6T 1W5.
March 8-12, 1976
Gerontological nursing workshop to
be held at Toronto hospitals. For
information, write: Dorothy Brooks,
Chairman, Continuing Education
Program, University of Toronto
Faculty of Nursing, 50 St. George
Street, Toronto, Ontario, M5S 1 A 1.
March 11-12, 1976
Seminar "Conflicts in the Physical
Rehabilitation Team" to be held in
Ottawa (was to be in January). For
information, contact: Carolyn Belzile,
Coordinator, Continuing Education
Program, School of Health
Admmistration, University of Ottawa,
Ottawa, Ontario. Telephone:
231-5062.
March 11-12,1976
"Nursing Care in the Postpartum
Period" to be in Vancouver. Contact
Continuing Education in Health
Sciences, University of British
Columbia, Vancouver, B. C. V6T 1 W5.
March 17-18, 1976
"Optimum Cardiac Rehabilitation" to
be held in Vancouver. Contact:
Continuing Education in Health
Sciences, University of British
Columbia, Vancouver, B. C. V6T 1 W5.
March 18, 1976
"Stress -Coping with it in Nursing" to
be in Calgary. Contact: Division of
Continuing Education, University of
Calgary, Calgary, Alberta, T2N 1 N4.
March 23-25, 1976
"Role of the Nurse Administrator in
Staff Evaluation Programs" in
Vancouver, for supervisory personnel.
Contact Continuing Education in
Health Sciences. University of British
Columbia, Vancouver, B.C. V6T 1W5.
April 5-6, 1976
"Being Old and Human Too -
Implications for Nursing" to be in
Calgary. Contact: Division of
Continuing Education, University of
Calgary, Calgary, Alberta T2N 1 N4.
April 21-23, 1976
Pediatric Intensive Care Nursing
Conference at the Hospital for Sick
Children, Toronto, Ontario.
Information from: Hilda Roistin,
Nursing Education Department,
Hospital for Sick Children, 555
University Avenue, Toronto, Ontario,
M5G 1X8. (Phone) 1-416-597-1500
ext. 1517,
April 26-30, 1976
British Columbia Operating Room
Nurses Group fifth biennial institute to
be held at the Hotel Vancouver,
Vancouver. B.C. For information,
write: Ellen Schrodt, 103-930
Glenacres Drive, Richmond, B.C.,
VlA 1YB.
May 16-19, 1976
American Lung Association -
American Thoracic Society annual
meeting to be held in New Orleans. La.
For information, write: Chairperson.
Annual Meeting Nursing Program
Subcommittee. American Lung
Association Nursing Department.
National League for Nursing, 10
Columbus Circle, New York, N.Y.,
10019, U.S.A.
May 24-28, 1976
International Ophthalmic Study
Courses for nurses to be held at
Wolverlõampton and Midland
Counties Eye Infirmary. For
information, write: the Secretary,
Wolverhampton & Midland Counties
Eye Infirmary, Compton Road,
Wolverhampton WV3 9Q4, England.
May 28
une 1, 1976
Annual convention of the American
Society of Adlerian Psychology to be
held at the University of British
Columbia, Totem Park Convention
Centre. Vancouver. For information,
write: Edna Nash, BCAAP, P. O. Box
33823, Station D, Vancouver, B.C.,
V6L 4L6
June 6-11, 1976
American Nurses Association
Biennial Convention in Atlantic City,
N.J. For information, write:
Convention Unit. ANA. 2420 Pershing
Road. Kansas City, Missouri 64108.
June 7-10, 1976
Canadian Conference on Youth.
Society, and the Law. sponsored by
the Canadian Criminology and
Corrections Association, is to be held
at Queen's UniversIty. Kingston,
Ontario. For information, write:
Chairman, Canadian Conference on
Youth, Society, and the Law, 55
Parkdale Avenue, Ottawa, Ontario,
K1Y 1E5.
June 13-17, 1976
Biennial Canadian conference on
social welfare to be held at Skyline
Hotel, Toronto, Ontario. Sponsored by
the Canadian Council on Social
Development. For information, write:
Reuben C. Baetz, Executive Director,
CCSD, Box 3505, Station C, Ottawa,
Ontario K1Y 4G1.
June 16-18,21-23, or 24-26, 1976
Regional conferences cosponsored
by the Registered Nurses Association
of Ontario and the Ontario Hospital
Association will be held June 16-18 at
New Parkway Hotel, Cornwall: June
21-23 at Laurentian University.
Sudbury; June 24-26 at Ontario
Hospital Association, Toronto. For
information, write, Beanor Trutwin,
Professional Development, RNAO, 33
Pnce Street, Toronto, Ontario,
M4W 1Z2.
June 21-23, 1976
Annual meeting of the Canadian
Tuberculosis and Respiratory Disease
Association will be held at the
Regency-Hyatt Hotel, Vancouver,
B.C. The Nurses Institute and the
Canadian Thoracic Society s scientific
sessions are held at that time. For
information, write: CTRDA, 345
O'Connor Street, Ottawa, Ontaf/o,
K2P 1V9.
June 21-23, 1976
Canadian Nurses' Association annual
meeting and convention to be held at
Hotel Nova Scotian, Halifax, Nova
Scotia. Theme: The Quality of Life
June 22-25, 1976
Canadian Public Health Association
annual meeting to be held in Moncton,
New BrunswIck. For details, write:
CPHA. 55 Parkdale, Ottawa, Ont.,
K1Y 1E5
July 23-25, 1976
Kingston Psychiatric Hospital Nurses'
Alumnae Association Reunion 76. For
information, wnte the general
convenor, NR. Ferguson, 312
College Street, Kingston, Ontario,
KlL 4M4.
July 25-30, 1976
Tenth Biennial Conference of the
Caribbean Nurses' Organization will
be held in Barbados, West Indies. For
information, write: Caf/bbean Nurses
Organization P.O. Box 2018,
Curacao, Netherlands Antilles.
August 29-September 3, 1976
Ninth International Conference on
Health Education will be held at the
Skyline Hotel. Ottawa. Ontario.
Theme: "Health Education and Health
Policy in the Dynamics of
Development. -, For information, write:
Canada's Organizmg Committee,
Ninth International Conference on
Health Education, c/o CHESS, P. O.
Box 2305, Station D., Ottawa, Ontario,
K1P 5KO.
October 28-31, 1976
International Congress of Sexology,
cosponsored by the Department of
Sexology of the University of Quebec
in Montreal and the Society for the
Scientific Study of Sex, to be held at
the Sheraton-Mount Royal Hotel in
Montreal. For information, write: Prof.
Robert Gemme. Department of
Sexology, University of Quebec m
Montreal. P.O. Box 8888, Montreal,
Quebec, H3C 3P8.
June 19-25, 1977
International congress of the World
Federation 01 NeurosurgIcal Nurses to
be held in Sao Paulo, Brazil, in
conjunction with the 6th international
congress of neurological surgeons of
the World Federation of Neurosurgical
Societies. For information, write:
Rosanne Mazzola, Secretary, WFNN,
277 Forest Avenue Paramus, N.J.
07652, U.S A
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16
The Canadian Nurae January 1976
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"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
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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
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The Canadian Nurse January 1976
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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
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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
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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.
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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.
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Hazel K. Moggach
Of course, there had to be a better way.
Although two nurses had been trained as
dental preventive technicians a year
previously, they were still unable to organize a
system to ensure that the 750 adult retarded
residents of our Centre had clean mouths and
teeth. Yes, there had to be a way. . .
For nearly a year, our dentist had carried
out her moral and professional responsibilities
to ensure that her services were benefiting the
residents who received them. She had
communicated with the administrator, the
supervisor, and the counsellor regarding the
implementation of new and efficient programs.
The residents kept their dental appointments,
but they had dirty, foul-smelling mouths and
discolored, plaque-infested teeth and gums.
I"'" ........a....a..."'......... .......ua., .;;II'Q
decreased with conditioning, until it ceased
after one week. On one occasion, a male staff
member was grabbed in the genital area. The
dentist did not consider that this was done with
intenf to harm. She did suggest. however, that
the staff learn how to grasp a resident's head
and maintain a firm grip before taking over the
program.
One highly motivated, mute resident
seemed to sense the dentist's time of arrival,
so did what he could to get his peers into
formation, and the brushing materials in order.
From her study, the dentist concluded
that, jf counselling staff schedules a daily
Brushing Brigade
The usual excuse was: no time for cleaning
teeth as other activities had high priority;
besides, some residents had aberrant biting
habits.
The dentist decided to go outside her
"sanctuary," the dental clinic, to set up a
tooth-brushing program and man the project
each evening for six weeks. She wanted to see
for herself and assess the difficulties
encountered in helping severely retarded
persons with oral hygiene.
Her research sample was the 35 male
residents of a renovated hospital ward; the
tooth-brushing procedure was to be
accomplished in a relatively confined area that
had two small sinks. A staff member
prearranged the schedule and cared for the
equipment; the brushing started at 18:00
hours, when the dentist arrived. She applied
paste to the tooth brush and did all the
brushing (33 ml tooth paste was used at each
session).
The first brushing session was completed
in 90 minutes; the second. in one hour; and
eventually they needed no more than 40
minutes.
The residents gums bled profusely the
first evening. The bleeding gradually
tooth-brushing place and time and knows the
art of gripping the head firmly to ensure
optimum vision and stability, the residents can
be motivated to accept oral care daily and to
need a minimum of staff and time for it. Also,
with improvement in a resident's motor
coordination, she expected even the most
severely retarded person to practice personal
hygiene daily with minimal reinforcement and
assistance from staff members.
The dentist communicated effectively with
the other members of the health team - not
only by what she said, but how she said it and
her firm belief in what she said. Now the
nursing staff carryon the tooth-brushing
program throughout the Centre, and it goes
like clockwork ..
Hazel K. Moggach, RN, B.A., M.Ed., IS
acting coordinator of human resources at the
Oxford Regional Centre. Woodstock, Ontario.
Sophie Rozycki, D.D.S., D.D.P.H., who was
then the Centre's dental coordinator, set the
oral hygiene program in motion.
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As a nurse, you have a responsibility - to yourself
and to your clients - to know what can be done
to prevent blindness.
Fifty percent of all blindness is preventable.
Which half will you be classified in?
Fern Doner
............................................................
Today, prevention is a top priority in all areas of
health care. In theory, we are doing quite well;
in practice, our actions do not match our
words. Physical fitness experts warn that lack
of exercise and poor eating habits are leading
more and more Canadians to the coronary
care units of our hospitals. "The Department of
National Health and Welfare advises that
danger to health increases with amount
smoked" but the number of smokers continues
to climb. We know more about prevention than
I we care to admit but we are great
procrastinators. When was the last time you
had a complete physical? When did you last
visit the dentist?
You the Nurse
The nurses' role in preventive health
programs can be divided into two areas: that of
observer, and that of teacher or informant.
Eye care begins at birth. Although the
initial examination is the responsibility of the
doctor, the nurse should be aware of possible
congenital problems, e.g., cataracts, hazy
cornea. subconjunctival hemorrhages,
hemangioma (nevus flammeus), crossed eyes
due to sixth nerve palsy, conjunctivitis and
dermoid cysts. The symptoms of infantile
glaucoma - irritability, tearing, and
photophobia require immediate attention to
prevent blindness.
Health care personnel. particularly the
nurse, should make parents aware that, if all IS
well, their baby will start to follow light at three
months of age, and will start reaching for
objects at four to six months. A baby's eyes
should be straight by the age of six months and
though the parents may only think that "the
baby's eyes look funny," it is better to be sure
by having an examination.
Strabismus which appears after the
child is a year old may be caused by a number
of other conditions needing immediate
treatment, including congenital malformations,
cataracts, corneal opacities, uveitis and
tumors. A white pupil may suggest cataract,
retinoblastoma, or retrolental fibroplasia - a
condition found in premature babies who
receive high concentrations of oxygen.
Preventive health care by the nurse involves
stressing the need for early treatment of
strabismus to the parents.
The public must continually be exposed
to the potential hazards in their immediate
environment through lectures, films,
pamphlets, and "nagging". The attitude is
always - "it could never happen to me." But it
can and does, and nursing has a responsibility
to reinforce these preventive health programs.
For example: .
. R. T., a 14-year old boy, took a drink
from a bottle he found in his father's truck.
Today R. T. is legally blmd from optic atrophy
because the bottle contained antifreeze. He
functions in school using a low vision aid and
large print type.
. Mr. D.H. decided to stop taking his
glaucoma drops for awhile because he was
having headaches. Fortunately, the nurse
stopped in for a regular visit and explained
why it was necessary that the drops always be
taken as ordered by the doctor. Although D.H.
will use glaucoma drops for life, he can still
see today to manage his hardware store.
The nurse should be informed about the
use and abuse of contact lenses. With the
growing popularity of these optical aids,
frequent questions are posed to the nurse by
wearers and prospective wearers. Are they
aware of the necessity of following the
cleaning routine? Do they stop wearing the
lenses when their eyes feel irritated or sore
and contact the doctor? All this knowledge
belongs to the nurse.
Sadly, one of the slogans least likelý to
be followed is, "Be Wise, Take Care of Your
Eyes." This fact is a major concern of The
Canadian National Institute for the Blind (CNIS)
whose founder, Colonel E.A. Baker, instituted
the prevention of blindness program in 1918.
Each of the eight divisions of CNIB has a
prevention of blindness program. Some
Provinces (Le. Ontario, Quebec, and
Newfoundland) have a specialized area of
prevention in the Mobile Eye Care Units
(MECU).
Mobile Eye Care Units
The Mobile Eye Care Units are
ophthalmologist s offices on wheels. They
travel into rural areas not already served by a
resident ophthalmologist, providing eye
examinations, testing, and minor surgery on
an emergency basis. The vans are staffed by
ophthalmologists from across Canada who
volunteer their services for one- or two-week
periods, and by trained CNIS staff who
coordinate the programs in each community
with the help of service clubs, local doctors,
and the Public Health Departments. People
needing further care or follow-up are referred
back to a local doctor or Public Health nurse.
Industrial Hazards
The necessity for wearing safety glasses
in industry is well publicized by the Wise Owl
Club of Canada. Employees who have saved
their sight by wearing eye safety equipment
are eligible for membership in this club. The
Wise Owl Club began in 1947 as the result of
an idea dropped into a suggestion box at a
plant in St. Louis, Mo. The Canadian
equivalent was formed in 1957,
There are three main concerns in
industry: the chemical splash, the radiation
burn, and the foreign object.
One of the many instances of eyesight
being saved by the wearing of safety lenses i
that of Mr. F., a millwright helper for
Inter-Provincial Steel and Pipe Corporation
Limited, Regina. Mr. F. was putting an arch i
front of an electric furnace while another cre
member was gunning the furnace from the
inside with an air gun. Somehow the gun
slipped and Mr. F., who was in front of the
furnace, received the full blast in his face.
Although the force of the flow broke one of hi
safety lenses, his eyes were undamaged. I
Hazards at home
Safety lenses should also be used in thl
home. Sawdust or paint can easily blow inti
your eyes when doing woodwork or painting
But, prevention of blindness involves more
than wearing safety glasses. Hazards in thE
home are easily overlooked:
. Spray cans that dispense hair spray,
perfume, deodorant, insect repellent, air
fresheners, cooking aids, paints, and waxe
for example, represent potential hazards,
especially for preschoolers.
. The ingestion of corrosive or alcoholic
liquids such as antifreeze or cleaning agen
can cause optic atrophy and permanent
blindness.
. Homemade and unsupervised firework!
displays, scissors, knives, pellet guns, and
elastic bands can also be a great hazard to
both children and adults.
Hazards in Sports
A survey of the 1973-74 hockey seaso
by the Canadian Ophthalmological Society
reveals that this popular sport poses seriou
potential hazards to the players. Eye injurie
were numerous; they ranged from broken
socket bones to nerve damage, hemorrhage
and cuts on the eyeball from sticks and puck!
Six percent of these injuries resulted in leg,
blindness: Another sport that is causing
concern in ophthalmologists' offices is squasl
a game of increasing popularity, but, with a ba
as hard as a stone that fits neatly into the eYE
socket.
. A person is considered blind if the visual acuity il
both eyes with proper refractive lenses is 20/20
or less with the Snellen chart (or equivalent) or
the greatest diameter of the field of vision in bo
eyes is less than 20 degrees. (As defined in tt
Blind Persons Act, Ottawa, Can., July 1962.)
............................................................
Car Safety
"Buckle up for safety" is another
preventive slogan which goes unheeded.
Some provinces are considering legislation to
make the wearing of seat belts mandatory.
Certainly, seat belts (done up!) can save your
life; they can also save your eyesight. Eye
injuries in car accidents are far too common,
especially among children. They are just the
right height to suffer a concussion from
knocking their heads against the dashboard on
a sudden stop.
Eye Examinations
There is nothing to fear from a visit to
the eye doctor, but a regular checkup by an
eye specialist is another example of our
tendency to procrastinate. In Saskatchewan,
yearly eye examinations are covered by a
Health Plan up to the age of 17 years, every
three years from 17-46. and then every two
years over the age 46. Once a person reaches
approximately age 25, he should have a
regular examination for glaucoma. This is a
simple. painless test. Glaucoma when
diagnosed early can be controlled by drops;
left untreated, it can lead to blindness.
Glaucoma surveys are conducted periodically
by CNiS and positive readings are referred to
eye specialists for treatment.
CNIS and/or Public Health Departments
also screen preschool children for amblyopia.
Amblyopia, or "lazy eye", is a condition in
which one eye has poor vision, although there
is no disease or malformation present. One of
the main causes of amblyopia is strabismus or
crossed eyes. The child suppresses vision In
the turned eye to avoid seeing double. This
eventually leads to very poor vision. After
approximately the age of seven years it is too
late to correct the situation, therefore the
treatment of amblyopia must begin early.
Home Eye Test
Recently, a home eye test has been
developed and circulated by CNIS which
enables parents to test their child's eyesight
The E-game includes a large black E, an eye
patch shaped like a daisy, and three smaller
E'S in graduated Sizes, The child is seated on a
chair ten feet away from a light-colored wall.
The daisy eye patch is placed over one eye at a
time and the child holds the large "E He is then
asked to point the hands of his "E" in the same
direction as the "E" that mother is holding up to
the wall.
If the child has trouble with any of the
sizes, the parent is instructed to arrange for an
eye examination. Signs and symptoms of
possible trouble such as dizziness, frequent
rubbing of eyes, crossed eyes, and stumbling
over small objects, are fisted in the pamphlet
with the E-game. The text of the pamphlet is
approved by the Canadian Ophthalmological
Society.
-
Eye Q Test
How large is Canada's blind
population?
41,000
29,000
17,500
2. Of 3,187 people seen at Mobile Eye
Care Units in Ontario in 1973,
(MECU) how many reported having had
no previous examinations?
874
253
631
3. What percentage of people seen in the
MECU have some problem related
to an abnormality of the eyes?
48 73 81
accidents infections glaucoma
22 81 52
4. What was the third leading cause
of blindness in 1974?
5. How many people were blinded in 1974
from injuries and poisonings?
6. How many eye injuries are on record
as having occurred during the
1973-74 hockey season?
279
102
589
7 Which group has more injuries?2
Unorganized hockey
Organized hockey
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Progress
Medicine makes rapid advances and no
one knows when a breakthrough in
ophthalmology may come, enabling many of
our blind population to see again. Even today,
some people have regained their sight as the
result of corneal transplants and the work of
the Eye Bank of Canada. Research into the
effect of diabetes on the eyes will someday
provide an answer to that cause of blindness.
Vaccination for rubella has virtually wiped out
those statistics and now in some provinces,
preadolescent girls are routinely vaccinated
as part of the school health program. The
National Retinitis Pigmentosa Foundation of
Canada was founded last year to direct
research into a cure for this disease which
strikes primarily children and young adults.
It is estimated that 50% of all blindness is
preventable. Which half will you be
classified in? Take care of your eyes: they
must last a lifetime. ..
Fern Doner (R.N. Toronto East General and
Orthopedic Hospital) is Supervisor,
Prevention of Blindness and Eye Service for
CN/B. Saskatchewan Division, Regina, Sask.
References
1, Wise Owl News vol. 7, no. 3, Summer 1974
2. Ibid vol. 8, no. 1, Winter 1975.
Bibliography
1. Arstikaitis, M. Looking over infant s overlookec
eye problems. Canad. Faro Phys. 21 :5:67-70,
May 1975.
2. Lawton, Robert D. CNIB mobile eye care units il
Canada, by ." et at Canad. J. Ophtha/.
10:3:334-45, Jul. 1975.
3. Vaughan, Daniel. General ophthalmology
by . . . et al. 6th ed. Los Altos, Ca., Lange Medica
Publications, 1971.
30
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31
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Nursing .
Å TECLITE
Modern telecommunications are helping to
bridge the gap that often separates northern
citizens from the medical assistance
they need.
Nicole E Henderson
Most of us use the telephone, turn on the radio or television and find out
what is going on in the world without giving a thought to the technology
involved. Telecommunications are an integral part of the professional
and 'private life of those who live in southern Canada. In the northern
areas of the provinces. the Northwest Territories and the Yukon, it is a
different story; reliable communications can be a matter of life and
death.
Notaraluk Ijaituk of Ivujivik, Quebec, knows this from personal
experience: "It was in September of 1970 thatit happened. My son was
about four months old at the time. He got what seemed like an ordinary
cold; the first he'd had. We were not too worried at first but then it got
worse. We radioed the nurse in Salluit and she told us what to do. There
was no nurse here, and so there were three Inuit and a white man all
helping to look after the baby. The baby seemed to be getting better
after a while, but he suddenly got very sick just as the radio faded out.
For three days we could not raise anybody on the radio. During this
time the baby was hot and sweating all the time and he couldn't eat. We
were sure that he would never pull through. Finally, on the third day, we
we e able to get a message out for help and a plane came. As we put
the baby on the plane, my wife thought he was already dead. The plane
rushed him to Salluit, and there the nurse put a tube down his throat
and took out the poison in his lungs and he is living now. The thing that
really worries me is that the radio is no different today than it was then.
The people here are always worried that someone will die here
because of that radio. "I
Communications take on a special importance for northerners
because, although there are 58,000 of them, they are spread over an
area of 1.5 million square miles - approximately 40 percent of Canada.
This isolation is a serious problem for people whose health is constantly
threatened by accidents, inadequate sanitation and mental stress. Dr.
H.B. Brett, principal medical officer with the Medical Services Branch of
Health and Welfare Canada, says that mental health problems affecting
both native and non-native can be crucial in isolated settlements where
the interaction between different cultures can create difficulties and
where the pattern of education separates families for months on end.
He points out that there is a lack of psychiatric facilities in the north. 2
In addition, infant mortality rates are high - estimated at 89 per
1,000 live births for the Inuit in 1968, and 49 for the Indian people -
compared to 21 for the whole of Canada. 3 Accidents, poisoning and
violence (suicide included) accounted for 33 percent of all deaths in the
Yukon and N.W.T. in 1973. Neoplasms, diseases of the circulatory
system, and respiratory problems rank next in significance. Dr. Brett
believes that better telecommunications, especially radio, would helpto
Improve health conditions in the north.
Health and Welfare Canada is acutely aware of the health
problems faced by northerners. The department operates 72 nursing
posts (37 ofthem in the N. W. T.) staffed by nursing practitioners. Four of
its 13 hospitals are beyond the 60th parallel - all have at least eight
beds and a resident doctor.
There is great variation in the communication services available to
support northern health services. Dr. H.J. Bagnall, a consultant with
Medical Services, says, "Generally speaking, the most isolated posts
have only high frequency (HF) radio. (HF radios reach great distances
by bouncing the signals off the ionosphere.) There are 16 posts of this
type, Radio communications can be cut off for days by disturbances in
the ionized part of the atmosphere (ionosphere) which, incidentally,
also create the northern lights. Other organizations such as the
Hudson's Bay Company or the Royal Canadian Mounted Police
(RCMP), whose radios are more powerful. can otten be of help in these
circumstances. There are times, however, when no one can establish
communications with the outside. " Other posts have very high
frequency radio which is suitable for linking stations about 40 miles
apart on flat ground.
A more sophisticated system is used by nursing stations and
hospitals in the Mackenzie Valley, where Canadian National
Telecommunications (CNT) has microwave links between Yellowknife
and Inuvik. The Yukon has a system of land lines in addition to
microwave links.
Hundreds of miles of wires, or microwave towers spaced 30 or 40
miles apart, are required to carry telephone, telex, radio or television
services. Systems of fhis type are expensive and tend to be located in
the more accesible areas where population density and level of
development make them economically feasible.
Other northern health care stations, such as the hospital at
Frobisher Bay, are linked to the telecommunications network by
satellite. The advantage of satellite communications is that they are not
32
The Canadian Nurse January 1976
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subject to disruption by atmospheric disturbances. The earth stations
they require can be installed fairly easily and with minimal lead time.
Satellites became part of Canada's telecommunication system in
1973. Operated by Telesat Canada, a commercial corporation, the
channels in the three Anik satellites are leased by such companies as
the Canadian National Telecommunications (CNT), the Canadian
Broadcasting Corporation (CBC) and Bell Canada. Besides
transmitting television and telephone in southern Canada, satellites
provide northern communities with telephone, radio and television
services. Dr. John Chapman, assistant deputy minister, space
programs, Department of Communications, notes: "There are, at
present. 10 communities in the N.W.I. and seven communities in
Ontario and Quebec served by Anik with telephone services. , . In the
Yukon and Northwest Territories, 33 communities receive radio and 22
communities receive television. "Dr. Chapman predicts: "In the next
seven to ten years, all communities with over 200 people are expected
to be able to receive radio, and communities with over 500 people are
expected to be able to receive television. "3
In the near future, a new breed of high-powered satellites will push
back the frontiers of communications. In this context, the federal
Department of Communications this month launches the experimental
Communications Technology Satellite (CTS). It will test the feasibility of
using mobile earth stations much smaller than those used by traditional
lower-power satellites, and will be light enough to be carried on a big
sled or in a bush plane. CTS will be able to transmit voice, images and
data to and from these small terminals. It will also be capable of/wo-way
transmission of voice alone or voice plus video. CTS is a joint project
with the United States and satellite time will be shared equally by the two
countries. The satellite was designed and assembled at the Research
Centre of the federal Department of Communications near Ottawa.
In 1972, the department invited interested Canadian groups to
suggest experiments using CTS. Universities, federal and provincial
governments, native groups, private industry and broadcasters
submitted proposals. Possible applications of the satellite have been
discussed at a number of meetings between the department and
researchers. As a result, a series of technical and social experiments
will be carried out, involving telemedicine, tele-education, cultural
exchanges and television programming by native groups, during the
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expected two-year lifetime of CTS.
T elemedicine has been described as a "mode of delivering medical
care (which) serves to replace the physical presence of a physician with
an electronic presence" 5, or the practice of medicine at a distance. It
seeks to extend to isolated areas the professional hospital and health
care services available in larger centers, and to facilitate the exchange
of information essential to better diagnosis and treatment.
T elemedicine systems can be used for distant consultations among
nurses in remote areas as well as for continuing education.
Among the proposed CTS telemedicine experiments is one by Dr.
Lewis Carey of the Health Science Centre, University of Western
Ontario, involving three levels of health care. Under the proposal, the
nursing station at Kasatchewan, a village on James Bay in Northern
Ontario, would be equipped with a small dish-shaped antenna one meter
in diameter. This would allow the nursing station to communicate with
the General Hospital at Moose Factory, which provides obstetrical,
medical and minor surgical care. A second link would be established
between the hospital in Moose Factory and the Health Science Centre
of the University of Western Ontario, where specialists would assist in
the interpretation of ultra sound images, radiographs or ECGs.
This experiment would assist in evaluating the usefulness of
television as a tool for consultation, diagnosis, and triage. It would also
demonstrate the degree of facility in maintaining the satellite link, and
whet her the work of the nu rse or resident doctor is made easier or more
complicated by communications technology.
Another CTS telemedicine experiment has been proposed by
Memorial University of Newfoundland under the direction of Dr. M.
House. The University plans to transmit medical education programs to
four communities. The effectiveness of live audio and video interaction
would be compared with the present system involving the circulation of
videotapes by mail. This experiment would also evaluate the
effectiveness of telehealth education in areas such as nutrition, family
planning and accident prevention. In addition it would enable doctors to
consult through audio channels.
Before participating in the CTS experiment. the group is testing
techniques such as the use of slow-scan equipment to transmit still
pictures of X-rays over telephone lines: in February, a room-to-room
link, for example, between the emergency and X-ray service will be
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established at St. John's General Hospital. In April 1976, a microwave
link will be set up between the General Hospital and the Health Science
complex at Memorial University to be used in continuing education for
doctors, for administrative purposes and as a means of following up on
inpatient visits.
Two other telemedicine projects are scheduled to be carned out on
CTS. One of these involves the supervision of health care delivery in the
Queen Charlotte Islands. The other is a purely administrative project to
be undertaken as part of a multiministry operational experiment by the
province of Ontario.
In Canada, telecommunications have not yet been perceived as an
integral part of the health care system. Anna Casey-Stahmer, a social
policy analyst with the Department of Communications, is of the opinion
that procedures will have to be set up to ensure the most effective
integration ot health care and communications. "At present, information
is being collected on this subject. It appears that only rarely are
arrangements made to routinely schedule telephone visits between
physicians and remote nurses, even where reliable communications
exist. An overall objective of the telemedical experiments is to assess
the utility and cost-effectiveness of telecommunications in supporting
quality medical care and in providing the greatest access to such care."
Two telemedical experiments carried out in Alaska through the
ATS-1 (1971) and ATS-6 (1974) clearly demonstrated the importance
of regularly scheduled contacts between doctors and health aides. The
first carried only an audio link while the second had audio and video
inter active links. Both experiments took place under the auspices of the
Indian Health Service of the U,S. Department of Health, Education and
Welfare.
A report ot the results of the first experiment, carried out using an
audio link via A TS-1 showed that; "Satellite villages had an increase of
about 500% in the number of contacts completed and 400% in the
number of health aide-to-doctor consultations over those villages with
HF radio... In half fhe consulting cases, the doctor believed the health
aide had planned or could have planned correctly using his or her own
judgment. Of the remaining cases, 20% required minor changes, and
30%, major changes... At the Alaska Native Medical Center, the
average length of stay has decreased, with the largest reduction
occurring among patients brought in trom satellite villages. "6
'
\..08n80gn Nur.. January I
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33
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References
1 The Northerners (Taqramuit); les
Septentflonaux. Quebec, Northern Quebec Inuit
Association, 1974.
2 Canadian Telemedlcine Symposium,
University of Western Ontario, October 17,1975
Health care delivery in Northern Canada. Paper
presented by HB.Brett.
3 Canada. Department of National Health and
Welfare. Brief to the Senate Committee on Poverty
Ottawa, 1970.
4 Canadian Telemedlclne Symposium,
UniverSity of Western Ontario, October 16, 1975
Satellite technology in Canada. Paper presented by
J.H. Chapman.
5 Benefits and problems of seven exploratory
telemedicine projects. Washington, MITRE Corp.,
1975. (MTS-6787)
6 AIM Communications Satellite Conference
for Health Education Applications, Denver,
Colorado, 1975. The AT S-B health care experiments
and an approach as to how to proceed from here.
Paper presented by A. Feiner.
Both the ATS-1 and ATS-6 satellites were used in the second
experiment, which had video as well as audio capabilities. The system
also made it possible to transmit X-ray photos and electrocardiograms,
and to hold long distance pediatric and other medical consultations. A
sound amplifier was included for transmitting heart, lung and abdominal
sounds and used for auscultation and percussion. The communications
system also gave access to statistics and medical tiles.
This experiment provided a unique opportunity to test a wide range
of telemedical methods. It showed. among other things, how television
could relay information on eye movements. gait abnormalities. patient
response to palpation and visual evidence of patient distress.
Dr. Martha Wilson of the Alaska Area Native-Health-Service,
Anchorage. a participant in the experience, reported to the Canadian
Telemedicine Symposium held last October in London, Ontario, that
teleconsultation, carried out In a routine and systematic way, had given
both patients and health care personnel a sense of security.
Experiments such as these may provide a useful frame of reference
for Canadians, but they cannot give us all the answers for all situations.
In planning for telemedicine, health care specialists,
telecommunications planners. behavioral scientists and economists
must work together to develop worthwhile. economically feasible
experiments and to evaluate the results fairly. We must find ways to
benefit from all that technology has to offer, while recognizing that it has
its limits as well as professional and legal implications. ..
The author is assistant director of the information directorate of the
federal Department of Communications. She has also worked with
Health and Welfare Canada and is a former associate editor of
L'infirmière canadienne.
34
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Immuni _ s In livin
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In Canada, for example, only fOIJr cases of
poliomyelitis occurred in the pa
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compared with 1,000 cases anr.ually in the
preceding decade (1955-65). TMse figures
indicate that we are close to achieving optimal
confrol in the prevention of thi:S crippling
disease. Significant reductlOf'':> 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
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W8r1 é'1Olt:>U
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opl!fT1al control
ÖftI& ,en
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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
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,
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o t01'llJ01'(-
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MEDI-CARD SET: DNo. 289
I NITIALS as required
\ Pi.... .dd 50r handlina/po.taao
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No COD's or billing to individuals. Mass. reSIdents add 3% S. T.
Send 10 .
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SATISFACT.ON GUARANTEED! Pi.... .lIow time for dellv.ry
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'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.
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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.
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.
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.
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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.
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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.
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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.
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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).
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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).
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Wellcome
Burroughs Wellcome & Co
(Canada) ltd
Montreal, P.O.
Resumés are based on studies placed
by the authors in the CNA Library
Repository Collecllon of Nursing
Studies.
Ilesetll-ell
I ne \..snaalBn Nurse January 19fb
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, Ont., 1975. Thesis
(M.Sc.N.) U. of Western Ontario.
Within an 18 months' period
almost all registered nursing staff at
University Hospital, London, had
voluntarily commenced working the
12-hour shift. Although the
implementation of the 12-hour shift on
each nursing unit was carefully
controlled, there was some concern
about the quality of care that could be
provided by nurses working this shift
This study was undertaken to
compare the quality of care provided
by registered nurses working the
12-hour shift and those working the
8-hour shift at University Hospital.
Three criteria were used to
measure the quality of care provided
by registered nurses on the only
remaining 8-hour unit and a
comparable 12-hour unit in the
hospital. The criteria used were
implementallon of the nursing
process, attitudes of nurses toward
nursing and nursing care, and
attitudes of patients toward the
nursing care provided. Three
hypolheses slaling there was no
significant difference between the 2
units with respect to the above aspects
of quality of care were tested.
The methodology included an
audit of nursing records, and the
administration of questionnaires to all
registered nurses and 20 patients on
each unit
In all cases, the null hypothesIs
was rejected if p = .05 or less, using a
2-tailed test. The test of significance
used was the sign test. All 3 null
hypotheses were accepted, indicating
that there was no significant difference
In the quality of care provided on both
units.
Some findings of particular
relevance are:
1. Twelve-hour nurses maintained
more complete records and were
more knowledgeable about patient
details and more satisfied with the
quality of care they were able to
provide than 8-hour nurses.
2. Attendance at inservice programs
and awareness of program scheduling
was a greater problem for 12-hour
nurses than for 8-hour nurses.
3. Written evidence of nursing
assessment and planning was
generally minimal on both units,
however, slightly more prevalent on
the 8-hour unit.
4. Patient responses, although
generally positive, tended to favor the
8-hour nurses.
Although the results were not
overwhelmingly in favor of the
12-hour shift, it was concluded that it is
reasonable to assume that the quality
of care will not be adversely affected
when nurses work a 12-hour shift.
Bain, HoW.; Cahoon, M.C.; and
Jones. P .E. An educational
programme for nurse
practitioners, 1972-74.
Toronto,Ont., 1975. Report. U.
of Toronlo.
This report documents the
experience of a 3-year joint project of
University of Toronto Faculty of
Nursing and Faculty of Medicine and
supported by National Health Grant
No. 606-22-32. The aim of the project
was to improve health care services
through increasing the skills of nurses
in primary care services.
The methods designed to achieve
the objectives consisted of a 4-month
continuing education program, offered
6 times dUring the period of the project;
the series of programs was arranged
in 3 phases of approximately one year.
each to build on accumulatrng
experience. Registration in Phase 1
was limited to applicants from Medical
Services Branch, Health and Welfare
Canada. In Phase 2, admission was
broadened to Include nurses from
other primary health care settings.
Phase 3 was designed to continue
refinement of cUrriculum developed in
Phases 1 and 2, and admission
requirements were as for Phase 2.
Evaluation measures focused on
the level of achievement of
educational objectives, the level of
graduate performance, peer
acceptance, and job satisfaction.
Methods included written tests,
assessment of student clinical
performance at specified intervals,
and questionnaires to graduates and
employers one year post-course.
Instruments were developed for use
by physician and nurse evaluators in
judging pre- and post-course
performance in a number of activity
areas. Scores, based on the
satisfactory ratings, were then
derived.
Fifty-one students enrolled in the
program during the 3 years under
study; 21 of this total came from
Medical Services Branch and the
other 30 from a wide variety of pri mary
care settings, largely urban. The
educational background of students
and the year of initial graduation
varied greatly. -
Student performance was
demonstrably improved post-course
compared to pre-course. This level of
satisfactory performance appeared to
be maintained, as judged by physician
and nurse assessors, 6 months after
completion of the course. Data from
questionnaires one year post-course
will not be complete before spnng of
1976; plans are made to complete this
phase of reporting at that time.
Based on the experience of the
project and on current developments
related to nursing in primary care, the
report recommends that the
educational program continue for the
Immediate fulure and includes a
number of other related
recommendations. It urges further
Investigation of such matters as
outcome for nursing care and
development of standards for primary
health care.
Tubman, Norma Helen. Nursing
and related needs of young
adults with post-traumatic, spinal
cord lesions in the home.
Toronto, Ontario, 1975. Thesis
(M.Sc.N.) U. of Toronto
Twenty-seven post-traumatic,
spinal cord lesion patients between
the ages of 18 and 30 years were
interviewed in this descriptive study
The primary purpose of the study was
to identify and describe the
expressed and observed nursing and
related needs of these patients. The
ultimate purpose was to improve the
quality of nursing care for these
patients in the home.
A structured interview schedule
was developed to identify nursing and
related needs in the following major
areas: medical and nursing.
psychosocial, educational. vocational,
and environmental. The sample was
obtained from a rehabilitation center
and an official public health agency.
The findings showed that the
largest number of expressed and
observed needs was in the medical
and nursing area. The areas of
teaching most frequently needing
Improvement were identified as:
prevention of urinary infections,
prevention of pressure sores, and
implementation of an exercise routine.
Although the majority of the
respondents appeared to be well
adjusted to their injury, some
psychosocial needs were identified.
These needs were related to sexual
information, emotional feelings, home
arrangements, and marital problems.
No needs were identified in the
areas of education, vocation, or
environment at this time although.
previous to the interviews, some
changes had been made in these
areas. Other needs identified were
related to the patienls' initial discharge
to their homes and included
adjustment to the family adjustment to
being In a wheelchair in the
community, and not being able to
perform household maintenance
tasks.
The suggestions made by the
respondents for Improving treatment
and services were: Improved public
facilities; increased public awareness
of persons in wheelchairs; increased
emotional, sexual, and marital
counseling; better qualified and
trained health professionals:
family-centered nursing care.
including counseling; integration of
community resources; and improved
training and placement services.
Although these patients with
spinal cord lesions functioned
relatively well in the home, findings
suggest a need for continuous
assessment and planned follow-up If
they are to attain a high level of
self-care
BecaLtSe you're
really serious
about
your
profession;
you know how importallt it is to stay on top of advances in nursing care-
especially as nurses assume more and more responsibility. Easier said than done?
Even if your schedule hardl)' lets you pick up any journal other than the one
you're reading now, we'd li
"e to suggest another that can provide a better
balance to your regular readi ng.
The Nursing Clinics of North J \merica combine the best features of books and
journals, making them unlike a ny other clinical periodical:
. Each issue is devoted to only one or two central topics. leaders in nursing
practice and education are sel ected as guest editors to oversee each symposIum
. All articles are written express Iy for the Nursing Clinics. Contributors are chosen
for theIr expertIse and activity ir' the subject at hand.
. The Nursing Clinics carry no lett I
rs, columns Or advertising. We offer a welcome
change of pace from other profess onal journals.
. Each issue is published hardbounIJ' With its symposium format, each volume is a
monograph that takes a permanent place in your nursing library.
. The Nursing Clinics are published 0 r Iy four times a year. That way issues don't
pile up-or compete with monthly jc .,nnars for your attention. We keep you
informed of changes in nursing with e coch change of season.
. They're a trusted source of continuing I
ducation. Since Iheir inception in 1966
thousands of nurses have come to rely on the Clinics for accurate and timely
iniormation. They keep you as informed <is today's graduate.
This year s issues will feature the following s vmposia;
March; Cancer in Children I Geronto/o"
ic Nursing
June: Reachmg and Rehabilitating the (
ardiac Patient
September: Alcoholism and Drug Addie lion I Ostomy Care
December: Biological Rhythms I and a s.?cond topic not yet selected.
It takes more than just texts and journals to ke.?D the serious nurse fully informed.
Enter your subscription to the Nursing Clinics a'c'r 1976 and find out,
,-----------------------------
CN1I76
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Yes! Enter my subscription to the Nursing CI inics
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IJooks
The Right Combination: A
Guide to Food and Nutrition by
Elizabeth Chanl Robertson. 180
pages. Toronto, Gage
Educational Publishing Limited,
1975.
Reviewed by Elizabeth Lambie,
Assistant Professor in Nutrition,
School of Nursing, Dalhousie
University, Halifax, Nova Scotia.
Hurrah, here is a perfeclly
delightful book on nutrition. The cover
is attractive, the photography is
exciting and some of the pictures
stimulate one's digestive processes
inadvertently. It is a book on food,
written for Canadian students
practicing and studying in Canada.
The Canadian Dietary Standard,
Canada's Food Guide, and
information from the first reports of
Nutrition Canada -
National Survey are used in this
edition of nutrients, foods and meals.
If you are going to be a professional
nurse in Canada and you are giving
applied nutrition information to a client
it is recommended that Canada's
Food Guide be the directive and not
that of another country. The use of the
information fabric in this text will
prevent our nutrition standards from
being lost.
Teachers of different levels and
types of students will discover that the
variety of methods of content
presentation are beneficial, e.g. the
practical test of materials related to the
text, questions following each chapter
to allow students to test themselves,
the crossword puzzle, the reference
list of films and publications, and
summaries itemized at the side of the
page for the working value of each
nutrient.
This book is a mixture of the science
of nutrition and applied nutrition. There
are pertinent comments on income
variations and misinformation and
how these may affect eating patterns
(a reference copy could be used in
every Public Health Nursing office).
Many faddist beliefs on food are givr In
simple, correct, and scientifically
supported explanations. The authc r i',
always gently nudging the "health
food addict" and "crash dieter" Vlill,
sound information in a matter-of ,fE ,ct
manner.
Following a detailed discussiof' on
milk, its chemistry and even the '>0
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 <<topic beats without prior
acceleration in hean rate (e.g. by Isoproterenol
or by elcctric pacins) may provoke more frequent
and serious
entricular arrh\,thmias.
AD\ ERSE REACTIO
S -S"temic reactions or
the following types have been reported.
(I) Central Ncrvous System: lightheadedness.
drowsiness: diuiness: apprehension: euphona.
tinnitus; blurred or double vISion: vomiting: sen-
sations of heat. cold or numbness: twitchmg.
tremors; con\'ulsions; unconsciousness; and respl-
ratOf\l depression and arrest.
(2) Cardiovascular Svslem: h"polcnsion; car-
diovascular collapse: and bradycardia which ma\'
lead to cardiac arrest
There have been no repons of cross senSluvlt)
between Xylocaine and procainamlde or between
Xylocaine and qumidine.
DOSAGE AND ADMIMSTRATlO," Singlo
Injeclion: The usual dose is 50 mg to 100 mg
administered mtra\'enously under ECG monitor-
ing. This dose may be admmistered at the ratc
of approximate1" 25 mg to 50 mg per minute
Sufficienillme should be allowed to enable a slow
circulation to carrv the drug to the site of action
I( the initial mJ
tion of 50 mg to 100 mg does
not produce a desired response. a second dose ma\'
be repeated after 10-20 minutes
NO MORE THAN 200 MG TO 300 Me. OF
X\ lOCAINE SHOULD BE ADMINISTERED
DURING A ONE HOUR PERIOD
In children cxpenence with the drug IS limned.
Continuou!!i Infusion: Following a SIOgie injection
in those patients in whom the arrhythmia tends
to recur and who are incapable of recei\'ing oral
antiarrhythmic Iherapv. mlravenous infusions of
X)locainc may be administered at the rate of I
mg 10 2 mg per minule (20 10 2S ug/kg per minule
in the avcrage 70 kg man). Intravenous ,nfuslOns
ofXylocaine must be administered under constant
ECG monitoring to avoid potential overdosage
and toxicit". Intra\'enous infusion should be tcr.
minated as soon as the patient"s basIc rhythm
appears to be stable or at the earliest signs of
tOJucllY It should rarely be neccssal) to continue
intra\'enOU5 infusions beyond 24 hours. As soon
as possible. and when indicated. patients should
be changed to an oral antiarrh)1.hmic agent for
maintenance thcrap".
Solutions for intravenous infusion should be
prepared b\ the addition of one 50 mt single dose
vial of Xylocamc 2f,f or one 5 ml X\'locaine One
Gram Disposable Transfer Syringe to I liter of
appropnate solution This will provide a 0 I
solution: that is. each ml will contain I mg of
Xvlocainc HC). Thus I ml to 2 mt per minute
","I pro, ide J mg 10 2 mg or XvlocalDe HCI per
minute
What the well-bandaged
patient should wear=
Bandafix is a seamless round-
woven elastic "net" bandage,
composed of spun latex
threads and twined cotton.
Bandafix does not change in
the presence of blood, pus,
serum, urine, water or any
liquid met in nursing.
Bandafix has a maximum of
elasticity (up to lO-fold) and
therefore makes a perfect
fixation bandage that never
obstructs or causes local
pressure on the blood vessels.
......
Bandafix saves time when
applying, changing and
removing bandages; the same
bandage may be used several
times; it is washable and
may be sterilized in an
autoclave.
Bandafix is not air-tight,
because it has large meshes; it
causes no skin irritation even
when used for the fixation of
greasy dressings. The mate-
rial is completely non-reactive.
Bandafix is an up-to-date
easy-to-use bandage in line
with modern efficiency.
I
Bandafix stays securely in
place; there are eight sizes,
which if used correctly will
provide an excellent
fixation bandage for
every part of the
body.
-.......;
Bandafix replaces hydrophilic
gauze and adhesive plaster,
is very quick to use and
has man
possibilities of
application. It is very suit-
able for places that otherwise
are difficult to bandage.
fI
, l!f{j
,
Bandafix is economical in use,
not only because of its rela-
tively low price but because
the same bandage may be
used repeatedly.
\
Bandafix does not fray,
because every connection
between the latex and cotton
threads is knotted; openings
of any size may be made with
scissors or the fingers.
---.-
Bandafix*
Distribllted by
Now available
"Ready to Use"
Bandafix
. Pre-measured
. Pre-cut
. 14 different applications
. Individually illustrated
peel-open packages
IONg
1956 Bourdon Street, Mon1real, P.Q. H4M 1V1
.Registered trademark of Continental PhaTTlta
I
i I) .ellleIJ ['"1)(111 t P
72. Stavrou, Marta. The environment'
selected sources. Bowling Green,
Ohio, Bowling Green State University,
Science Library, 1975. 16p.
IBibliographic series, no. 38)
73. Wandel, Sten E. A conceptual
framework for nurse staffing
management, by. . . and John C.
Hershey. Stanford, Calif., Health
Services Administration, Dept. of
Community and Preventive Medicine,
Stanford University, 1974. 10p.
74.-.0uantitative procedure for
nurse staffing management. a survey,
by. . and John C. Hershery. Stanford,
Calif. Health Services Administration,
Dept. of Community and Preventive
Medicine, Stanford University, 1975.
32p.
75. When the patient comes home.
Princeton, N.J., Squibb Hospital Div.,
1975.8p.
76.Working with film: experiences
with a group of films about workmg
mothers. Montreal. National Film
Board of Canada, 1975. 22p. (Access,
no. 14, Spnng, 1975)
GOVERNMENT DOCUMENTS CANADA
77. Canada Council. Aid to the hu-
manities and social sciences. Ottawa,
1975. 22p.
78. Conférence nationale sur la santé
et I excellence physique, Ottawa, déc.
4, 5 et 6, 1972. Procès-verbal. Ottawa,
Information Canada pour santé
national et du bien-être social, c1975.
167p.
79. Manpower and Immigration. Staff
Training and Development Division.
How to prepare organization charts. A
self-Instruction manual. Prepared by
Louise Newton. Ottawa, Information
Canada. 1975. 1v. (various pagings)
80. Dept. of External Affairs.
Canadian representatives abroad.
Ottawa, Information Canada, 1975
73p.R
81.-Diplomatic corps and consular
and other representatives In Canada.
Ottawa. Information Canada, 1975.
86p. R
82. Health and Welfare Canada.
Posture and rest positions for
expectant mothers. Rev. ed. Ottawa,
Information Canada. 1974. 44p.
83. Law Reform Commission.
Divorce. Ottawa, Informallon Canada
1975. 70p. '
84.-.Report. Ottawa. Information
Canada, 1975. 31p.
85.-.Ministère des affaires
extérieures. Corps. diplomatique et
représentants consulaires et é/utres
au Canada. Ottawa, Information
Canada, 1975. 86p. R
86.-.Représentants du Cané.da à
I étranger Ottawa, Information
Canada, 1975. 77p. R
87. National Conference on Employee
Physical FItness, Ottawa. Dec. 2, 3
and 4, 1974. Proceedmgs. Ottawa,
Dept. of National Health and Welfare,
c1975, 100p
88. National Film Board of Canada.
Projecting women: a catalogue of
films. Ottawa, 1975. 57p.
89. Solicitor General. Guide: research
program, 1975-76. Ottawa,
Information Canada. n.d. 41,43p.
90. Treasury Board. Personnel Policy
Branch. A guide to the isolated posts
regulations. Ottawa, Information
Canada, 1975. 28p.
Great Britain
91. Control Office of Information.
Reference DIvision. Social security in
Britain. Rev. London, Control Office of
Information, 1975. 37p.
United States
92. Healtm Services and Mental
Health Administration. Towards a
systematic analysis of health care in
the United States: a report to the
Congress. Washington, U.S. Gov!.
Print. Off., 1972. 49p. (U.S. DHEW
Publication no. (HSM) 73-25)
93. National Institutes of Health.
Clinical Center. Nursing clinical
conferences. Bethesda, Md..
1968-1972.13 no. In 1.
Contents:
Hemipelvectomy with total pelvic
exenteratlo'l: the challenge and the
response. 18p. (no. 2)
Nursing care of the manic depressive
patient. t8p. (no. 12)
Nursing care of patients in the laminar
air flow room. 16p. (no. 9)
Nursing care of outpatients with acute
leukemIa. Bethesda, Md., 22 p. (no. 8)
Nursing care of the patients with
cerebral seizures. 16p. (no. 5)
Nursing care of patIents with
cystinosis. 24p. (no. 3)
Nursing care of patients with
homocystinuria. 22p. (no. 4)
Nursing care of patients with internal
or external pacemakers. 20p. (no. 6)
Nursing care of patients with midline
granuloma. 16p. (no. 7)
Nursing care of patients wIth periodic
paralysis. 14p. (no. 10)
Nursmg care of patients with
pheochromocytoma. 16p. (no. 1)
Professional progression in the nurs-
ing department. 18p. (no. 11)
STUDIES DEPOSITED IN CNA REPOSITORY
COLLECTION
94. Bainbridge, J. Health project
management; a manual of
procedures for formulating health
projects, by. . . and S. Sapirie.
Geneva, World Health Organization,
1974. 280p. (WHO Offset publication,
no. 12)
95. Carnell, Mary Ann. Resource
power of community mental health
nurses as perceIVed by self and
professIonal work groups. Seattle,
Wash., 1974. 104p. R
96. Mcintosh, Kathleen Kerr. A study
of the effect of immediate video-tape
feedback on nurses' interpersonal
skill. Vancouver, B.C., c1972. 56p.
(Thesis (MA (Educ.)) - Simon
Fraser) R
97. MacKenzie, Lillian G A study on
the nurses' concept of death, by. . et
al. Teachers College, Columbia
University, New York, 1953. 87p. R
98. Reid, Una Vivienne. A survey of
resources for continuing education in
nursing in northeastern Ontario.
Vancouver, B.C. 1975. 214p. R
99. Tubman, Norma Helen. Nursmg
and related needs of young adults
with post-traumatic, spinal cord
lesions in the home. Toronto, c1975.
87p. (Thesis (M.Sc.N.) - Toronto) R
AUDIO-VISUAL AIDS
100. Association des médeclns de
langue française du Canada
Sonomed, série 2, no. 8. Montréal,
1974.
101. Québec. Régie de
I'assurance-maladie du Québec. Un
tour d'horizon. La consommatlon de
services médicaux en 1971-72.
Préparé par Richard David et Daniel
Larouche. Québec (ville),
Gouvernement du Québec, 1975.
46p.
102.-.Report, 1974-75. Quebec,
1975. 87p.
103. National Library of Medicine
Medical subject headings. Jan. 1975.
Washington, U.S., Dept. Health,
Education, and Welfare, 1975. 770p.
Request Form for "Accession List"
Canadian Nurses' Association Library
Send this coupon or facsimile to:
librarian, Canadian Nurses' Association
50 The Driveway, Ottawa K2P 1E2, Ontario.
Please lend me the following publications, listed in the
. . . . . . .issue of The CanadIan Nurse,
or add my name to the waiting list to receive them when available
Item
No,
Author
Short title (for identification)
Request for loans will be filled in order of receipt.
Reference and restricted material must be used in the CNA library.
Borrower. . . . .
Registration No
Position.. ".'.
Address
Date of request . .
('1lilssi (-ied
.... \fl'-Pl-t iSPlllellts
Alberta
Registered Nurses required lor 70,bed accrediled active Irealmenl
HoSPItal. Full t,",e and summl!f reliet All AARN personnel policies.
Apply in wriling tothe: Direclor 01 NurSing, Drumheller General Hospl'
tal, Drumheller. Alberta.
British Columbia
Registered and Graduate Nurses required lor new 41-bed acute
care hospital, 200 miles north of Vancouver, 60 miles from Kamloops.
limited furnished accommodation available Apply. Director of Nurs-
Ing Ashcroft & Disirici General Hospllal. Ashcrolt, Bnlish Columbia.
Graduate Nurses - looking for variety in your work? Consider a
modern 10-bed hospital located on a beaull'ul fiord-Iype inlet 01 Van-
couver Island's wesl coast Apply: Admlnlstralor, T ahsis Hospilal, Box
399, Tahsis, British Columbia, VOP 1 XO.
Graduate Nurses lor 21-bed hospðal preferably wðh obslel11cal ex.
perience Salary In accordance wðh RNABC. Nurses' reSidence.
Apply to Malron, Totino General Hospllal, Tofino, Vancouver Island.
Brihsh Columbia.
Experienced Nurses (eligible for B.C. reglstratton) required I.....
409-bed acute care, teachIng hospRallocaled In Fraser Valley, 20
minutes by freeway from Vancouver I and wi1hin easy access of vaned
recreational facllilles. Excelfent Orientation and ContinUing Education
programmes. Salary $1,049.00 10 $1,239.00. Clinical areas Include.
Medicine. General and Specialized Surgery. Obstetncs. Pediatrics.
Coronary Care HemodialysIs Rehabllilahon, Operating Room, Inlen.
slve Care, Emergency. Practical Nurses (elrgible tor B.C. License)
also required. Apply to: A:dmlnlstratlve Assi
tant. Nurs
ng Person
l.
Royal COlumbian Hospital, New Westminster, Brrtlsh Columbia.
V3L 3W7.
Experienced General Duty Nurses required lor small hospital. North
Vancouver Island area. Salary and personnel policies as per RNASC
contract. Residence accommodation 530.00 per month. Transporta-
hon paid from Vancouver. Apply 10: Director of Nursing, St. George s
Hospllal. Box 223. Alert Bay Blltlsh Columbia, VON 1 AD.
General Duty Nurses lor modern 41.bed hospital localed on the
Alaska Highway. Salary and personnel policies in accordance with
RNABC. Accommodalion available in residence. Apply: Director of
Nursing, Fori Nelson General Hospllal, Fort Nelson, Blllrsh Columbia
General Duty Nurses for modern 35-bed hospital located in south-
'ð B
i
?C1
e
w,:
c
Ja"
1
e
"'ÁB
ci
::i
r
g
Nurse S home. Apply: Director of Nursing, Boundary Hospital Grand
Forks, British Columbia. VOH IHO.
""anted: General Duty Nurses for modern 70.bed hospllal, (48 acute
beds - 22 Extended Care) located on the Sunshine Coasl, 2 hrS. from
Vancouver. Salaries and Personnel Policies in accordance with
RNABC Agreement. Accommodation available (Iemale nurses) in
residence. Apply: The Director of Nursing, St. Mary's Hospðal, P.O
Box 678, Sechell, Bnlish Columbia.
Ontario
Registered Nurses for 34.bed General Hospllal. Salary $945.00 10
$1,145 00 per monlh, plus expellence allowance. Excellenl personnel
policies. Apply 10: Dllector of NurSing. Engleharl & Dlstllct Hospðal
Inc.. Englehart. Onlallo, POJ 1 HO
Registered Nurses and Registered Nursing Assistants lor 45.bed
Hospital. Salary ranges Include generous expenence allowances.
R N s salary $1,045. to $1,245 and RN.A:s salary $735. to $810
Nurses residence - p"vale rOoms wllh bath - $60. per month. Apply
to: The Director of Nursing, Geraldton Distllcl Hospital Geraldton,
Onlallo, POT 1 MO.
Saskatchewan
Director of Nursing: Immediate applications are invited for the posi-
lion of Director of Nursing .n the 43-bed Wadena Union Hospllal.
Fringe benefits inc)ude Registered Pension Plen. Group life Insur-
ance and Income Replacement Plan. This is a seven year old well-
eqlUpped hospilalln a lown of 1500 populahon servIng a large rural
populahon Wadena is cenlrally localed 130 miles 110m each of Iwo
major Saskatchewan centres. Supervisory experience IS essential.
NurslnQ AdrmrÑstration course desirable. Atlractive salary scale
:
:
AJ
I
;t
sgp
rli
O
:
x
:.IOs
r:t
I
=
:
SOA 4JO
Registered Nurses are required Immedl"tely for the 43-bed Wadena
Union Hospital This is a modern. atlractive acute care hospllal
situated in the town 01 Wadena, Saskalchewan, a friendly parldand
communlly with a population of 1S00. Altracllve salary and 'rlnge
benehts are provided under the Saskatchewan Union ot Nurses ag-
reement In effect Please direct applications to: Administrator.
Waoena Union Hospital. P.O. Box 10, Wadena, Saskalchewan.
United States
United States
R.N. 's -Iowa Methodist Medical Center Invites you to explore nurs-
ing opportunibes In orthopedics. rehabilitation. ICU and CCU,
medlcsl.surgical and pediatncs lOO-bea general leaching hospl1al
with expansion plan Well organized and directed nursing program
:
b
:
t
rg
a
tt:;
lllt
:
f:J
W
I
&
:1
Wdl assist with v,sa for Immigration U Inlerested In further de1ails
please conlact: Personnel Director. Iowa
"ethodlsl Medical Center.
1200 Pleasanl Streel, Des MOines, 10w
l. 50308 or phone (515)
283-63 t 3.
Texas wants you! If you are an RN. experienced or a recer
graduate. come to Corpus Chnstl Sparklmg City by Ihe Sea a Cli
budding'or a better 'uture. where your opportunilies lor recreation an
studies are limitless Memonal Medical Cenler SOO-bed. genera
leachmg hospital encourages career advancement and provides If
service ollenlalion Salary Irom $78520 10 $1.052 13 per men"
commensurate with education and experience Dlfferentlal'or ever
Ing shifts. available. Benefits Include holidays. sick leave, vacallon'
paid hospilallzatlon. health, II'e Insurance pension program. Becorn
a vital pert of a modern. up-to-date hospital. wnte or call John V
Gover, Jr. Director of Personnel. Memorial Medical Center. P 0 Bc
5280, Corpus ChllS11 Texas 78405
Heel, elbow protection
The new
Heel50
eliminates
stricture!
Tough-minded research has made our
heel and elbow protection the best in
the world.
Straps and fasteners that can restrict
circulation are eliminated,
Rigid boots that make walking
hazardous for semi-ambulatory
patients are rendered obsolete,
The shearing effect that creates painful
ulcers between bone and tissue is
thwarted by a simple bartacked
Tricot-covered foam pad which allows
the outer knit to move, (There are no
seams to create pressure points or
compression.)
The fire-retardant, washable Heelbo
fits all 100 to 270-pound patients
without restriction It's an attractive,
dignified "sock" that provides your
patients with comfort and protection.
Act now to update patient care with a
collect call to me, Martin Shepherd at
(312) 271-8500, or by writing:
Heelbo Corporation
P. o. Box 950 Evanston, Illinois 60204
't
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 complette resume, to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
NSA 2V6
(Area Code 519, 271-2120. Extn. 217)
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 fhe
Registered Nurses' Association of
the Province in which they are
interested in working.
Address correspondence to:
The Canadian Nurse
50 The Driveway
Ottawa, Ontario
K2P 1E2
Lakehead . University
School of Nursing
Invites Applications
for
Faculty Positions
in
Medical/Surgical Nursing
Maternal and Child
Psychiatric Nursing
Master's or Doctoral Degree, with
Clinical Nursing experience,
Curriculum Development, and
Research to teach in Baccalaureate
Program.
Rank and Salary commensurate with
education and experience.
Appointment - July 1, 1976.
Apply to:
Mr. Donald E. Ayre
Secretary of the University
lakehead University
Thunder Bay, Ontario
P7B 5E 1
-Intø'-lUItionøZ
-I&øZtb
,.
(- xp
ri
nc
d nurSt'S ar
ne
ded to
work in AFRICA. LATH"';
AMERICA. and PAPUA J\EW
GUINEA. Background in puhlic
health nursing or teaching is an
asset.
Local
alary: transportation costs
paiL! by CUSO.
For more information contact:
('USO Health. 8
IS I Slater SI..
Ottawd.Ont.
KIP SH5
The Executive
Nurse
A THREE-DAY SEMINAR
for
DIRECTORS, ASSISTANT
DIRECTORS, SUPERVISORS,
HEAD NURSES
and
TEAM LEADE RS:
Jan. 12-14, FREDERICTON,
N.S.
Diplomat Motel
Feb. 4-6, TORONTO
Inn on the Park
Feb. 11-13} SUDBURY
Sheraton-Caswell
April 7-9 TORONTO
Inn on the Park
The Educator-
Manager
A THREE-DAY WORKSHOP
for
STAFF DEVELOPMENT &
INSERVICE EDUCATION
CO-ORDINATORS:
May 12-14, TORONTO
Inn on the Park
The Manage-
ment Of
Motivation
A TWO-DAY WORKSHOP
for
ALL HEALTH CARE
PROFESSIONALS:
Feb. 19&20,TORONTO
Inn on the Park
Apr. 26&27 TORONTO
, Inn on the Park
All courses are available on an
in-hospital basis,
for more information write or call:
A.M. BROWN CONSULTANTS
1701 Kilborn Ave., Suite 1115
Ottawa, Ontario K 1 H 6M8
telephone: (613) 731-0978
North Newfoundland & Labrador
requires
Registered Nurses
Public Health Nurses
InternallOnal Grenfell Association provides
medical services for Northern Newfoundland
and Labrador. We staff four hospItals, eleven
nursing staloons, eleven Public Health units. Our
main 180-bed accredited hospItal is situated at
SI. Anthony. Newfoundland. Active treatment IS
carned on in Surgery. Medicine, Paediatncs,
Obstetrics, Psychiatry. Also, Intensive Care
Unci. Onentation and In-ServIce programs.
40-hour week, rotatIng shilts. LIving
accommodations supplied at low cosl. 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
SI. Anthony, Newfoundland
AOK 4S0
The General Hospital
Sf. John's, Nfld,
A 1 A 1 E5
Registered nurses with experience in
Renal DialysIs, Intensive Care - Medical
and Surgical, Post-op Cardiovascular
Surgery, Coronary Care.
355 bed hospital. Major leaching hospital
for Memorial University of Newfoundland
Medical School.
Liberal personnel policies.
For further information or application
form write to:
Personnel Director
Conestoga College of
Applied Arts and
Technology
The College invites applications for
Faculty positions In our various Nursing
Division which are located in Cambridge,
Guelph, Kitchener-Waterloo, and
Stratford. We have immediate openings.
Candidates must have suitable
qualifications and at least two years
nursing experience. Salary will be
commensurate with background and
experience. This position is open to both
women and men.
Applications, in writing, should be
forwarded to:
Personnel Manager
Conestoga College of Applied Arts and
Technology
299 Doon Valley Drive
Kitchener, Ontario
N2G 3W5
Registered Nurses
Required
For a 138-bed Acflve 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
The Lady Minto Hospital
at Cochrane
Invite applications from
Registered Nurses
54-bed accredited general hospital
Northeastern Ontario. Competitive
salaries and generous benefits. Send
inquiries and applications to:
Miss E. Locke
Director of Nursing
The Lady Minto Hospital at
Cochrane
P.O. Box 1660
Cochrane, Ontario POL 1 CO
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
t403 29 St. N,W, Calgary, Alberta
T2N 2T9
University of Victoria
School of Nursing
New School of NursIng requires 4 laculty members
with at least Master s level preparation and successful
expenence In rehabilitatIOn/gerontology group
work/problem solVing/community heahh to Implement
a 2 year mtegrated 8 S.N. curnculum for R N S
This program seeks to enhance the current skills 0'
R N s by expandmg psychosoaal awareness and
developing skill in USe of the sCientlfJC method as related
to nursing
Generalist IS focused. clinical practice will be pnmanly
In extended care and rehabilitation unrts. some clinical
work arranged on the bases 0' students experiences
and career goals Interdisciplinary sludles and
InnovallVe learning experiences lor highly motivated
academically able students require ck:)se lacuhy
coordination and co-operatlon. and proVideS an unusual
opportunrty lor creallvlly. Salary and rank based on
education and experience
Application and curriculum vitae before March 1 to:
Dr. Isabel MacRae, Director
School 01 Nursing
University of Victoria
P.O. Box 1700
Viclo..a, British Columbia
V8W 2Y2
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,
operallng 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.
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 applicant with
practical experience at the senior
administration level combined with
baccalaureate degree and/or other
formal education in the field of
administration.
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
The Montreal
Children's Hospital
Director
Information Services
Registered Nurses
Nursing Assistants
The Canadian Nurses' Association, a
national organization of over 100,000
members, invites applicallons for the
position of Director, Information Services.
Duties consist of planning and directing
the communications program of the
organization, includmg public relations
activities and publications. The program is
directed to membership, the public, allied
professions and government.
The applicant must be bilingual. have
relevant academic preparation as well as
experience in the organization and
implementation of communications
programs.
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.
Send application and résumé to:
Canadian Nurses' Association
50 The Driveway
Ottawa, Ont. K2P 1 E2
Interested qualified applicants should
apply to the:
Director of Nursing
Montreal Children's Hospital
2300 Tupper Street
Montreal 108, Quebec
. Meeting Today's Challenge in Nursing"
Queen Elizabeth Hospital of Montreal Centre
A Teaching Hospital of McGill University
requires
Registered Nurses
and Registered Nursing Assistants
Quebec language requirements do not apply to Canadian applicants.
. 255-bed General Hospital in the West 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
'"
,
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-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.
L!:J
Health Care Services
Upjohn Limited
(Operating in Ontario as
HCS Upjohn)
VIctoria. Vancouver. Edmonton
Calgary. Wlnnopeg . Windsor. London
5t Catharines. Hamilton. Toronto West
Toronto East. Ottawa. Montreal
Trois Rivières. Quebec. Halifax
The University of Alberta
School of Nursing
Invites applications for the following positions: -
Senior Appointment. Responsible for undergraduate
(baccalaureate) programs. Master s or higher degree in Nursing;
teaching experience at university level; administrative skills and
preparation in curriculum development.
Assistant Professor In Maternal-Child Health Nursing In Basic
Baccalaureate Program. Master's degree or higher; experience in
maternal-child health nursing.
Assistant Professor In Community Mental Health Nursing in
degree program for Registered Nurses. Master's degree or higher;
experience and preparation in community mental health nursing.
Assistant Professor in Community Health Nursing in degree
program for Registered Nurses. Master's degree or higher;
experience in community health nursing.
Salary and rank for positions commensurate with qualifications
and experience, and In accord with The University of Alberta salary
schedule.
Positions open to male and female applicants. Submit Curriculum
Vitae and names of three references to: -
I
I
Ruth E. McCture. M.P,H.
Director
School of Nursing
The University of Alberta
Edmonton, Alberta
T6G 2G3
.._ ......._.... .,......_ v...u..,. "ø.....
Canadian Nurses' Association
requires a
Project Director
to direct the development of
Standards for Nursing Practice
The incumbent will carry out the project with the assistance
of advisory committees.
Eligibility for appointment to this position must include
demonstrated outstanding competence in, and
commitment to, nursing practice as well as demonstrated
competence in independent research following
completion of formal academic training.
Apply to;
Canadian Nurses' Association
50 The Driveway
Ottawa, Ontario
K2P 1 E2
. Modern 700 bed non-sectarian hospital
. Excellent personnel policies
. Registered Nurses and Nursing Assistants
are asked to apply
If Paris appeals to you
. . . so will Montreal
. 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
u
ORTHOPAEDIC II: ARTHRITIC
HOSPITAL
'V IV'
43 Wellesley Street, East
Toronto, Ontario
M4Y 1H1
Enlarging Specialty Hospital offers a unique
opportunity'to nurses and nursing assistants
interested in the care of patients with bone and joint
disorders.
Currently required -
Registered Nurses and Nursing Assistants for all
units
Clinical specialists for Operating Room, Intensive
Care. Patient Care and Education.
Executive
Secretary- Treasurer
required by
New Brunswick Association
of Registered Nurses
for May 1976
Major Responsibilities
Administration of Association policies.
Co-ordination of all NBARN activities including finances.
Secretariat and Consultant Services to Council and
Executive.
Qualifications
Demonstrated leadership abilities.
Administration or management experience.
Baccalaureate degree required. Master's preferred.
Professional association involvement }
Bilingual preferable
Salary -
commensurate with experience and preparation.
Apply to:
Personnel Committee
N.B.A.R.N.
231 Saunders Street
Fredericton, N.8.
E3B 1N6
Vancouver General Hospital
Invites applications for
Regular and Relief
General Duty
Nursing positions in all clinical areas of an
active teaching hospital, closely affiliated
with the University of B.C. and the
development of the B.C. Medical Centre.
For further information, please write to:
Personnel Services
Vancouver General Hospital
855 West 12th Ave.
Vancouver, B.C.
V5Z 1 M9
Clinical Nursing Head
for Psychiatry
Applications are invited for the above position in a 877 -bed
fully accredited teaching hospital with modern facilities
offering a wide variety of services.
This
Publication
is Available in
MICROFORM
Qualifications desired:
. Eligible for Registration in Manitoba
. Extensive Psychiatric Experience
-
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. B. Sc. In Nursing
Duties to include:
. Responsibility for planning, coordinating and evaluating
nursing activities in the active treatment in-patient
program, the Day Hospital. out-patient, Moditen and
Drug Rehabilitation programs.
. Focus will include assessment of nursIng needs of
patients, formulating nursing care plans, writing nursing
orders. and the evaluation and upgrading of clinical
competence of the nursing staff.
Please address all inquiries to:
Mrs. P. McGrath, M.Sc.N.
Director of Nursing Services
St. Boniface General Hospital
409 Tache Avenue
Winnipeg, Manitoba
R2H 2A6
\
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Xerox University Microfilms
300 North Zeeb Road
Ann Arbor, Michigan 48106
Xerox University Microfilms
35 Mobile Drive
Toronto, Ontario,
Canada M4A 1H6
University Microfilms Limited
St. John's Road,
Tyler's Green, Penn,
Buckinghamshire, England
PLEASE WRITE FOR COMPLETE INFORMATION
. þ.
. .
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St. Joseph's Hospital Toronto, Ontario
invites applications from
Registered Nurses
. We offer opportunities in Emergency, Operating Room,
P.A.R., Intensive Care Unit, Orthopaedics, Psychiatry,
Paediatrics, Obstetrics and Gynaecology, General
Surgery and Medicine.
. We offer an Orientation program and opportunities for
Professional Development through active In-Service
programs.
. We offer - Toronto - with some of Canada's finest
Theatres, Restaurants and Social events,
Apply to:
Miss M. Woodcroft, Associate Director of Nursing Service
St. Joseph's Hospital, 30 The Queensway, Toronto, Ontario M6R 185
. We offer progressive personnel policies.
. We offer a starting salary, depending on experience, of:
effective April 1, 1975 - $945 to $1,145 per month.
. We offer monthly educational allowances up to $120,
per month in addition to the above starting salary.
Extension Course in Nursing Unit
Administration
Applications are invited for the extension course in Nursing Unit
Administration, a program to help the head nurse, supervisor or
director of nursing up-date his or her management skills.
Candidates will be registered nurses or registered psychiatric
nurses employed in management positions on a full-time basis
The program provides a seven month penod 01 home study with
two five day intramural sessions, one preceding and one following
the home study. For the 1976-77 class the initial intramural
sessions will be held regionally as follows:
Vancouver August 23-27
Ham,IIon Seplember 13-17
Toror110 September 20-24
MontreallFrench) A"gusl 30 - Seplember 3
Halltax August 30 - Seplember 3
W,n..peg September 13-17
Onawa September 20.24
Early application is advised. Applications will be accepled until
May 15, 1976, if places are stili available at that time. After
acceptance. the tuition fee of $250 00 is payable on or before July
1, 1976.
The program IS co-sponsored by the Canadian Nurses Association
and the Canadian Hospital Association and is available in Frençh
or in English.
For additional information and application forms write to:
Director,
Extension Course in Nursing Unit Administration,
25 Imperial Street,
Toronto, Ontario,
M5P 1C1.
Registered Nurses
1260 bed hospital adjacent to University of
Alberta campus offers employment in
medicine, surgery, pediatrics, obstetrics,
psychiatry, rehabilitation and extended care
including:
. Intensive care
. Coronary observation unit
. Cardiovascular surgery
. Burns and plastics
. Neonatal intensive care
. Renal dialysis
. Neuro-surgery
Planned Orientation and In-Service Education
programs. Post Graduate clinical courses in
Cardiovascular - Intensive Care Nursing and
Operating Room Technique and Management
Apply to:
Recruitment Officer - Nursing
University of Alberta Hospital
112 Street and 84 Avenue
Edmonton, Alberta T6G 287
657 bed, accredited, modern,
well equipped General Hospital, r
. 4J
rapidly expanding...
Saint John :1f
\ ./
General \
\
CJ{oÆPital
Saint Cjohn.NB,
CANADA
CJWQUIRES:
Genetãlðtaff f\{yrses
Registered Nursing Assistants
In all general areas: Medical, Surgical,
Pediatrics, Obstetrics, Chronic and
Convalescent, several Intensive Care
areas and Psychiatry.
. Active. prog,essive in-service education pr09,am.
Special Attenlion 10 O"en/a/ion.
A IIowBnce fo, Expe,ience and Post Basic Prepa,ation
FOR FUR11I\JR INFæMATION APPlY TO
tpERSONNEL DIREèTOR
intfjohn General Hospital
POBOX 1000 Saint John. New Brunswick E1L4U
I
[l]@
University of
Alberta Hospital
Edmonton, Alberta
o
Serve Canada's
native people
'"
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In
a well
equiDped
hospital.
. . Heanh and Welfare Santè eI B.en-êlre soc.aI
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: Prov: _
------_________J
72
__n__.p ......
Index to
Advertisers
January 1976
America n Hospital Supply
Astra Pharmaceuticals
Bata Shoes
Burroughs Wellcome & Company (Canada) Ltd
15
53
2
47
The Canada Starch Company limi t ed Cover 4
Design ers' Choice 9
EqUity Medical Supply Company 25
- -
--- --
Health C are Services UPJohn Limited 59
Heelbo Corporation 5 6
Hollister Limited 4
ICN C anada Limited 54
MedoX 12
--
The C, V, Mosby Company LImited 43, 44, 45, 46
Mostly Whites Limited 16
Posey Compan y 5
R eeves C o mpany 41
Rouss el (Canad a ) limited 11 , 5
W,B. Saunaers Company Canada limited 49
----
Uniforms Registered 14
-----
Uniform Specialty C over 3
-- -
White Sister Uniform Inc. 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,
Gæ1:]
) 76
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The Canadian Nurse
E
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35
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I
Input
News
Names and Faces
Calendar
What's New
Books
Audiovisual
Library Update
The Canadian Nurse
The official journal of the Canadian
Nurses' Assoaation published
monthly in French and English
editions.
6
8
38
43
44
46
48 Frankly Speaking
48 Stroke
P1. 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&
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..
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... 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
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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
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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
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AT YOUR FAVOURITE STORE
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A PROUD CANADIAN NAME
IN THE FASHION INDUSTRY
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Sizes 3-15
Pristine Royale
White, Mint. Cantaloupe
About 529.00
B) Style No. 46540
Sizes 5-15
Pristine Royale
White
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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
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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.
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The Canadian Nurse February 1976
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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.
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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.
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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.
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Pampers construction
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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
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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." Yet we do spend at least 3
minutes with a patient every day, Are they the best
possible 3 minutes for the patient? ..
14
The Cllnad"In Nurse
FeÞrullry 1976
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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
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18
The CanadIan Nurse February 1976
S'troke
ACUTE
NURSING
CARE
IN THE
STROKE
UNIT
5 1
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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
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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
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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
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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.
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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
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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
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)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
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-
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
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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.
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30
The CanadIan Nurse February 1976
Reaching
Tomorrow's
Citizens
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. 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.
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<D THE PRACTICE OF EMERGENCY
NURSING
..lI 'I)
".II
ØJ
By James H. Cosgriff, Jr. M.D., F.A.C.S.; and Diann Laden
Anderson, R.N., M.N.; with 31 contributors.
Practical guidelines in this comprehensive new book will
enable the emergency department nurse to properly
assess the patient and implement a sound plan of nurs-
ing management. It's the most complete book of its kind!
All types of clinical emergencies are covered, including
those associated with particular organ systems and age
groups. Emphasized is the emergency nurse's need to
acquire and apply facts once associated exclusively with
"medical practice." Expanded responsibilities of emer-
gency nursing are stressed, as is the need for teamwork,
based on a colleague relationship between physician
and nurse.
Features include: anatomy, physiology, and pathophysi-
ology reviews; lists of commonly used drugs, drug reac-
tions, and interactions; chapter end summaries; exten-
sive data in tabular, quick-reference form; and a color
plate on eye conditions.
488 pages/illustrated/1975
$15.75
'From Lippincott
THE LlPPINCOn MANUAL OF
NURSING PRACTICE
By Lillian S. Brunner, R.N., M.S.; and Doris S. Suddarth, R.N..
M.S,N.; with four co-authors, three contributors.
This now-famous ready reference puts virtually all of nursing
right at your fingertips! In three major units. . . medical/surgi-
cal, maternity, pediatric. . . this unique book presents clinical
problems, their causes, manifestations, potential complica-
tions, plus overall nursing management in concise, outline form
. . . instant information you can put to immediate use, With
Capsule Guidelines to Nursing Action, Nursing Alerts, Sections
on Pharmacology and Medication, and much, much more!
1473 Pages/Profusely Illustrated/1974 $21.50
<i MASSACHUSETTS GENERAL
HOSPITAL MANUAL OF NURSING
PROCEDURES
By Department of Nursing, M,G.H.
General procedures for efficient and effective patient care are
covered, as well as more specialized material on cardiac( in-
cluding cardiopulmonary resuscitation}, respiratory, urological,
ostomy, neurological, orthopedic, eye, ear, and nose, burn, and
psychiatric nursing care. All procedures are presented in a
clear, step-by-step format. When necessary, notes stressing
the rationale behind a particular step, critical techniques, and
specific notes on good care are also offered. The content of
this book has been rigorously tested, reviewed by specialists,
and approved by a board of reviewers from the medical and
nursing staffs at the Massachusetts General Hospital.
389 Pages/lllustrated/1975 $8.95
. . .
@
CARE OF THE ADULT PATIENT
MEDICAL-SURGICAL NURSING
A superbly useful tool for nursing education and practice, this
well established text has been massively revised, updated and
expand'ed, and provides an authoritative basis for understand-
ing the patient's therapeutic regimen, including surgery, drugs,
nursing intervention and rehabilitation. The nursing process is
stressed and pathophysiologic content has been expanded,
Each chapter emphasizes assessment of the physical, emo-
tional and social needs of the patient and his family. New
chapters include The Nursing Process, Nursing Assessment,
and The Development Process.
By Dorothy W. Smith, R.N., Ed.D.; Carol P. Hanley Germain,
R.N., M.S.
LIPPINCOTT
Illustrated/4th Edition/1975 Paper $15.50
Cloth $19.75
e
@INTERPRETATION OF DIAGNOSTIC
TESTS
By J. Wallach, M.D.
This unique and useful book provides readily accessible and
reliable data for maximum efficiency in making an early diag-
nosis, determining the stage and activity of disease, detecting
recurrence of disease, and measuring the effects of therapy.
It aims at eliminating unnecessary tests and at conserving the
physician's time and patient's money.
LITTLE, BROWN
529 Pages/1974 $7.97
HUMAN DEVELOPMENT AND
BEHAVIOR
Psychology in Nursing
This book, with its special focus on nursing practice, will be a
welcome addition to practitioners of nursing, In it are delineated
the major psychological concepts as they relate to the life cycle
of individuals in periods of health as well as illness. What
emerges is an overview of behavior that enables the nurse to
Intervene more effectively with her patients to promote better
psychological adaptation.
By BERNARD D. STARR, Ph.D. and HARRIS S. GOLDSTEIN,
M.D., D. Med. Sc.
SPRINGER
436 pages/1975 $10.50
@.' A GUIDE TO PHYSICAL
!EXAMINATION
An expertly-illustrated, "how-to" text that bridges the gap be-
tween anatomy and physiology and their application to the
physical examination. Within each body region or system, three
topics are covered: 1) anatomy and physiology basic to the
examination, 2) examination techniques, 3) selected abnormali-
ties. A superb teaching tool for any program in primary health
care.
375 pages/profusely illustrated/1974 $18.75
Barbara Bates, M.D.
Also available. . .
PHYSICAL EXAMINATION FILMS
A series of twelve sound motion pictures, correlated with the
content of A Guide to Physical Examination. (Write to the
Marketing Coordinator, AN Media for information,)
@:NURSES' HANDBOOK OF
FLUID BALANCE
2nd Edition
This edition reflects the nurse's expanded role in diagnosis,
treatment and evaluation of laboratory findings. All chapters
include the latest findings in types of imbalances, treatments,
and medication; each element, deficit and excess is discussed
in greater depth and clarity. A new chapter on Fluid Balance
in Pregnancy incorporates recent knowledge of body fluid dis-
turbances. Other new chapters deal with routes of transport,
organs of homeostasis, and disturbances of water and electro-
lytes. Many new illustrations.
313 pages/illustrated/2nd edition/1974/paperbound $8.75
Norma M. Metheny, R.N., M.S.; and W. D. Snively, Jr., M.D,
F,A,C.P.
@, BASIC PEDIATRICS FOR THE
PRIMARY HEALTH CARE PROVIDER
By Catherine DeAngelis, M.D., R.N., M.P.H.,
The goal of this innovative new paperback textbook is to impart
specific, pertinent knowledge from the broad field of pediatrics
that will be useful to nonphysicians who function as primary
health providers. The material is organized into four general
areas. Part I, Date Base, discusses history-taking. physical
examination, screening tests, and the problem-oriented record.
Part II, Therapy, covers immunization and nutrition, Part III
details Common Signs, Symptoms and Diseases and is organ-
ized by organ systems. Three special chapters - on allergies;
on acute, benign, and communicable (ABC) diseases; on strep-
tococcal illnesses and complications - will be of particular
interest. Part IV, Problems of Behavior, considers both child-
hood and adolescence.
397 Pages/IIJustrated/1975 $9.95
Leadership in learning.
@TEXTBOOK OF MEDICAL-SURGICAL
NURSING
By Lillian S. Brunner, R.N., M.S.; Doris S. Suddarth, R.N.,
B,S.N.E., M.S.N.
Outstanding in its depth of scientific content and in the prac-
ticality of its application, this leading text has been heavily re-
vised and updated, with much new material. In the unit, Assess-
ment of the Patient, three new chapters have been added: Clini-
cal Interviewing of Patients; Physical Examination by the
Nurse; and Guidelines for Writing Problem-Oriented Records
to promote continuity of patient care, Other new chapters in-
clude Care of the Cardiovascular Surgical Patient, and The
Person Experiencing Pain. Nursing management in various
clinical situations is frequently outlined in tabular form.
lIIustrated/3rd Edition/1975 $19.75
@ PRINCIPLES AND PRACTICE OF
INTRAVENOUS THERAPY
2nd Edition
By A. L Plumer, R.N.
As the value of intravenous therapy in clinical medicine in-
creases, there is a proportionately growing need to equip
nurses with the special knowledge and skills necessary for
optimal care of the patient receiving such therapy.
This new edition has been updated to include: . technological
advances in intravenous equipment and techniques' the latest
findings on asepsis and hazards of contamination . practical
means of ensuring safe, successful care' a complete chapter
on total parenteral nutrition . valuable information that intra-
venous therapists need in order to integrate their contributions
into the overall care of the patient.
LITTLE, BROWN
348 Pages/lllustrated/1975 Paper $6.95
Cloth $10.95
J. B. Lippincott Company of Canada Ltd:
Please send me the books I have circled
1
2
10
11
3
4
5
6
7
8
9
Name
Address
City Provo Postal Code
o Payment enclosed, ship postage and handling paid
o Charge and bill me
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.
Lippincott
J. B. LIPPINCOTT COMPANY OF CANADA LIMITED
Serving the Health Professions in Canada Since 1897
15 HORNER AVE. TORONTO, ONTARIO M8Z 4X1 (416) 252.5271
34
The CanadIan Nurse February 1976
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The Canadian Nurse February 1976
35
Dorothy Miller
...........................................................................................
This oldest English city in Canada. founded in
1749, has cherished and preserved its history
while becoming very much a city of this
century, High-rise office and apartment
buildings with clean modern lines contrast
sharply with the grace and architectural
elegance of the commercial and residential
structures of another day. Scotia Square in
downtown Halifax is a $65 million complex of
residential. retail and commercial facilities.
When completed. it will be the largest
concrete structure in North America. On the
waterfronl. just below this towering complex
is the Restoration of Historic Waterfront
Buildings project that includes some of the
oldest maritime buildings still standing in
Canada.
The site has now resumed much of ItS
nineteenth century appearance and is an
exciting place to visit. The choice of quality
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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.
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. 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.
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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.
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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.
.............................
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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.
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Knit
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Sizes 4-16 .$28.00
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Style 131 PantSuit
Polyester 'Ny'
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Knit-White L . Trim
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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
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E
a true test of knowledge
I
I
Rely on these new texts to help students perform
with optimum results-optimum patient care
\
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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
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THE C V MOS8Y COMPANY L TO
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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
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· 4
.: 4
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....
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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<<IIOÐ .nd .ttocto 10 __
i-------------------------------------.
IT'S EASY TO ORDER REEVES NAME PINS FOR YOURSELF OR FRIENDS! I
I
bottom ngf1t Attach edra st/eo!'t fof ackhtlon.al pins
NOTE SAYIN
S all 2 10ENTICAl. PlItS. . .or. c.....i.oI,
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LETTERING.______________________ 2nd LlNE._______________
STYlE I OI:SClIP110N MrTAL MfTAI. I w::
a:1I8 lIT1tI!lIIG I PIlUS
110 çOlOJ FlIIISit (Pili"') COlOJ E...... II.ioo E......... 2 '--'
All M[TAL - Smooth rounded 0 Duotone 00e5 0 BlaCk 0 1 Prn 2..49 0 I Pin 3.25
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In.or B
':r DPoIIv-.ed not o Ok. 81ue D2Plns.95
t>>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
<i plale D,mo-soled, plrHYck Spec,'Y RN. LPN. LVII, 0'
N I'\ NA Dn COOpol1
n No. 20S Enam. Pin 1.95 ea.
SERRATED NURSES SHEAR
Buz MEMO TIMER "'-"' :p
Can cut a penny! For bandages, gaJle. cr=.- "
- T,m. hol poc.s, -- II - small pI..te' casts, "'Iher shoes, /
hear lamps pa,1! mete,s. Remember to check vllal ......
l clothes, s.phnts, etc. Hardened staUr
.
signs, Rive medltabon, etc llptllelght compact less., serrated cuttln. edge. plast
n 11" dla) sets to buzz S to 60 mln key flng coated handles 8" IORio weighs only 2 OZI
S"WlSS RtIde ..
Stenhzeable; .JIUtoclave to 320"F
No. M-22 Timer... 6.95 .... No. 5-1000 Shear... 6.95. Initials enlf. add 50c
COIooWOLETI[ _
ACT1ON QUARANTImD' AI _
. _ _ __ __-...ry
. .
. .
Finest FO'1'ed Steel.
';uaranteed 2 years.
LISTER BANDAGE SCISSORS
3'
" ....i-scw.. Tiny, hindy, slip Into
uniform pocket or pune Choose jewefen
L lold or gleam,. chrome pIol. finish.
No. 35OO3"z" Mini,.,. .,,_ 2.75
No& 4500 41.12" size. Chrome only & . . 2.95
No. 5500 5 11 2" size, Chrome Dnly . . . 3.25
No. 702 7'1." size. Chrom. enly . . . 3.75
For enll'lved initials add 50, per instru.ment
5'h" OPERATING SCISSORS __
Poli>Þe<! Stainless Steel, sl",pt blad..
.
No. 705 Sharp/Blunl poinls". 2.95 ...
No. 706 Sharp/ Sharp point. , . . 2.95
No, 710 4'12" IRIS Scis.. Straight. . . 3,75
For enarlved initills add 50t per Instrument
3
"
4
"
5
.
1Jt4'"
Or----
'
KELLY FORCEPS
So lYnðy lor ever) nune l Ideal for clamping
No.o
t
nl
fJ:
i
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:. 4-49
No. 725 Curved, Box lock. . . . . . . . 4 49
No. 741 Thumb Dressing Forcep,
S."at'd, Strailht, 5'-!I" . .3.75
FOr Inafawoed initials add 50t per Instrument
"U
MEDI-CARD SET Handlesl reler
ence eYe,1 6 smooth plastic cards (3"''' ]C
51h") crammed with inlormation; Equlva-
lenci.. 01 Apolhecary 10 "'cl"c 10 Household
Meas, Temp. .C to "F, 'rescrip_ Abbr , Unn-
alysis, Body Chem , Blood Chem ,L.ver l..ts,
Bone Marrow. Disease Inc:
Periods. Adult
Wgts elc. In wMe .IR1I holder.
No. 289 brd S'I . . , 1.50 eo.
\
::..a83'
amped on back of
l\
.... .
NURSES BAG f.nesl block
" thick genuine cowt\lde. beautrfullr
cr.Hed. stilch!'d and liVe! construc-
lion Water repellant. Roomy intanor,
With snap-in washable liner and com-
partments to orlanlle contents. Snap
:
:
r
ol.
g
US6;,
ar
x 12'" Your Inlti,ls lold embossed
FREE on top. An oulsland.nl
value of superb QUality.
No. 1544-1 Bal (wIth lin.rl. . 42 50 el.
Elltrl liner No. 4415 . . . 8.50
f I
14K G.F. PIERCED EARRINGS
Dllnty, delalle<! 1120 12K Gold Flileo c.....c.u, w'II1 141(
posts, for on or off' I1It,. wear. Shown actual Sile Gin
boled lor I".nds, 100 Ide.1 group/ groOual1O/l g.lt,
No. J3/035. . .5.95 per pair
CROSS PEN =----
. ioohI...Æ.x.._ 'fì
World-l.mousb.llpoIRI...ilh
W
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:=
eb:r
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Refills avail everywhere l,'etlme guarantee
No. 3502 Chrom. B.95 el. No. 6602 12kt G.F. 12.95 ea.
PIN GUARD Sculptured uduc.us chinned -
to your pr(Jff 510n,I letters. each with plnback
safety catch_ Or replace either w..rh class pin Gold
finish, gin boJ!ed Choose RN, LPN or LVII.
No. 3420 Pin GUlrd . . . 2.95 el.
,.,
,
, -
\
') -I)
r
Free Initials and
Free Scope Sac
with your own
LittmaUD Nursescope!
Famous Littmann nurses'
diaphragm stethoscope
a fine precisIon instrument
with high sensitivity for
blood pressures. apical pulse
rate. Only 2 OlS., fits rn
pocket with gray .inyl anti-
collapse tubing, non-chilling
epoxy diaphragm. 28' over.
all. Non.rotating angled ear
tubes and chest piece beau. No. 2160 Nursescope
tifUJly styled in choice of 5 including Free
jewel.like colors: Goldtone, Initials and Sack
Silverlone, Blue, Green, Pink: Duty Free 16.95 ea.
.,MPORTANT, New ' "'edaillon' slyllnl.nel..... tub,ng 'n tolD" 10 m'lCh
metal Oo1rts II desi,ed, odd $1 ea 10 P"to II>ove; 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 Importe<! I,om lapin, highesl
sensitivity fOl' apical pulse rate Chromed blMUfðls,
chest pIece ...,th J
" bell and I
" diaphragm,
Rrey an....(:ollapse tublng_ 4 oz , 29" long Extra
ear plugs and diaphragm Included TWI imtlals .A
.ngll.ed Iree FREE SCOPE SACK INCLUDED
No. 413 Dual Sloth. . . 17.95 .a.
Du.... Free
LOW-COST STETHOSCOPE
Our lowest cosl preCISion stethoscope' Single dIaphragm II'." dlaJ
Choose Blue, Grun Red Sliver or Gatti tubinl and ct1estplece sl!Yer
bm&lrals only 3 oz Three Initials engraved free fREE SCuPE SACK
No. 4140 Cloy. Steth ... 11.95 ea. Duty Free
/'- EXAMINING PENLIGHT
Wh,te barrel witll Clduceus Impnnt, alu-
mmum band and chp. 5" IonL US made. batteries
Included (replacement batteries available any slo,e).
No. Nl-10 Penlighl . , . 3.95 el. In,lill. enll....d, .dd 50..
.../u-
MRS. R. F. JOHNSON
SUPERVISOR
N
1.
CHARLENE HAYNES
,
. ,. OHN. L.P.N.
-
.......
1.
....
511
AI ......... -, c.edI
NURSES PERSONALIZED SPHYG.
Now in Fashion Colors!
A superb anerOid sph,g. especially deslgneð
for nurses by Reister. preCISion craftsmen
In W_ Germany EIS,'o-attach Velcro. cuff,
hgf1rwelgf11 compact. fils Into soh slm
lealher zlþper case 21h" x 4" J. 1"_ Dial
cahbrated to 320mm In-year accuracy
guaranteed to
3mm_ Servlud b,
Reeves If ever required Your Inilials
engraYed on manomeler and IDld
stomped on cose FREE. Choose BLACK
with chrome metal manomeler or
BLUE. GREEN or BEIGE w,th pI..I'"
mana housing, tubmg. cuff and caSe
all color-coordlnaæd (Sprcl'Y Dn coupon)
No. 106 SphYIL. . . . 39.95 ea.
Duty Free
Q -,
-
,
./
BLOOD PRESSURE SET
An OUlstandl8l aneroid sphyg made
In Japan especullr 101' Reeves Meets
,n. :
.
i
;' 'ro";.;',,3mm Bl :,r:.'ci
chrome manometer, cal fo 300nun
Velcr" g,ey cull, bl.ck tubIng, ..II
e::
e
= J.z'l
Se
ed m:S u 5:\",'
..er needed. Clayton No 414û
Stethcstope (Sllve,) .nd Stope SIck
..cluded (see pholo lellJ. fREE lold
inltrals on case Here IS . sensible
prllCliul, dependll>le ..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
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Send to . .
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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
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48
The CanadIan Nurse February 1976
... \11(1 i.Þ,-iHlllll
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. 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
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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
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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
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I
1
I
,
m\ H.\PPY! I
h,.d ugl
,upertluou, hair. . W."
unloved _ di'>C,'uraged. Iried man\
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. "Jolhing \\oa',
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faclOr
. J hen I dnd"ped a 'illl-
pie. painle". ine....pl.'n,i\e. nondeclric
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beaUI}. Ime, h.tppine',. \J
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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
,
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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
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rlj
loB
=nc;
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: 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
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:
t
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:
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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 Karl<heck - 307-
682-88 11
REMEMBER
HELP YOUR RED CROSS
TO HELP
Nursing Office
Supervisor
As a member of nursing administration
this Individual will have the responsiblity
for the management and assignment of
part lime and casual staff, and have an
interest in assuming more senior
responsibilities.
Preference is given to Baccalaureale
degree or equivalent and must be eligible
for Saskatchewan registration. Several
years experience in nursing service
indicating progressive responsibility
including Head Nurse level is necessary.
The position is available April 15, 1976.
Salary is commensurate with preparation
and experience.
Apply to:
Director of Personnel
University Hospital
Saskatoon, Saskatchewan
S7N OW8
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 slaff.
Inlerested qualified applicants should
apply to the:
Director of Nursing
Montreal Children's Hospital
2300 Tupper Street
Montreal 108, Quebec
The CanadIan Nurse February 1976
Okanagan College
Position Vacancy
Nursing Faculty
Okanagan College is Implementing a
Diploma-level Nursing Program in
September 1976. Applications are invited
for instructional positions. Two
appointments will be made in the Spring of
1976. A third appointment will be made
toward the end of the year.
Duties
Classroom and clinicalrnstruction;
curriculum development; other duties as
assigned by the Coordinator of Nursing
Education. Instructors will be required to
travel to nearby communities.
Qualifications
Mas1er's Degree preferred; Bachelor s
minimum. Teaching experience
desirable; at least two years' clinical
experience essential.
Other instructional positions may be
available in the Spring of 1977.
Salary and working conditions in
accordance with the Academic Faculty
Agreement.
Applications to be submitted to:
The Principal
Okanagan College
1000 KLO Road
Kelowna, B.C.
V1 Y 4X8
Closing date: March 15, 1976.
SOFAA-TUUE' Aoussel
Fr.mycetln Sulph.te B.P. Antibiotic
"dlc.tlona: Trealmenl ot InleCled or porent..ny "'tacled
bums. crush lTl,unes lacerabons Also v8f1Cose uk::ers. bed-
sores aod ulcerated wouncts
Contr_le.atlone: Known allergy 10 lanolin or Iramyce-
tin C-,oss-senSItIZallon may OCCur among the group of
streplomyces-denwd antoboobCS (neomycin paromomycon.
kanamyon) of whICh framycebn IS a member but thiS IS
not Illval1a.bIe
Pr....utl_ n most cases absorption ot the anbblOlW:: IS
so shght that
can be dlScountec1 Where ""'Y large body
weas are ,"volved (e g 30,*, or more body bum) the poss'-
bol
y of OtOtOXICity beIng eventually p<oduced should be
conSidered PrOk>nged use of antibiotics may resuh In the
overgrOw1h of nonsuscept1t>'e orgamsms. IOCludlng fungi
App<opnale measures should be taken d IhlS occurs
Do..g.: A Single layer 10 be applIed d"ectly to the wound
ana covered with an appropnate dressing If exudative.
dressIngs should be changed alleast daiy In case 01 leg
ulcers cut dressing accurately to SIZe of ulcer and when
Intecled stage has cleared replace by non-mp<egnaled
dressing
SU....II_ A I'gh...."'ght para",n gauze dressong rmpreg-
I " ] ...tn I'*' framycetln sulphate B P Solra-Tulle also
contains anhydrous lanolrn g 9596 Avaolable In 2 Sizes 10
em by 10 em slerlle Single units canons of 10 and 50, 10
em by 30 em stenle smgle umts. cartons 01 10 Store at
controlled room remperalure
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
Ho
cou
, 0
St.
bulance
ss
,
,
L II
.:)
When you are
asked about
nursing care...
Health Care Services Upjohn
Limited can assist you and
your patients by providing
qualified Health Care Person-
nel for:
. Private Duty Nursing
. Home Health Care
. Staff Relief
We are a reliable SOurce of
nursing care with whom you
can trust your patients Our
employees are carefully
screened for character and
skill, then insured (including
Workmen's Compensation),
bonded and made subject to
our high operating code of
ethics
Your patients' care and well-
being are Our business.
If you would like more informa-
tion about our services call the
Health Care Services Upjohn
Limited office nearest you.
Health Care Services
Upjohn Limited
(Operating in Ontario as
HCS Upjohn)
Victona . Vancouver. Edmonton
Calgary. Wlr1mpeg . Wlr1dsor . London
5t Cathannes. Hamilton. Toronto West
Toronto East. Ottawa. Montreal
Trois Rivlères . Ouebec . Halltax
56
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
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 applicant with
practical experience at the senior
administration level combined with
baccalaureat
degree and/or other
formal education in the field of
administration.
Salary commensurate with education and
experience.
Position available by May 1st 1976.
Please apply to:
Director of Nursing
Grande Prairie General Hospital
Grand Prairie, Alberta
T8V 2E8
Director of Nursing
\
,
I
I
I
Career opportunity to assist in
administration and planning of patient
care In progressive 348 bed hospital The
position will present a challenge for a
person with a desire to achieve and
maintain the highest standard of
excellence within the Nursing
Department.
Candidate should have a minimum of a
B.Sc.N. Degree as well as progressive
experience in Nursing Administration.
Salary commensurate with experience.
Full range of benefits and excellen!
working conditions.
Apply in confidence to:
Director of Personnel
Public General Hospital
106 Emma SI.
Chatham, Ontario
N7L 1 A8
The Canadian Nurse
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.NAB.C. Contract:
Salary: $850 - $1020 per month
(1974 rates)
Shift differential
Apply to:
Director of Nursing
Prince George Regional Hospital
Prince George, B.C.
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
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)
February 1976
The George Brown
College
Nursing Division in
Toronto
is offering a 19-week program in
Critical Care Nursing for
registered nurses, starting March
8, 1976, Theory and clinical
experience are combined for
optimum learning experience.
The program, which runs twice a
year, is taught at the College's S1.
Michael's Hospital Campus, 27
Queen Street East.
For more information call (416)
967-1212 ext. 269.
University of Victoria
School of Nursing
New School of Nursing requires 4 faculty members
with at least Master 5 level preparation and successful
expenence In rehabilitation/gerontology/group
work/problem solving/community heahh to Implement
a 2 year Integrated 8.S N cUrriculum tor A N. s.
This program seeks to enhance the Currenl skills 01
R.N. s by expanding psychosocial awareness and
developing skillin use of the sCientific method as related
to nursing.
Generalist IS focused. clinical praC1lce will be pnmarlly
In extended Care and rehabilitation unrts. some clinical
work arranged on the bases of students expenences
and career goals. InterdisCiplinary studies and
innovative learning expenences for highly motivated
academically able students require close faculty
coordination and co-operatlon. and provides an unusual
opportunity for creallVlty Salary and rank based on
education and expenence
Application and curnculum vitae before March 1 to:
Dr. Isabel MacRae. Director
School of Nursing
University of Victoria
P.O. Box 1700
Victoria. British Columbia
V8W 2Y2
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
;lour from Toronto.
Apply to:
Personnel Department
Guelph General Hospital
115 Delhi Street
Guelph, Ontario
N1E 4J4
Telephone: (519) 822-5350 Ex.: 203
Foothills Hospital, Calgary,
Alberta
Advanced Neurological-
Neurosurgical Nursing
for Graduate Nurses
A five month climcal and academic
program offered by The Department 01
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. Calgary, Alberta
T2N 2T9
North Newfoundland & Labrador
reqUires
Registered Nurses
Public Health Nurses
International Grenfell ASSociation provides
medical services lor Northern Newfoundland
and Labrador. We staff lour hospitals, eleven
nursing stations, eleven Public Health unats. Our
main 180-bed accredited hospital 15 situated at
S\. Anthony. Newfoundland. Active treatment,s
carried on in Surgery, Medicine, Paediatrics.
Obstetrics, Psychiatry. Also, Intensive Care
Una\. Orientation and In-Service programs.
4O-hour week, rotating shifts. Living
accommodatIOns supplied at low cos\. Public
health has challenge of large remote areas
Excellent personnel !Jenefits include liberal
vacation and sick leave. Union approved
salaries stan at $810.00..
Apply to:
International Grenfell Association
Assistant Administrator of
Nursing Services
St. Anthony, Newfoundland
AOK 4S0
Conestoga College of
Applied Arts and
Technology
The College invites applicallons for
Faculty positions in our various Nursing
Division which are located in Cambndge,
Guelph, Kitchener-Waterloo, and
Stratford. We have immediate openings.
Candidates must have suitable
qualifications and at least two years
nursing experience. Salary will be
commensurate with background and
experience. This position IS open to both
women and men.
Applications, in writing. should be
forwarded to:
Personnel Manager
Conestoga College of Applied Arts and
Technology
299 Doon Valley Drive
Kitchener, Ontario
N2G 3W5
The Canadian Nurse February 1976
57
"Meeting Today's Challenge in Nursing"
Queen Elizabeth Hospital of Montreal Centre
A Tedching Hospital of McGill University
reqUIres
Registered Nurses
and Registered Nursing Assistants
Quebec language requirements do not apply to Canadian applicants.
. 255-bed General Hospital in the West 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
\
A whole new world . . .
A whole new challenge
Medical Services, Northwest Territories
Region, is offering term and permanent
positions for qualified. experienced nurses
in Canada's North,
Openings will be available from May to
September at nursing stations and hospitals
throughout the Arctic,
If you would like the challenge of living and
working in one of our last great frontiers,
then fill out and mail the attached coupon.
Personnel Administrator, Medical Services,
Northwest Territories Region, Health and
Welfare Canada, 14th Floor, Baker Centre,
10025 - 106 Street, Edmonton, Alberta
T5J 1 H2
Or call collect: (403) 425-6787
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NAME
ADDRESS
CITY
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POSTAL CDDE _
PHDNE
58
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ORTHOPAEDIC &: ARTHRITIC
HOSPITAL
'V IV'
43 Wellesley Street, East
Toronto, Ontario
M4Y 1H1
Enlarging Specialty Hospital offers a unique
opportunity to nurses and nursing assistants
interested in the care of patients with bone and joint
disorders,
Currently required -
Registered Nurses and Nursing Assistants for all
units
Clinical specialists for Operating Room, Intensive
Care, Patient Care and Education.
The Canadian Nurse February 1976
Director of Nursing
The Hospital
A Director of Nursing Serv!ces is required for a new 100 bed extended
care hospital, presently under construction, and planned for opening
in November of 1976.
The Position
Responsibilities include planning, organizing, staffing, coordinating
and fully directing all aspects of the nursing services. The Director will
be a member of the senior management team concerned with the total
operation of the hospital.
Qualifications
Qualifications required are several years experience at a senior
supervisory level, or as an assistant Director, or Director of Nursing in
a hospital setting, preferably a baccalaureate in nursing, and eligibility
to register with the Provincial professional nursing organization.
Salary
This position offers excellent working conditions including the
challenge of opening an entirely new facility and working with other
senior staff in the development of all patient care programs for the
hospital. The salary is open to negotiation within R.NAB.C. pay
scales and will be commensurate with qualifications and experience.
The successful applicant must be prepared to assume the duties of
this position effective September 1, 1976.
Interested applicants should send their application and resume
to:
The Administrator
Overlander Extended Care Hospital
890 McGmvray Street
Kamloops, B. C.
. Modern 700 bed non-sectarian hospital
. Excellent personnel policies
. Registered Nurses and Nursing Assistants
are asked to apply
If Paris appeals to you
. . . so will Montreal
. 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
Extension Course in Nursing Unit
Administration
Applications are invited for the extension course in Nursing Unit
Administration, a program to help the head nurse, supervisor or
director of nursing up-date his or her management skills.
Candidates will be registered nurses or registered psychiatric
nurses employed in management positions on a full-time basis.
The program provides a seven month period of home study with
two five day intramural sessions, one preceding and one following
the home study. For the 1976-77 class the initial intramural
sessions will be held regionally as follows:
Vancouver August 23-27
Hamilton Seplember 13-17
Toronto September 20-24
Montreal (French) August 30 - Seplember 3
Halifax August 30 - Seplember 3
Winnipeg September 13-17
Ottawa September 20-24
Earl}o application is advised. Applications will be accepted until
May 15,1976, if places are still available at that time. After
acceptanæ, the tuition fee of $250.00 is payable on or before July
1, 1976.
The program is co-sponsored by the Canadian Nurses Association
and the Canadian Hospital Association and is available in French
or In English.
For additional information and application forms write to:
Director,
Extension Course in Nursing Unit Administration,
25 Imperial Street,
Toronto, Ontario,
M5P 1C1.
Community Mental Health Nurse
Opportunity for innovative Nursing practice in a Centre
located in semi-rural Nova Scotia near Acadia
University in Wolfville, Unique opportunity to work
cooperatively with a multidisciplinary group including
psychiatrists, social workers, and psychologists.
Participation in active clinical programmes including
individual, group, marital and family therapy. In addition,
duties are to include liaison and consultative services to
public health nurses, general hospital staffs etc.
regarding mental health programming,
Qualifications: At least 2 years experience in psychiatric
or mental health nursing. Current registration as a
registered nurse in the Province of Nova Scotia.
Master's degree in psychiatric nursing preferred.
Baccalaureate degree in nursing with additional
educational preparation in psychiatric or mental health
nursing or equivalent acceptable.
Apply stating qualifications and working resume to:
John W. Murphy, M.S.W.
Executive Director
Fundy Mental Health Centre
Wolfville, Nova Scotia
The CanadIan Nurse February 1976
59
657 bed, accredited r mod
rn,
well equipped General Hospital, . ,.
rapidly expanding...
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Saint John
General
GJIoÆPital
SaintG}ohn,NB,
CANADA
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GJWQUIRES:
Genelál Staff /Vyrses
Registered Nursing Assistants
In all general areas: Medical, Surgical,
Pediatrics, Obstetrics, Chronic and
Convalescent, several Intensive Care
areas and Psychiatry.
. Active, progressive in. service education program,
Special Attention to Orientation.
Allowance for Experience and Post Basic Preperation
fOR fURTHUR INFORMATION APPLY TO
C;PERSONNEL DIRECTOR
aintGjohn General Hospital
p... BOX 1000 Saint John. New Brunswick E1L 4Ll
Shaughnessy Hospital
Director of Patient Services
The establishment of a new management structure for Shaughnessy
Hospilal, appropriate to its role as a member hospital within the British
Columbia Medical Centre complex. requires a senior patient care
executive capable Of full participation in its development.
Shaughnessy Hospital is a large well-established facility providing
acute, intermediate and extended care services presently under
development as a major teaching referral centre.
Candidates should possess basic nursing qualifications with
post-graduate education in health or nursing administration and a
demonstrated record of innovative leadership, preferably in a teaching
hospital setting. Essential is the abilily to plan for and implement
anticipated changes in patient care concepts.
Please submit applications in confidence to:
Chairman, Selection Committee
Director of Patient Care
Shaughnessy Hospital
4500 Oak Street
Vancouver, B.C. V6H 3N1
60
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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
Faculty Positions
1
.
Professor or Associate Professor of Nursing to
coordinate the Master's Program in association witt"
the Director of the School. It is expected that the
candidate would have completed a doctorate, and
have had clinical, nursing education and research
experience. The appointment includes teaching in
the graduate and undergraduate programs, and
provides opportunity for research.
2 Because a number of our faculty will be leaving to
pursue further education at the end of this academic
year, there will be positions available for qualified
faculty, We are especially interested in candidates
with preparation in mental health and psychiatric
nursing, and in community health nursing,
The Canadian Nurse February 1976
Dean
University of Maine School of Nursing
The University of Maine School of Nursing is accepting applications
for the position of the Dean of the School of Nursing located in
Portland, Maine. The Dean, as chief administrative and academic
officer of the School, charged with directing the instructional programs
and executing the educational objectives of the School, is responsible
to the President of the University of Maine at Portland-Gorham. The
School currently has an enrollment of 400 undergraduates, an active
Bureau of Continuing Education for Nursing, and partidpates in a
consortium for graduate level education for Nursing. Requirements
include: Graduation from NLN accredited program in professional
nursing, and an earned doctoral degree. Clinical practice in Nursing
and experience teaching in a baccalaureate nursing program are
required, as are demonstrated administrative capabilities.
Rank and salary commensurate with experience.
Position available July 1, 1976.
Submit credentials by March 15, 1976 to:
Jacqueline Karabin
Chairman, Dean Search Commi"ee
University of Maine at Portland-Gorham
96 Falmouth Street
Portland, Maine 04103
We are an equal opportunity employer
Interesting developments for the future make Dalhousie
School of Nursing a challenging place in which to
contribute to nursing education and to further one's own
professional goals.
e new and modern quarters for the School are
planned
e our masters program is now in its first year
e some research projects are getting underway and
Dr. Margaret Scott Wright from Edinburgh, well
known in Canada and internationally,
will be our new Director.
Applications, with curriculum vitae, should be sent
to Muriel E. Small, Director, School of Nursing,
Dalhousie University, Halifax, Nova Scotia.
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Community Health
Nurse Coordinator
The City of Vancouver Health Department is seeking
a community health nurse to provide nursing
leadership in one of the five health units, The Nurse
Coordinator will be expected to work within a
multi-disciplinary setting by developing and
implementing comprehensive innovative health
programs and for ensuring the efficient
administration of already estabiished services.
The successful applicant will posses a university
degree in nursing, training and experience in the
public health field, and advanced training in
community health care, preferably at the master's
level and including COUfSes in supervision and
administration. Applicanls must be eligible for
registration as members of the Registered Nurses'
Association of British Columbia.
The 1975 monthly salary will be $1583 - $1856
depending on qualifications and experience
All applications should be made on" Application
for Employment" Form Pers. 35 and returned,
preferably together with a detailed resume, to
the Department of Personnel Services, 453 West
12th Avenue, Vancouver, B.C. V5V 1V4.
The Canadian Nurse 1 February 1976
61
John Abbott
College (CEGEP
Ste. Anne de Bellevue
Suburban Montreal
3-Vear
Nursing
Program
requires additional teaching staff
for September, 1976.
Applicants should possess an R.N. or eligibility for
licensure in Quebec, a Bachelors Degree in Nursing and a
minimum of two years general nursing experience.
John Abbott College is a community college serving the
West Island of Montreal. It offers a park-like setting, close to
the city, on-campus sports, recreation and the possibility of
residence close to the campus.
Teaching salaries according to Quebec teachers scale,
excellent fringe benefits. group insurance, pension plan,
health benefits and two months paid vacation.
Address application and completed
curriculum vitae to the:
Director of Personnel
JOHN ABBOTT COLLEGE
P.O. Box 2000,
Ste. Anne de Bellevue, Quebec
H9X 3L9
or call: (514) 457-6870
Director of Nursing
required for
The Royal Melbourne Hospital
Australia
One of Australia's leading teaching and General
Hospitals - with a nursing force of 1,000.
Duties:
As a member of the Executive Committee of the Board
of Management, and as part of the Management team,
to contribute to the overall objectives and policies of the
Hospital - and with the assistance of three Deputy
Directors (Service, Education and Administration) to
further the quality of nursing care, to manage the total
nursing activity, to represent the Hospital where
appropriate and to be responsible for the total efficiency
of the nursing function.
Qualifications:
A proven record of leadership in nursing, well informed
in recent developments, with the enthusiasm to accept
the challenges necessary in on-going progressive
attitudes and growth.
Salary:
Remuneration will be appropriate to such an important
post and will be such as to attract the most outstanding
people.
Applications:
Confidential. Airmail full particulars of experience,
qualifications, age, training, telephone numbers, and
other relevant information to:-
John P. Young & Associates (VIC) Pty. Ltd.,
Management Consultants,
2 Glen Street, Hawthorn, Victoria, 3122, Australia.
62
The University of Alberta
School of Nursing
Invites applications for the following positions: -
Senior Appointment. Responsible for undergraduate
(baccalaureate) programs. Master's or higher degree in Nursing:
teaching experience at university level: administrative skills and
preparation in curriculum development.
Assistant Professor in Maternal-Child Health Nursing in Basic
Baccalaureate Program. Master's degree or higher; experience in
maternal-child health nursing
Assistant Professor in Community Mental Health Nursing in
degree program for Registered Nurses. Master's degree or higher:
experience and preparation in community mental health nursing.
Assistant Professor in Community Health Nursing in degree
program for Registered Nurses. Master's degree or higher:
experienæ in community health nursing.
Salary and rank for positions commensurate with qualifications
and experience, and in accord with The University of Alberta salary
schedule.
Positions open to male and female applicants. Submit Curriculum
Vitae and names of three references to: -
Ruth E, McClure, M,P.H.
Director
School of Nursing
The University of Alberta
Edmonton, Alberta
T6G 2G3
Registered Nurses
1260 bed hospital adjacent to University of
Alberta campus offers employment in
medicine, surgery, pediatrics, obstetrics,
psychiatry, rehabilitation and extended care
including:
. Intensive care
. Coronary observation unit
. Cardiovascular surgery
. Burns and plastics
. Neonatal intensive care
. Renal dialysis
. Neuro-surgery
Planned Orientation and In-Service Education
programs. Post Graduate clinical courses in
Cardiovascular - Intensive Care Nursing and
Operating Room Technique and Management.
Apply to:
Recruitment Officer - Nursing
University of Alberta Hospital
112 Street and 84 Avenue
Edmonton, Alberta T6G 2B7
The Canadian Nurse February 1976
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 AÝenue
Corner Brook
Newfoundland
A2H ').17
[l]@
University of
Alberta Hospital
Edmonton, Alberta
o
I
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-SurgicaJ" - "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
The Canadian Nurse February 1976
63
Ap
yt
. .
Director 01 Nursing Ongomg staff education
Montreal Neurological Hospital
3801 University St.
Montreal, PO. H3A 284
Individual orientation
e-
Vancouver General Hospital
Invites applications for
Regular and Relief
General Duty
Nursing positions in all clinical areas of an
active teaching hospital, closely affiliated
with the University of B.C. and the
development of the B.C. Medical Centre.
For further information, please write to:
Personnel Services
Vancouver General Hospital
855 West 12th Ave.
Vancouver, B.C.
V5Z 1 M9
64
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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
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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
\)
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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-;;'.
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SHOE
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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
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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.
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CCanadian Nurses Association
1976.
4
The Canadian Nurse March 1976
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The CanadIan Nurse March 1976
5
l-el-SI)t.>>(-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
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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.
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6
The Canadian Nurse March 1976
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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
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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.
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Available Styles and Sizes 3 pairs 6 pairs lor IZ pairs for TOTAL
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l' eggs - Regular $ 4.47 $ 7.45 $14.90
l'eggs- Queensize $ 4.77 $ 7.95 $15.90
Sheer Energy' -SlzeA $1197 $19.95 $39.90
Sheer Energy -Size B $11.97 $19.95 $39.90
Sheer Energy -Queensize $11.97 $19.95 $3990
(Check v right box) TOTAL PURCHASE
Ontario residents add 7'1, sales tax SALES TAX
CON N376 TOTAL AMOUNT
NAM F
ADDRESS
CITY
PROVINCE_POSTAL COD E
Please do not send cash
Enclose cheque or money order. Make cheque or money order
payable to L'eggs Nurse White.
L_______________________J
12
The Canadian Nurse March 1976
X(t,,-S
o
Canadian women at work
"La différence" persists
I
I
I
I
I
The 1975 edition of Facts and Figures
on Women in the Labour Force is out
and in it are some interesting statistics
that indicate, in the wake of
International Women's Year, some
important differences that still persist
In 1974, there were 3,324,000
women at work in Canada. They made
up 34.4% of the total labor force. A
decade earlier, in 1964, working
women comprised only 28.4% of the
labor force. In 1974, 39,7% of all
women 14 and over worked, an
increase of almost 10% over 1964
(30.5%). For men, the "participation
rate" is currently 77.3%.
Nurses, as an occupational
group, fare better than many others.
Women make up 93.7% of all nursing
graduates (except supervisors) and
male nurses, on the average, earn
only $400-$500 a year more than
female nurses. This compares with a
$2,300 - $12,000 gap between male
and female secretaries! The
difference of $400 a year between the
salaries of male and female nurses,
ages 25 - 34, with some university
training, increases to a more
significant $5,000 In the same group
between the ages of 55 and 64. (In
1970, the average salary of male
nurses between 55 and 64, with some
university training, was $13,096, while
that of their female counterparts was
$7,800).
If nursing supervisors are
considered, the results are even more
indicative of persistent differences.
Although 94% of nursing graduates
are women, only 91% of all
supervisory positions are filled by
women. Looked at another way, 24%
of all males in the nursing profession
are supervisors: only 18% of women in
nursing hold supervisory positions.
Some other highlights of the
report are'
. There were 1,084,000 working
mothers in Canada in October 1973,
representing 35.1 0 0 of all mothers.
The largest number of working
mothers were 25-34 years old: in this
group 39.7 0 /0 of all mothers were
working .
. In 1974, women represented
73.9% of all persons employed in
medicine and health occupations.
. The participation rates of women
in the labor force in 1974 ranged from
43.3% in Alberta to 28.3% in
Newfoundland.
. In 1974, 25.2% of all employed
women worked part-time; the
comparable percentage for men was
6.2%.
Alberta research team
Receives H & W grant
Two nurses are part of a four-member
team from the Division of Health
Sciences Administration, Faculty of
Medicine, University of Alberta,
Edmonton, that has been awarded a
research grant to develop and test an
assessment instrument for Patient
Classification by Types of Care.
The grant by the National Health
Research and Development Program
of Health and Welfare Canada, is In
the amount of $92,695 for the first 18
months of the 27-month project.
The research director of the
project is Peggy Overton, a registered
nurse employed in full-time research
in the Division of Health Sciences
Administration at the University of
Alberta. The second nurse associated
with the project is Fernande Harrison,
a health services administrator at the
Alberta Hospital Services
Commission, who is also
member-at-Iarge for nursing
administration for the Canadian
Nurses' Association.
The principal investigator for the
project is Dr. Kyung Bay whose area of
expertise is research methodology.
Dr. David Flathman is the fourth
member of the team. The research will
build upon the definitions and
descriptions of Patient Classification
by Types of Care outlined in The
Report of the Working Party on Patient
Classification to the Advisory
Committee on HospItal Insurance and
Diagnostic Services, National Health
and Welfare, Ottawa, 1973. The
system will be tested out in extended
care and selected acute care settings
in Alberta. The exact location of the
demonstration project has not yet
been decided.
Fi re costs Up
In U.S. hospitals
The National Fire Protection
Association (NFPA) reports that fires
in hospitals and mental institutions in
the United States are occurring more
frequently and costing more than ever
before.
NFP A statistics show an increase
of nearly 200 percent in the number
of fires reported in health care
institutions in the U.S. during the past
six years. Property loss over the
six -year period is estimated at close to
$80 million.
Several facto(s help to explain the
dramatic jump in dollar losses -
hospitals have expanded their
facilities, increasing the areas
exposed to fires; more people are
using hospitals: there is more
electrical equipment and much of it is
more complex. The rate of inflation in
recent years also lends an
exaggerated character to these totals.
"Health care institutions must have
adequate motivational fire prevention
programs," states Charles S. Morgan,
President of NFPA. "Sometimes the
possibility of fire in a hospital seems
remote but the statistics tell a different
story.
A recent U.S. survey (not by
NFPA) of 75 hospitals with various bed
capacities (50 to 600) disclosed that a
high percentage of fire incidents that
occurred in hospitals had not been
reported and never became statistics
Survey director Charles K. Spalding of
Boston notes: "Fortunately, only a
small percentage of hospital fires are
allowed to become serious. It is the
small fires that produce little damage
or concern that should attract the
attention of those responsible for
hospital fire prevention."
He also reports that the "majority
of fires were attributable to fhe
careless use of smoking materials.
Patients' visitors were often
responsible for the unexpected
situations, for they are usually
unfamiliar with areas where specific
controls are required.:. nurses'
lounges were found to be common
areas for the wastebasket-type fire."
Spalding says that a proven
reason why hospital fires become
serious situations is the lack of
effective educational programs for
personnel, especially those working
the night shifts. The most common
mistake is neglecting to summon
professional (fire department) help
before attempting other action.
Virtually every fire involving injury or
death that has been reported in recent
years is traceable to the failure of
hospital personnel on the scene to
follow established fire plans.
NFPA findings are that most
hospital and mental institution fires
(55.2 percent) occur in patients'
rooms, with the second and third
highest areas being storage (15.3
percent) and lounging rooms (6.8
percent). The most common Source of
ignition was smoking materials (50.8
percent) and wearing apparel was the
material ignited most often (68.8
percent) .
New health services
Program planned
A northern Ontario university,
Lakehead University School of
Business Administration located in
Thunder Bay, plans to offer what it
believes to be the first Canadian
undergraduate degree in Health
Services Administration beginning in
September, 1976. The three-year
program leading to a B. Admin. is oper
to both full-time students and part-time
employees in hospitals and other
health care institutions.
Allowance is being made for
relevant credits and courses
previously undertaken. Of the fifteen
credits, ten provide a broad educatloP
in administration: principles, decision
making, economics, basic accounting
personnel management, finance etc.
The major includes many options, and
courses in Canadian Health Care
Organization, Hospital Administration
Materials Management, Community
Health, Sociology of Medicine and a
research project.
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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.
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"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
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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
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ARIFJf
seru h Recentl
M" m c olesterol y, a dieta ry
mnesot I' was re ted progra
fish, lean a
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':; "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
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Llving up t
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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
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The CanadIan Nurse March 1976
19
........................
=ernande Harrison author of this month's
orum, is CNA member-at-Iarge for nursing
Idministration. 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....
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The Canadian Nurse March 1976
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The CanadIan Nurse March 1976
21
PHYSICAL
AS)ESSMENT
OF IF-iE
NEWBORN
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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.
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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
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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
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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.
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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
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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
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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.
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34
The Canadian Nurse March 1976
A guide to drug use during breast-feeding
BABES
AT R SK?
,
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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.
-
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From Lippincott.
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Rita K. Chow, R.N., Ed.D.,
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SPRINGER
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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:
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Prepared childbirth at the General
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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
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41
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Hotel Nova Scotian
Chateau Halifax
The Lord Nrlson
Holiday Inn
SI. Mary.s University
SPRING
GARDEN
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The Canadian Nurse March 1976
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The leading convention center in
the Atlantic provinces, the Hotel Nova
Scotian, is the site of this year's CNA
convention. The Nova Scotian
features luxurious lounges, dining
spots, shops and a beauty parlor
within the hotel, in addition to
comfortable rooms, many of which
have a sea view. The sessions will be
held in the Commonwealth Room.
The "Greetings" Committee will
meet planes and tr
ins, wearing their
yellow"Sou Westers" or Evangeline
Caps if they're bilingual, ready to
welcome and help delegates. There
will be information desks at the airport
and the hotels, with both English-and
French-speaking personnel.
The RNANS Hospitality
Committee has arranged for a pipe
band to greet delegates arriving at the
Nova Scotian on Sunday to register
for the convention. Space has also
been booked at three other Halifax
hotels, as well as at St. Mary's
University. Chateau Halifax at Scotia
Square, IS one of the city's newest
and most prestigious hotels where
shopping is just an elevator ride
away There s an indoor-outdoor
swimming pool and the well-known
Noon Watch/Night Watch restaurant
offers a breathtaking view by day or
night. The Lord Nelson overlooks the
beautiful Public Gardens with
seventeen acres of lawns, flowers,
trees and a lake. It is also in a
convenient location close to the
shops and fine restaurants on Spring
Garden Road.
The Holiday Inn, just completed
last year, faces the green Commons
toward Citadel Hill. In addition to the
coffee shop and dining room, there IS
also an indoor swimming pool and a
popular nightclub.
St. Mary's University offers
accommodation for both families and
singles. Apartments consist of two
bedrooms, kitchen, living room and
bath and shower facilities. Each
bedroom is furnished with two single
beds, two desks, shelves, drawers.
and closet. All linens are supplied but
dishes and kitchen utensils are not.
There's no charge to pu1 your children
on air mattresses, if you run out of bed
space. Cribs are available at a small
rental charge.
Apartments
Rates
One day. , .
Two days...
Three days .
Four days
Five days...,.
One week
- .$30
. .. .$60
. .$90
.$110
.$125
.$135
Suites are divided Into double
and single rooms. Each room is
furnished with beds. desks, shelves,
drawers and closet space. Linens are
supplied. Bath and shower facilities
are provided for each suite. There are
no kitchen facilities, but meals are
available in the residence cafeteria on
an "à la carte-' or meall'lan basis.
Rates
Hotel Nova Scollan
Chateau Halifax
The Lord Nelson
Holiday Inn
Single
$31
$27
$20-$28
$30
Double or twin beds
$36
$33
$24-$34
$37
There's an indoor swimming
pool. mini-market, art gallery, and the
famed Burke-Caffney Observatory
where on a clear night you really can
see forever! St. Mary's is located in
the beautiful south end of Halifax,
only 10 minutes from the bUSiness
and shopping districts.
On receipt of your
pre-registration coupon and cheque.
you will be sent a hotel reservation
card, an admission card and
convention kit ticket, a receipt and
details on procedure for registration
Trdnsportation will be proVided to
and from the convention site and
hotel, but participants in the
convention must make their own
uavelar
ngemen
toHama
It's a good idea to pre-register!
Because of the interest
expressed in ttJe theme of the CNA
Convention and the popularity of the
speakers who will be appearing, the
convention coordinators strongly
advise that you pre-register with the
accompanying coupon, in order to
avoid unnecessary delays.
On-the-spot regIstration will begin
Sunday, June 20. at noon.
Further information concermng
speakers will appear In future issues
of The Canadian Nurse
Suites
Stopover at the CPHA
Convention!
"Changing roles in commumty
health" is the theme of the 67th
Annual Convention of the Canadian
Public Health Associallon, to be held
June 22-25 in Moncton, New
Brunswick (immediately following the
CNA meeting).
The format of this convention is
designed to involve the delegates
through panels and group
discussions. The topics chosen for
the scientific sessions are:
a) assessment of existing programs;
b) new members and new roles in
community health;
c) changing modes of delivery;
d) changes required in outlook. It is not
necessary to be a member of CPHA to
take part in these sessions.
The convention will be held at the
Beausejour Hotel and the UniverSity
of Moncton For more information,
contact CPHA, 55 Parkdale Avenue,
Ottawa, Ontario K1Y 1E5,
tel. (613) 725-3769.
Rates
Single
Double
Daily
$9
$15
2 days
$18
530
3 days
$27
545
4 days
$33
555
5 days
540
565
weekly
$45
$70
I ne l,8n80lan Nurse Marcn l
ro
".
Ralph Nader
w. O. Mitchell
--
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Ralph Nader and W O. Mitchell to appear at CNA convention!
At press time, CNA received confirmation that both Ralph Nader and W.O.
Mitchell will take part in the 1976 CNA convention in Halifax this June Nader,
who is internationally recogmzed as an ardent defender of consumer fights, WIll
address convention delegates In the Commonwealth room of the Hotel Nova
Scoftan on Monday morning. June 21, at 9:00 a.m. Following thIs address, he
will participate in an open forum for all CNA delegates.
Mitchell is a well-known Canadian author whose books include Who Has
Seen the Wind and The Vanishing Point He is scheduled to speak following the
opening ceremonies on Sunday night June 20th.
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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.
..... .....
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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.
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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.
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Style 131 PantSuit
Polyester/Nylon Corded Jersey
Knit-White Lace Trim
White-Blue- Pink- Yellow
Sizes 3.15 $30.00
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White-Blue- Yellow.lc
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Sizes 6-18 $28.:0
the
MJ
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sleeve
UNIFORMS
REGISTERED
778 KING ST WEST,
TORONTO, ONTARIO
M5V 1 N6
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THROUGHT CANJ.,...A
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46
The Canadian Nurse March 1976
'Vlltlt
S Ne\y
J..:j . .
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T- I
Q
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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
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Finest FOr'led Steel.
Guaranteed 2 yean.
LISTER BANDAGE SCISSDRS
3
H .......sew". Tiny. handy. sbp into
umform pocket or purse Choose lewelen
gmd Of gleaml" throme piat! finish
No. 3500 3 '/ 2'" Mini. . .. . . . . 2.75
No. 4500 4 1 '2'" size, Chrome only. . . 2.95
No. 5500 5 ' .'2- size. 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'
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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]
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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
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NI_ 111 O.ftJ Delu.. S....., 3 comPl,
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Nurses' POCKET PAL KIT
-..A..,
HaMliest lor bus)' nurns Includes wtnte T
Oelule Pocket Sa.-!r, With 5\'2" Lister Stlssors
(both sIIown abovel, Tr.-CoIOf ball"o,"1 pen,
plus handsome httle gen hght . all slaver
finished Chal1ge compartment ker chi.n
No. 291 Pal Kit. . . 6 50 .a.
Initials enlraw'ed on shears. add 5Oc.
\
.
'----'
TIMEX Pulsometer WATCH
Dep.ndabl. T,me. N",,",,' Pulsomer.r/C.,.....r Walch
Moveable outer ring computes pulse rate Date calen-
dar, ..M. numerals, sweep-second hand blue dool,
luminous, wtllt! strap_ Stainless back, water and ckIst.
resistant. Gift-bo.red, J fUr warrantee_ l.ib,ls .IJTI"I'
II Uck fl'!e.
No. 237761 Nurse.' Wllch , , .' J 7.95 ea,
PIN G U A R D .cull'lur'" caduceus, th.med
to your professional letters each With plnback,
safety catch 0, replace either with CYss pm Gokl
fimsh R.ft bo.ed Choose RN LPN or LVN
No. 3420 Pin GUlrd. . 2.95 '".
@) ENAMELED PINS Beaul.lully sculplured shlus
.. Insignia. 2-co1or keyed. hard-fired !namel on gold
\ ) (@) plot. D.m. sued pon-bat
Spec,f, RN, LPH, LVN, or
N I'ì NA D. coupon
t1 No. 205 Enam. Pin 1.95 ea.
- CiIJ
Bzzz MEMO-TIMER TIme hor I'ocks.
heat lamps, park meters Remember to chec" vital
iI:t
Signs. live medlCJtHm, etc. Lightweight. CÐmpiet ·
n
" dlaJ. sets to bun 5 to 60 mln Ke, flng
SWISS made . .,
No_ M-22 Timer. . . 6.95 ... ..
- -
'-. /
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,
........
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Free Initials and
Free Scope Sac_Ie with vour own
LittmaUÐ Nursescopef
famous Littmann nurses'
diaphragm slethoscope . . .
a fine precision instrumenl
with h'gh sensitivity for
blood pressures, apical pulse
rate. Only 2 OlS., fits in
pocket, with gray vinyl anti-
collapse tubong, non-chilling
epoxy diaphragm. 28" over-
all Non.rotating angled ear
tubes and chest piece beau. No. 2160 Nursescope
tifully styled in choice of 5 including Free
jewel-like colors. Goldtone. Initials and Sack
Silvertone, Blue, Green, Pink.' Duty Free 16.95 ea.
'1IiPORTAIIT, N... 'liedllI..." .lylona includes tubIng I. tolors 10 m.lch
met41 ø.arts_ " Msrred. add SI. ea to price above;
..... to Ord!r
....21601&0 ..._
fREE INITIALS AND SACK!
Your inlials engraved FREE on
chest piece, lend individual
dislinction and help prevent
loss. FREE SCOPE SACK neatly
carries and protects Hursl!-
scope. Heavy frosted vinyl. with
dust-proof press.type closure.
LITTMANN COMBINATION STETHOSCOPE
MaXimum sensitiVity from this fine protesslOl\ll Instrument C0n-
venient 22" ov!rall length. weighs only 3Y:J: 01. Chrorn! blnaurals
filed II corr!ct ang1e_ Int!fJ\Il spring. stainless chest pl<<e. ):J6"
diaphragm, 11/4" bell Removable non-thl!l sleeve Gra, vinyl tubing
Two imtials !ngr. on chest piece rr
[[ SCOPE SACM INCLUDED
No. 2100 Combo Steth .,.29.95 '". Duty Free
CLAYTON DUAL STETHOSCOPE
lIghlwe.gbl....1 scoøe II.ported from Japan; hig1lesl
sensitivity for aplul pulse rate. Chromed blnaurals.
cbesl p.ec. ...rn I.,." bell ond 1110" d.aphrll'".
Irey anb-collapse tubing 4 oz., 29" Ions: ú.tra
:
:::: d
1EhÉar
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8;!S CK)
No. 413 Dual Stelh .., 17.95 ea.
Q".y F.ee
LOW-COST STETHOSCOPE
Our lowest cost preciSion stethoscope I Smgle diaphragm n J.... dia t
ChoOse Blue. Gr!en. Red. Sliver or Gokl tubing and chestpl!C!. silver
blnaurals, only 3 02 Three initials enKraved free. FREE SCvPE SACI<
No. 4140 CII,. St.th . . . 11.95 ... Duty Free
,
NO. 149 Should.r
Baa.. . 32.95 ea.
NURSES SHOULDER BAG
Perfect for the visiting nurse l Combll'ts
convenience and smart stylll1g. wt1lle
avoiding the ris\, ..doctor's bag' took..
AdJustabl! shoulder straø. or carry in
hand Generous mSld! and outSide pockets
lor records. adjustable and fixed loops
Inside to hokt bottles tubes. Instruments,
etc In rich water rep!lIent vinyl sim
black leather. sturdy stitchll1g øokf fin-
ished hardware, lock clasø with key. Opens
widely for easy access fD c.ard holder on
.nd FREE ,..Ii.ls gold embossed 12
"
I 91,02" .. 5......._ Outstand,"I nJue'
l
MRS. R. F. JOHNSON
SUPERVISOR
)
1.
CHARLENE HAYNES
-
-MRS. \-\Olß. "--
" OHN.L.P.N.
1.
....
511
AI .... _ ...., .....
NURSES PERSONALIZED SPHYG.
Now in Fashion Colors!
A superb aneroid sphYI espK.allr df'sIgntd
lor nurses b, R!lster. precIsion craftsm!n
In W GermMl)' filSY to-aUach Vekro. curl
hght"!lpt. compact. fits Into soft sim
Jra"'Ie'r lippe' &.1St 2
" I"" .1" Oul
cahbr,ted to 320mm . lo-year accuracy
lu
'antud 10
3m,"_ SerYlced by
Reev!s If eV!r required Your Inltl,ls
rng"vt(lon INnometer and eo1d
slamped ... u.. FREE C...... BLACK
wlll1 chrome metal manorn!ter or
BLUE GREEN or BEIGE ...Ih pl"I'"
mana housln& tubing cuft and c
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all colot-coocdl
ted (spKlfy on coupon)
No. ID6 Sphyg".. 39.95 e..
Duty Free
....
....
..
;-
BLOOD PRESSURE SET
An out......,ng aneroMl sph,R made
In J.".an especilll, for Renes. Meets
all US Gov. spKs, :!:3nvn accuracy.
'IIOranleed 10 years. Black ond
throme INnomet!r. cal to 300mm
Velcro" Fe, cuft. black !ubinl. soh
e
."
Se
n5
,; ;
:;he="
:....
:
,.duded!see pholo l.ftJ FREE aold
Inlbals Of! case. Here is I sensibl!.
pracl,ul. dependobl.
il ....' nglll
tor every nurse!
NO. 41-100 B.P. S.t...
- Duty Free 33.95selcompl.t.
Sphyg. onl, No. lOB .26.95 IIith case
{)
CAP ACCESSORIES
CAP TOTE
eeps,..,r cops tnSI' Ind tI... - d
flellble clur plastic, .mile trrm. llþper carry,", l ......... -
-.
.Ir..., hlna loop. Stores fl.t Also for "'glets .
curl.rs, .11: Iy"" dia. 6" hIgh ....--
No. 333 Tote... 2.95 ea. '
Gold init.ldd 50,.
'-_
WHITE CAP CLIPS Holds t.p.
..........
hrmly In place I H....d-to-find .tllt! bobble pins.
" enamel on fin! Sþl'ing steel Seven r and fwr
...... .... chps Included In plastIC snap box
" A
No. 529 Clips 85c per bet. (mm. 3 boxes)
MOLDED CAP T
CS --
R!place cap band Instantly Tinr plastic taco dainty Äiiíi!
CålCtus Choose Black. Blue. Whit! or Crntal with
1
Gold Cacb::eus. The nNt!r wa, to fasten bands. :... __
Iì No. 200 - S.t of 6 Taos - .
W "'r ...1.25perset .. -
.i'1 METAL CAP TACS Pair of dlint,
n
lewelry-quallty bcs With II'IPP!rs. h
lds cap
e.t"I.1J
O;:::. S
u!el
td
= ::...tpf.'fV:,
ßm) Caduceus or Plain Caduceus Gift boxed
No. CT'IISp.cify Init.).... .No. CT-3 (RN
Cld.J . . No. CT.2IPllin Cld.). . . 2.95 pro
""-
TO: REEVES CO., Box 719- C, Attleboro, Mass. 02703
DROER ND. ITEM CDLDR QUANT. PRICE
---I
Use extra sheet for additional items or orders
.
.
I
. INITIALS a. desired, _ _ _
I TD DRDER NAME PINS, f,n out all informatIon in box, tOP
left, clip out and attach to thIs coupon.
Please add 50
handting/postal'
J enclose S I on orders tot..1l1ine under $5.00
No COO's or billing to individuals. Mass. residents add 3% S 1.1
I
.
Send to .
Street
City .
Stat.
ZIP
50
The Canadian Nurse March 1976
Stimulate
student Interest
and, arousp
classroom curiosity
mlth these oem texts
JIEDIf \ L S[ RGIC \L
New 3rd Edition!
NURSING CARE OF THE CANCER PATIENT
In this new edition, aspects of prevention, detection,
diagnosis, therapy, rehabilitation, and terminal care of
the cancer patient are discussed in depth. Related
pathology is presented in each chapter to illustrate how
normal physiologic processes are altered and how
nursing measures are adapted to meet the needs of each
individual. Suggested references found at the conclu-
sion of each chapter direct student interest to additional
resources.
By Rosemary Bouchard, A.B., A.M., Ed.D., R.N. and Norma F.
Owens, A.B., A.M., Ed.D., R.N. July, 1976. 3rd edition, approx. 320
pages, 7" x 10", 186 illustrations. About $9.45.
New 2nd Edition!
GASTROENTEROLOGY IN CLINICAL NURSING
Providing students with a clear, practical guide for care
of patients with common gastrointestinal disorders, this
book features important nursing aspects that include:
normal anatomy and physiology: pathogenesis; clinical
manifestations: specific diagnostic measures; and prin-
ciples of medical/surgical therapy. This broad approach
will help students in the future to better plan, administer,
and eval uate comprehensive care.
By Barbara A Given, R.N., B.S.N., M.S. and Sandra J. SImmons,
R.N., B.S.N., M.S. June, 1975. 2nd edition, 316 pages plus FM
I-XIV, 7" x 10", 70 illustrations. Price, $9.40.
New 2nd Edition'
REVIEW OF HEMODIALYSIS FOR
NURSES AND DIALYSIS PERSONNEL
The discussions in this newly revised edition reflect the
rapid expansion, new standards and programs, and new
equipment available in the field of hemodialysis. The
convenient question-and-answer format has been ex-
panded extensively to facilitate student learning. Such
common and perplexing problems as sexual dysfunc-
tion, rehabilitation, and discontinuance of treatment are
thoroughly investigated. An enlarged glossary com-
pletes this outstanding work.
By C. F. Gutch, M.D. and Martha H. Stoner, R.N., M.S. June, 1975.
2nd edition, 260 pages plus FM I-XVI, 5W' x 8W', illustrated.
Price, $8.95.
New 3rd Edition!
THE PROCESS OF PATIENT TEACHING IN NURSING
In this new updated and expanded edition, the
importance of the nurse's role in patient education is
emphasized. Organized around the teaching-learning
process, chapters explore: patient's bill of rights; social
leaming; behavioral objectives and educational tools;
delivery and development of patient education; informa-
tion processing and experientialleaming; and planning
and implementing. Throughout, excellent illustrations
and tables depict teaching strategies.
By Barbara Klug Redman, R.N., B.S.N., M.Ed.. Ph.D. July, 1976.
3rd edition, approx. 256 pages, 7' x 10", 25 illustrations. About
$8.15. .
The CanadIan Nurse March 1976
51
Fl 'D \JIE'T \LS B \SIC S('IE'CE
New 3rd Edition!
CLINICAL NURSING TECHNIQUES
This text is a precise guide to the basic techniques used
in medical/surgical nursing. Authoritative discussions
and excellent illustrations demonstrate procedures in a
step-by-step sequence. Principles and purpose are
emphasized - encouraging adaptation, modification of
techniques, individualization and self-learning. New
topics discuss: use of sterile disposable gloves, heel and
elbow protectors, commercial restraints blow bottles,
Asmastik unit. and MA-1 respirator.
By Norma Dison, R.N., B.A., M.A April. 1975. 3rd edition, 390
pages plus FM I-X, 7" x 10",691 illustrations. Price, $9.20.
New 2nd Edition!
BODY FLUIDS AND ELECTROLYTES:
A Programmed Presentation
Student-oriented, this useful self-teaching manual pres-
ents basic principles of normal body fluid and electro-
lytes, common abnormalities, and clinical application.
Key concepts of anatomy, physiology, and chemistry are
clearly related to each area. Information is given in
sequence proceeding from simple to complex. Com-
prehensive summaries and review questions conclude
each chapter and illustrations have been redrawn to
accurately depict content material.
By Norma Jean Weldy, R.N., B.S., M.S. April. 1976. 2nd edition.
approx. 120 pages. 7" x 10",24 illustrations. About $6.25.
New 2nd Edition!
THE COMPOSITION AND FUNCTION
OF BODY FLUIDS
Provide your students with a text that offers a basic
understanding of essential cell function and principles of
body fluids in an effective and efficient manner. This
book examines the role of body fluids in maintaining
health and ways in which deviations in their quantity and
composition can affect the well-being of patients.
Changes reflecting new information include a new
section that contains valuable data on blood clotting.
By Shirley R. Burke, B.S.N., M.S.N.Ed. April, 1976. 2nd edition,
114 pages plus FM I-XIV, 6V2 w x 9 1 2".24 illustrations. Price, $5.25.
A New Book!
THE NURSING PROCESS: A Scientific
Approach to Nursing Care
This comprehensive text presents a compilation of
various theoretical concepts of the four phases of the
nursing process: assessment, planning, implementation,
and evaluation. This is the first book of its kind to provide
such detailed information for effective nursing interven-
tion. Author introductions before each group of readings
feature an analysis of each phase including the concepts
discussed.
By Ann Marriner, R.N.. Ph.D. June, 1975.242 pages plus FM I-XIV,
6Y2" x 9W', illustrated. Price, $7.10.
A New Book!
NURSE-CLIENT INTERACTION:
Implementing the Nursing Process
This new book offers students a single source for
inclusive information on self-communication and inter-
personal relations. Psychodynamics and sociological
concepts have been compiled from primary theorists and
current research and adapted exclusively to the nursing
process. Relevant topics explore; dynamics of self-
growth; nurse-client relationship; communication and
more. A summary describing practical application ofthe
theories presented concludes this highly useful text.
By SandraJ. Sundeen, R.N., M.S.; Gail Wiscarz Stuart, R.N., M.S.;
Elizabeth DeSalvo Rankin, R.N., M.S.; and Sylvia Parrino Cohen,
R.N.. M.S. April. 1976. Approx. 240 pages, 7" x 10", 38 illustra-
tions. About $7.90.
New 7th Edition!
AN INTRODUCTION TO PHYSICS IN NURSING
As in previous editions this book continues to provide
nursing students with a basic knowledge of the concepts
and principles of physics as they apply to nursing
procedures. Fundamental physics are applied to patient
care, therapeutic procedures, and currently used
equipment. Up-to-date material examines: metric sys-
tem: use of radiation in the preservation of food; effects of
indoor lighting on calcium metabolism; educating the
public on the energy crisis; and brain pacemakers.
By Hessel Howard Flitter, R.N., Ed.D.; with a contribution by
Harold R. Rowe, R.N.. M.S. May, 1976. 7th edition, approx. 320
pages, 7W' x 10Y2", 180 illustrations. About $8.95.
New 9th Edition!
INTRODUCTION TO PHYSIOLOGICAL
AND PATHOLOGICAL CHEMISTRY
Student-oriented, the new edition of this popular text
clearly delineates the principles of chemical reactions
and their relationships to clinical medicine. The flexible
two-part format first outlines basic concepts of physical
and organic chemistry and then examines the role of
biochemistry in human physiology. Chapters have been
updated and the Appendix contains a revised table of
atomic weights and numbers.
By L. Earle Arnow, Ph.G., B.S., Ph.D., M.B., M.D. January, 1976.
9th edition, 492 pages plus FM I-XXII, 7" x 10",225 illustrations.
Price, $12.55.
New 9th Edition! INTRODUCTION TO LABORATORY
CHEMISTRY. By L. Earle Arnow, Ph.G., B.S., Ph.D., M.B.,
M.D. January, 1976. 9th edition 102 pages plus FM I-XVI,
5W' x 8W', 43 illustrations. Price, $4.50.
52
The CanadIan Nurse March 1976
FI 'D \. lIE'T \LS/
B \SIC S('IE
("E
A New Book!
MOSBY'S FUNCTIONAL ANATOMY:
A Practical Handbook
Prepared in consultation with leading authorities, this text
is specifically designed for students in the health
sciences. In a large format containing full color artwork,
this atlas provides an excellent tool for students to
explore and learn about human anatomy. By region, body
systems are individually illustrated in normal states as
well as abnormal and diseased conditions. A com-
prehensive glossary of key anatomical terms clarifies
important information.
Prepared in consultation with 11 leading educators in nursing
and medicine. January, 1977. Approx. 72 pages, 8Y2" x 11", 64
pages of full color illustrations. About $7.35.
New 12th Edition!
ROE'S PRINCIPLES OF CHEMISTRY
The new edition of this classic text continues to relate
principles to practice in its thorough coverage of the
essential areas of inorganic and organic chemistry, and
biochemistry. Plus, greater emphasis focuses on: metric
system, molecular and atomic structure, and recent
discoveries in biochemistry. New illustrations, tables,
and an appendix provide additional learning tools.
Throughout, material is written in a simple and uncompli-
cated style to encourage classroom learning
By Alice Laughlin, B.S., M.S., Ed.D. March, 1976. 12th edition,
approx. 464 pages, 6
" x 9
", 122 illustrations. About $12.55.
New 7th Edition! ROE'S LABORATORY GUIDE IN
CHEMISTRY. By Alice Laughlin, B.S., M.S., Ed.D. March,
1976. 7th edition, approx. 216 pages, 5W' x 8W', 47
illustrations including 2 color plates About $6.80.
11-\ TER' \.L & ('H ILD
HE.\LTH
New 2nd Edition!
THE PEDIATRIC NURSE PRACTITIONER;
Guidelines for Practice
A concise guide for the preparation of pediatric nurse
practitioners, this new edition increases emphasis on the
process of assessment and treatment. Topics extensively
examine. the nurse's expanding role; explanation of
various screening tests and assessment guides; descrip-
tions of clinical problems; and psychodynamics of the
child and society. New contributions from nurses include
chapters on neonatology, hematology, parasitology,
school health, and the art of working with parents.
By Fernando J. deCastro, M.D., M.P.H., F.A.A.P., FAP.H.A.;
Ursula T. Rolfe, B.A., M.D.. F.A.A.P.; and Janice Kocur Drew, R.N.,
B.S., P.N.P. March, 1976. 2nd edition. 212 pages plus FM I-VIII,
6" x 9", 8 illustrations. Price, $6.90.
New 2nd EdifÌon!
HIGH RISK NEWBORN INFANTS: The Basis
for Intensive Care
This book allows student nurses to keep up-to-date with
recent developments in nursing care of high risk infants
and the application of procedures. Specific methods are
discussed in depth to further the quality of patient
treatment. Chapters investigate: the fetus, consequences
of abnormal labor and delivery, evaluation and man-
agement after birth, thermoregulation, neonatal examina-
tion, perinatal care, metabolic disorders, maternal-infant
relationship, and the relationshir:; of birthweight to
gestational age.
By Sheldon B Korones, M.D. May. 1976. 2nd edition, approx. 288
pages, 7" x 10", 113 illustrations. About $11.00.
\D'I''''STR \ TIO'
A New Book!
DECISION MAKING IN NURSING:
Tools for Change
Concerned with the multidimensional aspects of health
care issues, this book provides practical tools to solve
complex patient care and management problems.
Material presented prepares students for leadership
roles and outlines responsibilities as future problem
solvers, decision makers, and change agents. To bridge
the gap between theory and practice, actual case studies
are examined and a systems model for problem solution
is developed.
By June T. Bailey R.N.. Ed.D. and Karen E. Claus, Ph.D.; with 4
contributors. May. 1975. 168 pages plus FM I-XII, 7" x 10, 63
illustrations. Price. $7.30.
A New Book!
NURSING ADMINISTRATION: Theory for
Practice With a Systems Approach
This practical new text synthesizes theories of business
management, behavioral science and scientific thought
into a cohesive conceptual basIs for practice in the
nursing administration field. Using a new general
systems frame of reference, cogent discussions demon-
strate theory in terms of setting objectIves, planning,
organizing, directing and controlling. Specific subjects
include: environments; evaluation and measurement;
change; interdepartmental relations, allocation of human
resources and funds; and much more!
By Clara Arndt. R.N., M.S. and Loucine M Daderian Huckabay,
R.N.. B.S., M.S., Ph.D. August, 1975. 292 pages plus FM I-XVI,
7" x 10', illustrated. Price, $12.55.
A New Book!
NURSING SERVICE ADMINISTRATION:
Managing the Enterprise
This valuable new text teaches nursing administration
functions at all levels. Firmly rooted In classical
administrative theory, the book offers a solid foundation
of knowledge from which to identify strengths and
weaknesses in administration and to deal with them
effectively. It encourages efficiency, completeness and
economy, and at the same time gives cohesiveness and
order to the task of providing nursing services. Planning,
organi.zing, staffing, directing, controlling, coordinating,
reporting, budgeting. public relations, research and
creativity, and more - all are closely examined.
By Helen M. Donovan, R.N.. M.A. October. 1975. 272 pages plus
FM I-XII, 7" x 10", illustrated Price, $7.10.
A New Book!
MANAGEMENT OF PATIENT CARE SERVICES
This new book is the first programmed text on the
management of patient care services. It provides a theory
of nursing management and a wealth of practical
information to help students and practicing nurses meet
the demands of constantly changing patient care
services Concise discussions explain how to. plan and
manage budgets: organize efficient departments with
established job roles and performance standards: make
decisions and set priorities; develop in-service educa-
tion programs; improve communication, evaluate and
control; and implement personnel policies. In addition,
all aspects of primary care are carefully detailed.
By Russell C. Swansburg, R.N. May, 1976. Approx. 432 pages,
7" x 10',4 illustratIons. About $11.50.
The CanadIan Nurse March 1976
53
PR \l'Tlf \1.. 'l RSI'(
New 4th Edition!
TOTAL PATIENT CARE:
Foundations & Practice
Fully updated and expanded, this important text
encompasses all areas of medical-surgical nursing The
authors offer in-depth Information on principles of
effective medical-surgical care, techniques for their
application in many clinical situations, and specific
guidelines for nursing care of patients with diseases and
disorders of various body systems. Emphasizing
pathophysiology, this new edition includes new material
on microbiology, pathology, intravenous solutions,
shock. blood, cardiac monitoring, and more. A percep-
tive new chapter on "Death and Dying" highlights the
text.
By Dorothy F. Johnston, R.N.. B.S., M.Ed. and Gail H Hood R N
B.S. M.S. February, 1976. 4th edition, approx . 672
ages'
7" x 10",311 illustrations. About $11.50.
New 4th Edition! MEDICAL-SURGICAL NURSING:
Workbook for Practical Nurses. By Dorothy F Johnston,
R.N., B.S., MEd. and Gail H. Hood, R.N. B S., MS.
February, 1976. 4th edition, approx. 224 pages,
7%" x lOW'. 18 illustrations About $6.05.
New 5th Edition!
STRUCTURE AND FUNCTION OF THE BODY
Now in a revised 5th edition, this popular text presents
fundamental information on the body structure and
function. It clearly indicates the relationship between
normal and abnormal structure. and links normal
anatomy and physiology to various laboratory tests.
treatments, and nursing procedures. Three new chapters
discuss cells, tissues, organs and systems; fluid and
electrolyte balance; and acid-base balance Swdents
will welcome expanded and revised information on the
nervous system, separate chapters on the male and
female reprQductive systems, and new illustrations and
tables. Complete, summarizing outlines, review ques-
tions, and a glossary are included to facilitate learning.
By Catherine Parker Anthony, R.N., B.A., M.S. and Irene B. Alyn.
R.N., Ph.D. April, 1976. 5th edition. approx. 240 pages 8' x 10",
118 illustrations with 31 figures in color. About $8.15.
IVIOSBV
TIMES MIRROR
THE C V MOSBY COMPANY l TO
86 NORTHLINE ROAO
TORONTO. ONTARIO
M48 3E5
54
The Canadian Nurse March 1976
Lil))-al-Y (J))(ltlte
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
pl.blisher.
Books and Documents
1. American Nurses' Association.
Accreditation of continuing education
in nursing. Kansas City, c1975. 69p.
2. -. Accreditation of continuing
education programs in nursing: State
nurses associations. . . Kansas City,
c1975. 44p.
3. -. Report on the survey of salaries
of nursing faculty and administration
in nursing educational programs,
December 1973. Kansas City, Mo.,
1975. 117p.
4. Andreoli, Kathleen G.
Comprehensive cardiac care: a text
for nurses, physicians, and other
health practitioners, by . . . et al. 3ed.
St Louis, Mosby, c1975. 357p.
5. Archuleta, Michael J. Sudden
infant death syndrome: an annotated
bibliography for the layman, by. . .
and Alyce J. Archuleta, San Diego,
Calif., Current Bibliography Series,
1975. 69p.
6. Becker, WesleyC. 1928- Teaching
2: cognitive learning and instruction,
by . . . et al. 2ed. Chicago, Science
Research Associates, c1975. 263p.
7. Bellak, Leopold 1916- The best
years of your life; a guide to the art and
science of aging. New York,
Atheneum, 1975. 297p.
8 Berni, Rosemarian 1925-
Problem-oriented medical record
implementation: allied health peer
review, by . . . and Helen Readey. St.
Louis, Mosby, c1974. 183p.
9. Bourgeois, Pierre. L'infirmière et Ie
pneumologue. Paris, Expansion
scientifique française, c1975. 143p.
10. Braestrup, Carl Bjorn 1897-
Manual on radiation protection in
hospitals and general practice, by .
and K.J. Vikterlóf. Geneva, World
Health Organization, 1974. 1v.
11. Bretz, H. Lee. Donny and
diabetes; an educational guide for
children with diabetes. Vancouver.
Tad, 1974. 55p.
12. Brown, Wilfred J. The impact of
federal financial support on
elementary and secondary education
in Canada. Ottawa, Canadian
Teachers' Federation. 1974. 284p.
13. Capuzzi, Cecelia F. Blood
transfusion reactions and
complications: a programmed text.
New York, Tiresias, c1975. 64p.
14. Caribbean Community
Secretariat. The Caribbean
community: a guide. Georgetown,
Tobago, BW.I., 1973. 111p.
15. Clark, Jill. Time out? A study of
absenteeism among nurses. London,
Royal College of Nursing and National
Council of Nurses of the United
Kingdom, c1975. 68p.
16. Clark, Nancy Fairchild. Normal
conduction system and the
electrocardiogram; a programmed
instruction unit. Philadelphia, Davis.
c1975.81p.
17. Cloutier, Jean. L'ère d'EMEREC
ou la communication
audio-scripto-visuelle à /'heure des
self-média. 2ed. Montréal, Les
Presses de I'Université de Montréal,
1975. 257p.
18. Coffey, Lou. Modules for
independent-individual learning in
nursing. Philadelphia, Davis, c1975.
389p.
19. -. Modules for learning in
nursing: life cycle and maternity care.
Philadelphia, Davis, c1975. 183p.
20. Crocker, Elizabeth J. Child life
programs in the Maritime Provinces: a
study of the non-medical needs of and
future directions for hospitalized
children. Halifax, Atlantic Institute of
Education, 1974. 62p.
21. Dong, Collin H. New hope for the
arthritic, by . . . and Jane Banks. New
York, Thomas Y. Crowell, c1975.
269p.
22. Dussault, René. Reform of the
professions in Quebec, par. . . et
Louis Borgeat. Québec (ville), Office
des Professions, 1975. 71 p.
23. French, Ruth M. Guide to
diagnostic procedures. 4ed. New
York, McGraw-Hili, c1975. 369p.
24. Gingras, Gustave. Combats pour
la survie. Paris, Éditions Robert
Laffont, Opéra Mundi, c1975. 382p.
25. Grummett, J.R. Directory and
index of safety and health legislation
for Canada. Prepared for The Labour
Safety Council of Ontario. Toronto,
Ministry of Labour, 1974. 162p.
26. Health care dimensions. Editor,
Madeleine Leininger. Fall 1974 -
Spring 1975. Philadelphia, Pa., Davis,
1974-1975.2v.
27. Health care for seniors.
Instructor's guide. 1 ed. Ottawa, St.
John Priory of Canada Properties,
c1975. 90p.
28. International Consultative
Conference of Health Workers
Unions, Moscow, Oct. 21-23, 1975.
Reports presented. 1 v. (various
pagings)
29. Jones, R. Kenneth. Sociology in
medicine, by, . . and P.A. Jones.
London, English Universities Press,
c1975. 222p.
30. Krathwohl, David R. Taxonomie
des objectifspédagogiques. Tome 2:
domaine affectif, par. . . Benjamin S.
Bloom et Bertram B. Masia. Traduit de
I'américain par Marcel Lavallée.
Montréal, Éducation Nouvelle, 1970,
c1964.231p.
31. Kübler-Ross, Elisabeth. Death:
the final stage of growth. Englewood
Cliffs, N.J., Prentice-Hall, c1975.
175p.
32. Lee, Betty. Lutiapik.. Toronto,
McClelland and Stewart, c1975. 237p.
33. Littman, David. The
electrocardiogram. New York,
American Heart Association, c1973.
81p.
34. Morrissey, George I
Management by objectives and
results. Don Mills, Ont.,
Addison-Wesley, c1970. 164p.
35. National League for nursing.
Council of Hospital and Related
Institutional Nursing Services.
Infection control. Papers presented at
a workshop conducted by CHRINS in
cooperation with The ALA Nursing
Department at NLN, New York, March
1975. New York, c1975. 52p. (NLN
Pub. no.20-1582)
36. Nicholson, Gerald W.L. Canada's
nursing sisters. Toronto, Samuel
Stevens, Hakkert, c1975. 272p.
37. Nursing Digest 1975 review of
medicine & surgery, ed, by Eileen
Callaghan Hodgman. Wakefield,
Mass., Contemporary Publishing,
c1975. 183p.
38. Patient care standards, by Susan
Martin Tucker et al. St. Louis, Mosby,
1975. 420p.
39. Phibbs, Brendan Pearse 1916-
The human heart; a guide to heart
disease, by. . . with contributions by
Lane Craddock et al. 3ed. St. Louis,
Mosby, c1975. 280p.
40. Planning and evaluating nursing
care; a Journal of nursing
administration reader. 1 ed.
Wakefield, Mass., Contemporary
Publishing, c1974. 48p.
41. Purtilo, Ruth B. Essays for
professional helpers: some
psycho-social and ethical
considerations. Thorofare, N.J.,
Charles B. Slack, Inc., c1975. 153p,
42. Registered Nurses' Association
of Ontario. A manual for team nursing.
Toronto, 1975. 130p.
43. Samson, Jean-Marc. L 'éducatiofi
sexuelle à /'école. Montréal, Guérin,
1974. 327p.
44. Secondi, John J. For people who
make love: a doctor's guide to sexual
health. New York, Taplinger, c1974,
1975. 190p.
45. Smart, Reginald G. Drug
education: current issues, future
directions, by. . . and Dianne Fejer,
Toronto, Addiction Research
Foundation of Ontario, c1974. 112p.
(Its Program report series no.3)
46. Staff development; a reader
consisting of nineteen articles
especially selected by The journal of
nursing administration editorial staff.
1ed. Wakefield, Mass., Contemporaf)
Pub., c1975. 91p.
47. Staffing 2; a reader consisting of
nine articles especially selected by
The journal of nursing administration
editorial staff. Wakefield, Mass.,
Contemporary Pub., c1975. 47p.
48. Techniques of nursing
management; a reader consisting of
nine articles especially selected by
The journal of nursing administration
editorial staff. led. Wakefield, Mass.
Contemporary Pub., c1975. 47p.
49. Travis, Luther B. An instructional
aid on juvenile diabetes mellitus. 3ed.
Galveston, Texas, UniversityofTexas
Medical Branch, 1973, c1969. 124p.
The Canadian Nurse March 1976
55
.50. Wilson, Michael. Health is for
Jeople. London, Darton, Longman &
Todd, 1975. 134p.
J51. Women of Canada; their life and
'Vork, compo by the National Council of
Nomen of Canada for distribution at
he Paris International Exhibition
1900. Ottawa, Reprinted by National
I
uncil of Women of Canada 1975.
1442p. R
52. Workshop Conference on the
Quality of Care and Medical
Education, Ottawa, April 25-26, 1974.
;Papers presented at conference
co-sponsored by the Association of
'Canadian Medical Colleges. The
IColiege of Family Physicians of
!Canada. and The Royal College of
!Physicians and Surgeons of Canada
I Ottawa, 1974. 9 pts. in 1.
53. World Health Organization.
,Promoting health in the human
environment. A review based on the
technical discussions held during the
Twenty-seventh World Health
Assembly, 1974. Geneva, 1975. 69p.
54. Yudelman, John. The national
context. A report on government
programs concerning the elderly.
Toronto, Pensioners Concerned
(Canada) Inc., 1974. 109p.
Pamphlets
55. Action on Smoking and Health
Ltd. A survey of the smoking habits of
student nurses, Nov. 71 - Sep. 72.
London, 1971. 2p.
56. American Academy of Nursing.
Papers presented at the annual
meeting. Kansas City. Mo., American
Nurses' Association, 1975. 1v.
57, American Nurses' Association.
Accreditation of continuing education
in nursing: colleges and universities.
Kansas City, c1975. 31p.
58 -. Accreditation of continuing
education programs preparing
nurses for expanded roles Kansas
City, c1975. 35p.
59 Association of Registered Nurses
of Newfoundland. Manual of approval
procedures and criteria for the
evaluation of schools of nursmg in
Newfoundland. St. John s,
Newfoundland, 1975. 17p.
60. Basic Systems Inc.
Administration des medicaments
vaso-constricteurs par voie
intra-veineuse. Québec (ville),
Corporation des Infirmìères el
Infirmiers de la Région de Québec,
rive-nord, Comité d ÉducatlOn, Amer.
J. Nurs. Co., 1965. 40p.
61. Bregman, Sue. Sexuality and the
spinal cord mjured woman:
guidelines concerning feminity,
social, and sexual adjustment.
Designed for physically disabled
women and health professionals who
work with them. Minneapolis, Minn.,
Sister Kenny Institute, c1975. 24p.
62. Canadian Teachers' Federation.
Teaching in Canada. Ot1awa,
Canadian Teachers Federation,
1974.30p.
63. Cantor, Marjorie Moore, ed. The
JCAH Standards: a Journal of nursing
administration reader, edited by
Marjorie Moore Cantor, 1 ed.
Wakefield, Mass., Contemporary
Pub., c1974, 45p.
64. Commonwealth Nurses
Federation. Report by Executive
Secretary for period 1973-1975.
London, 1975. 9p.
65. Conference on the Clinical Nurse
Specialist in Ontario. Geneva Park,
Lake Couchiching, Nov.3-6, 1974.
Report. Toronto, Re'listered Nurses'
Association of Ontario, 1975. 17p.
66. Connor, Desmond M. Citizens
participate: an action guide for public
issues. Oakville, Ont., Development
Press, c1974. 64p.
67. Corporation professionnelle des
médectns du Quebec. Code de
deontologie medica/e: actes
derogatolfes a rhonneur et a la dignite
professionne/s. 2ed. Montréal, 1975.
15p.
68. Davis, Carolyne K. Relation of
university preparation to nursing
practice. New York National League
for NurSing Dept 01 Baccalaureate
ana Higher Degree Programs, c1975.
14p. (NLN Pub. no.15-1583) (League
Exchange no. 1 08)
69. Hawkins, Jim. The complete
1975-76 paste-up guide to
faster-better ads and pages. A
handbook for trainees, journeymen,
students, supervisors in the
techniques of paste-up, by . . . and
Dorsey Biggs. Akron, Ohio, Portage,
c1975.40p R
70. League of Red Cross Societies
Nursing and community health.
Geneva, 1974, 15p.
71. Llgue des Sociétés de la
Croix-Rouge. Soins infirmiers et sante
de la communaute. Genève. 1974.
16p.
72 Lussier, Rita J. Professional
development 1973/74-1975/76.
Quebec, Order of Nurses of Quebec.
1974-1975. 3v R
73. -, Perfectionnement
1973/74-1975/76. Québec, Ordre
des infirmières et inhrmiers du
Québec, 1974-1975. 3v. R
74. Mather, June. Make the most of
your baby. Arlington, Texas, National
Association for Retarded Citizens,
1974. 24p.
Tropical
and
Parasitic
Diseases
75. National League for Nursing.
Schools of nursing - RN-LPN/LVN
1974-75. New York, National League
for Nursing, 1974. 39p. R
76. -. Biennial Convention, New
Orleans, May 18-22, 1975.
Accountability - a challenge to
educators. Papers presented at an
open forum at the 1975 NlN
Convention, New Orleans. National
League for Nursing. Dept. of Dipfoma
Programs. New York, c1975. 21p.
(NLN Pub. no.16-1594)
77. -, Dept. of Hospital and Related
Institutional Nursing Services. Four
approaches to staff development.
Papers presented at CHRINS meeting
during the 1975 NLN Convention. New
Orleans. Louisiana New York, c1975
15p. (NLN Pub. no.25-1578)
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 the 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 below, or telephone (416) 494-8900.
j iiW SENECA COLLEGE
OF APPLIED ARTS AND TECHNOLOGY
"'" 1155 SHEPPARD AVENUE EASI WILLOW DALE ONfARIO Ml.. l(l
56
The Canadian Nurse March 1976
..J I) '-il'- JJ ['"1)(1 il i___
78. - Council of Home Health
Agencies and Community Health
Services. Yearly review - 1974.
Some statistics on community health
services. New York, 1975. 42p. (NLN
Pub. no.21-1590)
79. -. Division of Nursing. The cost
of nursing education' a preliminary
report on methodological problems.
Panel discussion presented at an
open forum at the 1975 NLN
Convention, New Orleans, New York,
c1975. 35p.
80. -. Division of Research. Nurse
- faculty census 1974. New York,
c1975. 18p. (NLN Pub. no. 19-1548)
81. Ontario Hospital Association.
Competency model for registered
nurses. Memo to all directors of
nursing service O.H.A. member
hospitals, Aug.21, 1975. Don Mills,
Ont.. 1975. 6p.
82. Ordre des infirmières et infirmiers
du Québec Évaluation de la qualité et
Ie nursing. Montréat, 1975. 36p.
83. -. Inspection profession nelle,
programme: mecanismes
administratifs. principes directeurs.
Montréal 1975. 13p.
84 Professional Corporation of
Physicians of Quebec. Code of
medical ethics: acts derogatory to the
honour and dignity of the profession.
2ed. Montreal, 1975. 15p.
85. Ramström, Lars M. A national
smoking control programme:
condensed English version of a report
of an advisory committee to the
Swedish National Board of Health and
Welfare, by . . . et al. Stockholm,
Natiooal Smoking and Health
AssoCIation. 1973. 37p.
86. Registered Nurses' Association
of Nova Scotia. Folio of reports, June
1975. Halifax, 1975. 12p. R
87. Registered Nurses' Association
of Ontario. The altered work week in
nursing services. An annotated
bibliography. Toronto, 1975. 25p.
88 Saskatchewan Association on
Human Rights. Position paper on
health care Regina. 1974. 18p.
89 Seah Stanley K.K. Health guide
for travellers to warm climates.
Toronto, Canadian Public Health
Association. 1975. 49p.
90 Spraggon, Eileen. Urinary
diversion stomas: a guide for patients
and nurses. 2ed. Edinburgh, Churchill
Livingstone, c1975. 41 p.
91. Thibault, Danyelle. Contrôle de la
fécondité. Présenté à Carrefour 75,
Année Internationale de la Femme,
Université Laval, Pavilion de Koninch,
30,31 mai et 1er juin, 1975. Québec
(ville), Conseil du Statut de la Femme.
34p.
92. Trémolières, Jean. Obésité: faits
et méfaits. Toronto. General Foods,
n.d. 20p.
93. United Nations. Conference on
Human Settlements, Vancouver.
1976. Habitat information for
N.G.O. 's. Ottawa, Canadian NGO
Participation Group, 1975. 1 v.
(various pagings)
94. University of Wisconsin.
Extension Health Sciences Unit. Dept.
of Nursing. Reading to keep up with
nursing. Madison, WI., 1975. 20p.
95. There were giants In the land. An
historical review of the Registered
Nurses' Association of Ontario,
1925-1975. Toronto, Registered
Nurses' Association of Ontario, 1975.
16p. R
96. Weller, G.R. The politicization of
health services in Canada. Thunder
Bay, 1975. 42p. .
97. Western Nurse-Midwives
Association. The concept of special
interest groups in relation to the
nursing associations. A discussion
paper prepared by . . . for submission
to The Board of Directors of the
Canadian Nurses' Association, 1975.
12p.
98. -. Constitution and by-laws.
Edmonton, 1974. 9p. R
99. WHO Study Group on the
Planning of Schools of Medicine.
Geneva, 10-16 Sep. 1974. The
planning of schools of medicine.
Report. Geneva, World Health
Organization, 1975. 43p. (World
Health Organization. Technical
Report series. no.566)
100. World Health Organization.
Education and treatment in human
sexuality; the training of health
professions. Report of a WHO
meeting. Geneva. 1975. 33p. (World
Health Organization. Technical
Report no.572)
101. -. Western Pacific Region.
Technical Advisory Committee on
Nursing. Report of a meeting. Manila,
Philippines, 10-12 Dec. 1973. Manila,
Philippines, 1974. 28p.
102. Wynn, Margaret. Nutrition
counselling in the prevention of low
birth-weight, by . . . and Arthur Wynn.
. . 'ldon, Foundation for Education and
Research in Childbearing, 1975. 15p.
Government Documents
Canada
.03. Canadian MARC
Communication format: monographs.
2ed. Ottawa, Canadian MARC Office,
Research and Planning Branch,
National Library of Canada, 1974.
82p. R
104. Conseil du Trésor. Manuel de
gestion du personnel. Ottawa,
Information Canada. c1975. lv.
(various pagings)
105. -. Direction de la Politique du
Personnel. Hygiène et sécurité
professionnelles: politiques, normes,
guides. Fonction publique du Canada.
1 ed. Ottawa, Information Canada,
1974. 236p.
106. -. Division des Pensions et
Assurances. Direction de la Politique
du Personnel. Votre régime de
pension. Une explication de la 101 sur
la pension de la fonction publique.
Ottawa, Information Canada, c1975.
59p.
107. Health and Welfare Canada.
Earnings of physicians in Canada
1962-1972. Ottawa, 1975. 59p.
108. -. Guaranteed income
supplement guide 1975-1976.
Ottawa, 1975. 16p.
109. -. National health research
and development program, 1975-76.
Ottawa, 1975. 114p.
110. -. Spouse's allowance. Who is
entitled to spouse's allowance.
Ottawa, 1975. 8p.
111. -. Your old age pension: a
program 01 the Government of
Canada. Ottawa, 1975. 6p.
112. Health and Welfare Canada.
Special Advisory Committee to Advise
the Health Protection Branch on All
Aspects of the Safety and Efficacy of
Oral Contraceptives Marketed in
Canada. Second report. Ottawa,
Information Canada, 1975. 46p.
113. Institut canadien de l'information
scientifique et technique. Répertoire
de la normalisation. Ottawa, Conseil
national des recherches du Canada.
1975. 1v.
114. Laws, statutes, etc. Criminal
code. Office consolidation. R.S.C.
1970, cc. C-34, C-35 as amended to
1972 and selected statutes. Ottawa,
Information Canada, 1973. 700p.
115. LOIS, statuts, etc. Code criminel.
Codification administrative. S.R.G. de
1970, cc. C-34, C-35 modifié par à
1972 et des lois connexes. Ottawa,
Information Canada, 1973. 700p.
116. Minister of Finance. Attack on
inflation; a program of national action
Policy statement tabled in the House
of Commons. Ottawa, Information
Canada, 1975. 25p.
117. Ministère des Finances. La
fiscalité indirecte. Ottawa, 1975. 39p.
118. -. Offensive contre /'inflation,
un engagement national. Déclaration
de principe déposée à la Chambre des
communes. Ottawa, Information
Canada, 1975. 27p.
119. -. Le régime fiscal des
organismes de charité. Ottawa. 1975.
14p.
120. Ministry of State for Science and
Technology. Recommendations of
the Committee of Five and reports of
the Five Working Groups. Ottawa,
1974. 1v. (variOus pagings)
121. National Library of Canada.
Union list of serials in education and
sociology held by Canadian libraries.
Ottawa, 1975. 221 p. R
122. National Research Council of
Canada. Associate Committee on
Scientific Criteria for Environmental
Quality. Environmental Secretariat.
Status report, February 1975. Ottawa,
1975. 63p.
123. Santé et Bien-être social
Canada. L 'allocation au conjoint. Qui
est admissible à cette allocation?
Ottawa, 1975. 8p.
124. -. Année internationale de la
femme. Ottawa, 1975. 20p. (Hygiène
menta Ie au Canada, V.23, no.5,
supplément 1975)
125. -. Leguidepourlesupplément
du revenu garanti 1975-76. Ottawa,
1975. 16p.
126. -. Programme national de
recherche et développement en
matiére de santé, 1975-76. Ottawa,
1975. 114p.
127. -. Votre pension de vieillesse:
un régime fédéral. Ottawa, 1975. 6p.
The CanadIan Nurse March 1976
57
What the well-bandaged
patient should wear:
Bandafix is a seamless round-
woven elastic "net" bandage,
composed of spun latex
threads and twined cotton.
Bandafix does not change in
the presence of blood, pus,
serum, urine, water or any
liquid met in nursing.
Bandafix has a maximum of
elasticity (up to to-fold) and
therefore makes a perfect
fixation bandage that never
obstructs or causes local
pressure on the blood vessels.
Bandafix is not air-tight,
because it has large meshes: it
causes no skin irritation even
when used for the fixation of
greasy dressings. The mate-
rial is completely non-reactive.
-
Bandafix saves time when
applying, changing and
removing bandages: the same
bandage may be used several
times: it is washable and
may be sterilized in an
autoclave.
Bandafix stays securely in
place; there are eight sizes,
which if used correctly will
provide an excellent
fixation bandage for
every part of the
body.
Bandafix is an up-to-date
easy-to-use bandage in line
with modern efficiency.
.....,;
Bandafix replaces hydrophilic
gauze and adhesive plaster,
is very quick to use and
has many possibilities of
application. It is very suit-
able for places that otherwise
are difficult to bandage.
.
..
f.'(
Bandafix is economical in use.
not only because of its rela-
tively low price but because
the same bandage may be
used repeatedly.
,
'.
Bandafix does not fray,
because everv connection
between the Ìatex and cotton
threads is knotted; openings
of any size may be made with
scÍ!;sors or the fingers.
Bandafix*
Distl-ibzded by
Now available
"Ready to Use"
Bandafix
. Pre-measured
. Pre-cut
. 14 diHerent applications
. Individually Illustrated
peel-open packages
IONi[ffi\[g
1956 Bourdon Street. Montreal, P.O. H4M 1V1
ORellutered trademark of Continental Pharma
58
The Canadian Nurse March 1976
..Ail)'-ill-!] l""l)dilte
128. Santé et Bien-être social
Canada. Direction de f'usage non
medical des drogues Recherche sur
rabus des drogues 1973. Ottawa,
Santé et Bien-être social Canada,
1973. 1 portfolio.
129. -. Direction générale de la
sante et du sport amateur. Conditions
revisees régissant les contributions
financières. Ottawa, Santé et
Bien-étre social Canada, 1975. 10p.
130. -. Direction générale de la
protection de la Santé. Manuel pour
evalu'Vie. Ottawa, 1973. 1v. (various
pagings)
131. Statistics Canada. Principal
taxes and rates; federal, provincial
and local governments 1974. Ottawa,
Information Canada, 1975. 64p.
132 -. Techmcal report on
population projections for Canada
and the provinces 1972-2001.
Ottawa, Information Canada, 1975.
233p.
133. Statistique Canada. Rapport
technique sur les projections
demographiques pour Ie Canada et
les provinces 1972-2001. Ottawa,
Information Canada. 1975. 233p.
134. Travail Canada. Direction des
recherches sur la législation. Les
normes du travail au Canada, 1974.
Ottawa, Information Canada, 1975.
109p.
135. Treasury Board. Occupational
health and safety; policies, standards,
guides. Public Service of Canada.
1 ed Ottawa. InformallOn Canada,
1974. 228p.
136 -. Personnel management
manual. Ottawa, Information Canada,
c1975. 1 v. (various pagings)
137. -. Your superannuation plan.
An explanation of the Public Service
Superannuation Act. Ottawa,
Information Canada, c1975. 59p.
Do your
Part
Give to the
RED CROSS
Ontario
138. Ministry of Labour. Research
Branch. Paid vacations and paid
holidays in Ontario collective
agreements. Toronto, 1975. 47p.
(Bargaining information series, no.8)
139. Task Force on Section 4(1 )(g) of
the Ontario Human Rights Code.
Summary of the interim report.
Toronto, 1974. 14p.
Quebec
140. Office des Professions.
Information. Québec (ville), 1975. 10
pts in 1.
141. Office des professions du
Québec. Rapport d'activités,
1973/74-1974/75. Québec,1975.2v.
United-States
142. Air Force. Air University. School
of Aviation Medicine. Flight nUrsmg.
Randolph Air Force Base, Texas,
1949. 176p. R
143. Center for Disease Control.
Tuberculosisprograms 1973. Atlanta,
Ga., 1974. 1v. (U.S. DHEW
Publication no. (CDC) 75-8189)
144 Division of Nursing. Nurse
training act of 1975. Fact sheets.
Bethesda. Md., 1975 11 p.
145. National Institutes of Health. A
bibliography of Soviet sources on
medicine and public health in the
U.S. S. R., by Lee Perkins. Bethesda,
Md., 1975. 235p. (U.S. DHEW
Publication no. (NlH) 75-732)
146 -. Chinese herbal medicine, by
C.P, Li. Bethesda, Md., 1974. 120p.
(U.S. DHEW Publication no. (NlH)
75-732)
147. -. StatIstical reference book of
internaffona/acffwffes, fiscal year
1974 Prepared by International
Cooperation and Geographic Studies
Branch, Togarby International Centre.
Bethesda, Md., 1975. 52p.
148. National Library of Medicine.
Programs and services; fiscal year
1974. Bethesda, Md., National
Institutes of Health, 1975. 44p. (U.S.
DHEW Publication no. (NIH) 75-256)
Studies Deposited in CNA
Repository Collection
149. Archibald, Barbara. Report of
costs of application processing, by
AUCC and CNA. Ottawa, Canadian
Nurses' Association, 1973. 1v. R
150. Gauthier, Annette. Absence de
stimuli chez Ie patient cancéreux,
par. . et France Bélec. Ottawa,
1974. 45p. R
151. Griffin, Amy. Hypnotics, sleep
and the hospitalized obstetric patient,
by. . and Edith Benoit and Sr.
Carmen Morin. London, University of
Western Ontario, 1972. 43p. R
152. Ingenito, Françoise. Mémoire
sur la pénurie d'infirmieres. Étude
préparée par . . . et Suzanne
Rollin-Lepage. Hull, P.Q., Conseil de
la Santé et des Services sociaux de
rOutaouais, 1975. 200p. R
153. Registered Nurses' Association
of Ontario. Project for team nursmg
development. Phase 3, Sep. 1972 to
Aug. 1975. Toronto, 1975. 25p. R
154. Seymour, Margaret. A
comparison of consumers' and
providers' opinion of community and
health services in a Northern Alberta
town. Seattle, 1975. 85p. (Thesis
(M.N.) - Washington) R
Audio Visual Aids
155. Catalogue des films sur les
sCIences du comportement. Ottawa,
Institut canadien du film, 1974. 11 Op.
R
156. Catalogue des films sur les
sciences médicales disponible de la
cinematheque nationale scientifique.
Ottawa, Institut canadien du film,
1972. 144p. R
157. A catalogue of films on the
behavioral sciences. Ottawa,
Canadian Film Institute, 1974. 110p. R
158. A catalogue of films on the
medical sciences available from the
National Science Film Ubrary.
Ottawa, Canadian Film Institute, 1972
144p. R
159. Film title index Ottawa,
Canadian Film Institute, 1975. 1 v. R
160. Moreland-Latchford. Catalogue
of educational films. Toronto, Ont.,
1975. 151p. R
161. -. Films educatifs. Toronto,
Ont., 1975. 94p. R
162. Université de Montréal Centre
Audio-vlsuel. Audiovidéothèque.
Catalogue general des documents
audio-visuels. Référence et inventaire
cumulatif des ressources. Montréal,
1975. 1 v. (various pagings) R
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'1.188 i r1(>>(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..lere<l Nur..... and Nur..ing Supervisor.. requored by a 100.
,<I acute care and 40 bed exlended care accredlled hospnal. MuSI
eligible for B. C reglSlra\lOn Permanenl and summer rebel pasl'
ns available lor general duly and operallng room Experience pre-
red lor operating room posilions. Supemsory appllcanls muSI have
penence In admmistratlve or supervIsory nursing R.N s salary
049 to $1239 and SuperVisor s salary $1258 to $1481 (RNABC
jreemenl- 1975). Apply m "''''lIng 10 lhe Doreelolof Nursing. G R
I 'ker Memorial Hospnal. 543 Front Slreel, Quesnel. BnllSh CoIum-
a, V2J 2K7.
>gi,,'ere<l and Graduate Nur..... requored fOl new 41-bed acute
,.e hosp/lal, 200 mIles north of Vancouver. 60 miles Irom Kamloops
""led fumlShed accommodation available Apply. DoreclOl of Nurs-
g. Ashcroft & D,stnct General Hospllal Ashcroft. Bf/11Sh Columbia
.perienced Nurses (ehglble lor B.C reglslration) reqUIred 'v.
)9-bed acule care, teachIng hospnallocaled In Fraser Valley. 20
mu1es by freeway from Vaocouyet' and within eaS) access of varied
-creallOn8lIaCI
lies. ExceNenl OrienlallOO and Conhnulng EducatIOn
rogrammes. Salary $1.049.00 to $1.239.00 Clinical areas Include.
edlClne, General and Specialized Surgery, Obsletncs, Pedlalncs.
oronary Care, HemodialysIs Rehabll,lahon. Opera"ng Room, fnten-
ve Care. Emergency. Praclic.11 Nurse.. fellglble lor B.C llcens'"
ISO reqUired Apply 10. Adrru..S1rat,V8 Asslslan1. Nursing Personnel
0)'8: Columbian Hasp.la]. New Westminster. British ColumbIa.
3L 3W7.
xperienced General Duly Nurses required lor srnall hOSpital. North
ancouver lS1and area Salary and personnel poI'Cles as per RNABC
)ntract Residence accommodahon 530.00 per monlh Transpor1a-
)11 paId from Vancouver. Apply 10 DoreClor 01 Nursing. SI George s
ospllal. Box 223. Alert Bay, BrillSh Columbia. VON IAO
òeneral Duly Nurses tor modern 41-bed hospnal localed on thd
laska Highway Salary and personnel policies m accordance wnh
NABC Accommodation avaIlable In residence Apply Dorector 01
lurSlng. Fort Nelson General Hosp
al. Fort Nelson, Bn"sh Columbia
eneral Duty Nurse who Qualifies 10<" ReglStral.on m B. C.. lor 42-bed
osptlal Salary In accordance With RNABC. Resodence available.
pply to: Director 0/ NurSIng, Golden & c.stnct General Hospnal. Box
260, Golden. Bnlish Columbia.
enerlll Duly Nur... for modern 35-bed hospnal located In south-
B J;
nd
7ci
e;:, wa
J:
I
re
'rB
a
i.,sr1a
\å
urse.s home. Apply Dtreelo, 0/ NurSIng, Boundary Hospnal Grand
oll<s, Bn1ish Columbia, VOH 1 HO
\Jew Brunswick
'OSltlons available July 1. 1976 for lour teacher.. ",ho can Qualify as
sslStanl or ASSOCIate Professors ,n a baccalaureate program with
60 sludents. One teacher needed wllh Maste..s degree and
xpenence '" community nursing and one with Master s degree and
w.penence In medlcaJ arid surQlcal nursing. Other teachers needed to
ude basic and Post-R N. students in dlnical experience in hospitals
nd community. Moder" new curriculum. well eQuipped
elf'lnslruCllOnal labo<al"ry. new community hosprtal. beaulnul small
Ity. Wnte Dean, Facu"y ot NurSing, The University 01 New
<unswick, Fredeneton, New Brunswick, E3B 5A3
The Canadian Nurse
Nova Scotia
Psychiatric Nurse wanted 'or community mentaf health service
program In O1gby, Nova Scolla Dubes to Include clinical servICes.
community work pnmary preventive programs. Salary according to
classrtlcatlon Apply, slating QUalificatIons. experience 10 Mr J R
Mcisaac, Chairman. Digby-Annapolis Menial Health Service Board
Bndgelown, Nova Scot..
A new 75-Ded senIOr CItIZens resodence In the Amapolls Valley of
Nova Scoha IS Interested In recruttng nurses June Ihrough Sep-
lember Good working condlllOns. salary as per RNANS agreemenl
assistance In locating liVing accommodahons Approx 35 miles from
Halifax Apply O1recto, 0/ Nursmg. Hanls County Resodence lor
SenIOr Citizens, WIndsor. Nova Scolla. BON 2TO
March 1976
59
Nova Scotia
Faculty Positions - Poslbons available for all cllmcal nurstng areas
In an Integrated four -year baccalaureate program offered In coopera-
tion wllh Dalhousie University School ot Nursing Masler s degree In
dntesl speciality areas and or cUrriculum deve1opment. educatton
reqUIred POSrtlonS Involve responsIbility for theory and etln'calteach-
Ing In local hospnals Can,Mates should be available July 1 1976
Applications. with cUrricula vitae Should be directed to Or Waher
Shelton Academic Dean Mount SaInt Vincent Untversny Halifax
Nova Scalia 83M 2J6 Canada
REMEMBER
HELP YOUR REO CROSS
TO HELP
.,.
..A
·
_. · . i
'
T SUTTON oomma"'" lho h'<1''''' ,....
-' \J' within a radius of 100 miles of Montreal. 20
miles of trails and slopes, 6 modern hfts, ski
. .. school, ski shop and full range of faclhtles,
... great snow and supenor grooming'
GUEST HOUSES. .. HOTELS... MOTELS...
PRIVATE CHALETS... APARTMENTS,..
SKI DORMS...
SUTTON
TOURIST
INFORMATION
Mrs. Lamb
P.O. Box 418
Sutton, Quebec
Reservations:
514/538-2646
514/538-2537
1200 accommodations
within 12 miles
Package deals including meals,
ski lessons and lift tickets, Let us
know the kind of accommodation
you wish and rest assured of our
full cooperation for a pleasant
stay.
60
Ontario
Nurse Practitioner lor a modern attractive Family Health Centre In a
fnendly Northwestern Ontano commu Ity of 2500 Excellent winter and
summer sports faolltles. Qualified Nurse Pradltloner essential for a
challenging poslbon In a pnmary care setting. Past experience not
essential Salary negotiable. Write or phone Dr A A panJu. Ignace
FamIly Health Centre Bo. 390. Ignace. Ontano. POT ITO,
807.934-2266 or 807-934'2366
RegIstered Nurses lor 34-bed General H05p
al Salary $945 00 10
S 1 145 00 per month plus experience allowance Excellent personnel
policies Apply 10 Director 01 Nursing Englehart & DISInct Hospital
Inc. Englehart. Ontario, POJ IHO
Reglslered Nurses and Regislered NursIng AsslslanlS lor 45.bed
Hospital Salary ranges Include generous expenence allowances
RN s salary $1 045 10 $1 245 and R N A s salary $735 10 $810
NIJrses reSidence - private rooms Wllh bath - $60 per monlh Apply
to The Dnector 01 Nursing. Geraldton DISlrlct Hospital Geraldlon
Onlarlo POT IMO
Registered Nurses reqUIred for our uI1ramodern accredited 79.bed
General HospItal In bilingual convnunlty of Northern Onlano. French
language an assel bul 1101 compulsory Salary IS $ 1.115 to $ 1,315
monthly with allowance for past experience and 4 weeks vacahon
aner 1 year. Hospllal pays 100 0 0010 HIP L,fe Insurance (10 000)_
Salary Insurance (75 0 0 01 wages 10 Ihe age 0165 wllh U I C. carveoul).
a 35c drug plan and a dental care plan Master rolahon In effed.
Furnished bachelor apartments available nearby and reserved
Ihrough the Personnel Departmenl Excellent personne1 poIlOes
Apply to Personnel Dtreclor. Noire-Dame Hosp
al P 0 Bo. 8000,
Hearst. Onlarlo POL 1 NO
Heglstered Nurses tor tamlly.lype coed camp In Northern Ontano
Appro.. 90 campers ages 14 & 15, June 23 to Aug. 16: prlvale room
and board plus salary. Wnle/phone. Camp Solellm. 588 Melrose
Avenue_ Toronlo. Onlano, M5M 2A6. Area code 416-781-5156
e
r
n i:
aÉ:
B
IC
Harold B. Nashman_ Camp ServIces Co-op_ 821 Egllnlon Avenue
Wes!. Toronto, Onlano. M5N IE6
Saskatchewan
Director of Nursing: Immediate appllcallons are Invl1ed for the POSI-
lion of Director of Nursing In the 43-bed Wadena Uruon Hospllal
Fnnge benefits Include Reglslered Pension Plan. Group Life Insur-
ance and Income Replacement Plan This IS a seven year old we1l-
eqUIpped hospital In a town of 1500 populahon serving a large rural
population Wadena IS centrally localed 130 mIles from each of two
maJor Saskalchewan centres Supervisory expenence IS essential
Nursing Administration course desirable Allracllve salary scale
:
a A8
;t
rllfpc
n
x
g:lds
I
::
:
SOA 4JO
Registered Nurses reqUired for fifteen bed acute care modem hospl-
lal In Birch Hills. In the centre of a prosperous farrTllng community
close 10 excellent Winter and summer reaeatlon facIlities. S.U.N
salary schedule. Atlradlve living accommodation available. Apply to
Mr B R LewIs, Box 460, Strch Hills, Saskatchewan_ SOJ OGO
Registered Nurses needed '''' nor\hem 15-bed outpost hospital.
Remuneration as per S.U N.-S H A agreement Contact. Sister H
Desmarais. Dlredor of Nursing. 5t Martin s Hospital. LaLoche.
Saskalchewan
Registered Nurses are required Immedlc::.lely for the 43-bed Wadena
Unton Hosplal ThiS IS a modem. allractlve acute care hospl1al
SlIualed In the lown of Wadena Saskalchewan. a fnendly parkland
communtty wllh a populallon of 1500 Atlradlve salary and fringe
benefits are provided under the Saskalchewan UnlOl'1 of Nurses ag-
reement In effect. Please direct applications to. Administrator
Wadena Union Hosp
al. PO Bo. 10, Wadena, Saskalchewan
United States
rexas wants you! If you are an RN, expenenced or a recent
graduate. come 10 Corpus ChristI Sparkling CIty by Ihe Sea a clly
bUilding lor a belter future. where your opportumlles for recreallon and
studies are IImllless Memorial Medical Cenler. 500-bed. general.
teaching hospital encourages career advancemenl and provides In-
servIce Orlenlallon Salary from $78520 10 $1,052 13 per monlh.
commensurate wllh education and experience Differential for even.
Ing shifts. available Benefits Include holidays. sick leave. vacations
paid hospitalization. health. hfe Insurance, penSion program Become
a vllal part 01 a modern up lo-dale hospllal. wnte or call. John W
Gover, Jr. Dlreclorof Pe:sonnel. MemOrial Medical Center. P a Box
5260_ Corpus Chnsll. T e.as 78405
RN.'s needed Immediately lor a 31-bed acute care hosp
a'- Rotating
shifts. We will asslsl In making arrangements 10 come 10 beau1lful
WyomIng Call Collecl [)"eclor of Nurses. Cheryl Karl<heck - 307-
682-8811
The Canadian Nurse
Registered Nurses
for Recovery Room (S.I.C.) Operating
Room Psychiatry and other specialized
and general areas
This 546-bed hospital is located on
University campus. It promotes four
facets: (1) Service (2) Teaching
(3) Community (4) Research
Our concern is that the nursing care is
patient centred and that nursing practice
is rewarding_ An in service program is
conducted by Staff Development and
furthered at ward level. We have either the
team or unit systems and both offer
opportunity for learning and
advancement
Apply to:
Employment Officer, Nursing
University Hospital
Saskatoon. Saskatchewan
S7N owe
IIIIIIIIIIIIIIIIIIIIIIIII
BIAPART
i Df
- -
- -
- -
: :
- -
- :
BIAPART
Of THI ACTION
;11111111111111111111111111
Conestoga College of
Applied Arts and
Technology
The College invites applications for
Faculty posillons in our various Nursing
Division which are located in Cambridge,
Guelph, Kitchener-Waterloo, and
Stratford. We have immediate openings.
Candidates must have suitable
qualifications and at least two years
nursing expenence_ Salary will be
commensurate with background and
experience_ This position is open to both
women and men
Applications. in writing. should be
forwarded to:
Personnel Manager
Conestoga College of Applied Arts and
Technology
299 Doon Valley Drive
Kitchener, Ontario
N2G 3W5
March 1976
Advertising
rates
For All
Classified
Advertising
$15.00 for 6 lines or less
$2.50 for each additional
line
Rstes 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 ofthe
hospitals and agencies
advertising in the Journal.
For authentic information,
prospective applicants
should apply to the
Registered Nurses'
Association of the Province
in which they are interested
in working.
Address correspondence
to:
The Canadian
Nurse
50 The Driveway
Ottawa, Ontario
K2P 1E2
The Canadian Nurse MarCh 1976
61
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 doctors 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
.. As a registered nurse
with more years experi-
ence behind me than I
care to think about. I
know how important it
is to Io..eep growing in your job-to
avoid that awful feeling of being
stuck in the same rut. Certainl}
what you're doing is tremendousl}
worth-while, and heaven knows
there is a desparate shortage of
nurses. But your job must be
worthwhile to you, or else you'll
eventually want to drop out".
"That's why Medox has so much
to offer a nurse today". "You see.
at Medox. we supply quality nUf!;-
ing staff on a temporary assignment
basis to hospitals. clinics. doctors'
offices. nursing homes and pri\ate
residences. We're a part of the
world-widt' Drake International
group of companies and we operate
in major cities across Canada, the
V,S. V.K, and Australia".
.. As far as you're concerned.
however. the key phrase is "Tem-
porary Assignments". Because, as
you can see b} the chart above, you
can choose just about any working
condition. or shift. or professional
discipline you want". ..It comes
dov.n to this: if you v. ant more from
nursing than you're getting nov.,
talk to Medox"
"Write to me. Virginia Hintoft.
R.;'\;.. StaffSupenisor.
ledox, 55
Bloor St. W., Toronto, Ontario. or
call the local Medox office"
lMEDOX,
a DRAKE INTERNATIONAL company
If you care for people.
you're Medox.
62
Rehabilitation Nursing
The T cronto Western Hospital Campus of
the Nursing DIvISion offers a two-part
program in Rehabilitation Nursing for
Registered Nurses, who wish to develop
their understanding and skills in this
aspect of nursing.
Admission Requirements: Applicants
must hold valid registration as a nurse in a
provinæ or territory of Canada and have
at least one year s nursing experience.
Applicants for Part II of the program, must
have successfully completed Part I or an
acceptable equivalent.
Part I - April 12 - May 7, May 10 to June
4 and June 14 to July 9, 1976.
Part II
March 15 - April 2 and July 12 -
July 30, 1976.
For further information or application
forms. contact the:
Admissions Officer (Nursing)
The George Brown College
Box 1015 Station B
Toronto, Ontario
M5T 2T9 or Telephone: (416)967-1212
SOFRA-TUUE' Rou...1
Sulf.te d. tramyc6t1n. B.P. Antlblotlqu.
indication.: Traltement des brulures des teSions d.écra.
semenl. des laæratlons Inlectées au suscept1btes de I'ë-
Ire Ulcères variQueux escarres de decubitus et plales
ulcérees
Contr.-Indcatlo...: Allerg.e connue à la lanoline OU à
Ia framycétlne Orgamsmes reSistants à Ia tramycétlne
.... en 118rd.: Dans Ia plupart des cas, l'absorpllOn de
I antlblotlQue est 51 .albae QU on peut la com;.dérer comme
néghgeable T cuteta.s 51 Sofra- Tulle recouvre une grande
sur1ace (p ex une brülure s.étendant sur 30% au plus du
corps). II eXIS1e un riSQue d'ototoxlClté au de nephrototmu-
Clté L'emplol prolongé des anllbtOllQues paut resulter en
une proliferation des orgamsmes non senslbles Induant
les champlgnons Dans de tets cas, des mesures appro-
nées dOlvent ètre pnses
Po.Olog..: AppliQuer dlfectement une seule couche sur
la plait. et la COUVrir d'un pansement 51 la plale sUinte
abondamment, renouveJer Ie pansement au mOlns 1 folS
par Jour Dans les cas d"ulcères, decouper Ia eompresse
sek>n 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
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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
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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.
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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
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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
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n and women
ealth and Welfare Canada
edical Services Branch
obisher Bay, N.W.T.
1ENT AL HEALTH/PUBLIC HEALTH
IURSE
!Iary: $13,298 per annum
(plus Isolated Post Allowancesl
ef. No: 76-STP-22,100ICNI
,troduction
POSition has been created in mental health/publi
health
ursing in the town of Frobisher Bay, N.W.T. FrobIsher
ay has a population of 3,000 and is located 1,300 miles
orth of Montreal. Two mental health/public health nurses
e currently employed-one in Yellowknife and one in
1uvik.
"uties
he mental health/public health nurse is responsible for
clentifying mental health problems in the community;
rranging for mental health care treatment to patients
nd for implementing generalized public health nursing
,rograms.
lualifications
:Iigibility for or registration in a province or territory
If Canada. Certificate or Baccalaureate in Public Health
ursing or in a specialty relevant to the duties of the
losition. Nursing experience and demonstrated compe-
ence in psychiatric nursing. Knowledge of English is
'ssential.
'low to Apply
=orwiJrd completed "Application for Employment" (Fofm
'SC 367,4110) available at Post Offices. Canada Manpower
'::entres Of offices of the Public Service Commission of
'::an
da, to: .
I1r. Rustv Gabert
'ersonnel Administrator
I1edical Services, Northwest Territories Region
14th Floor, Baker Centre
10025 -106 Street. Edmonton, Alberta T5J 1H2
Please Quote the applicable refefence numbef at a/l times.
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The
Johns Hopkins
Nurse is You
Some people have the idea that
to get into Johns Hopkins Hospital
you have to be someone special.
You do! You have to be an RN with
an enthusiastic interest in your pro-
tession! That's the most important
qualification. You'll tind the oppor-
tunities to specialize; to obtain a
wide range ot clinical experience;
start with your first day in orienta-
tion. There are only a few major
tacilities in the nation that can otfer
the scope ot protessional opportu-
nity that you'll find in our interna-
tionally known 1,100 bed acute care,
teaching and research complex.
We ofter excellent salaries and
benefits including tuition reimburse-
ment. If you'd like to learn more
about the unusual range of speciali-
zation opportunities available to new
graduates as well as experienced RN's,
write or call 301 955-559
collect.
An Equal Opportunit" Employer '" F
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Suzanne L Perry R"'D
OI,jurse RecrUIting SN D
The Johns Hopkins Hospllal
BaltImore, 'I-1d 11205 CN376
Please send me mlormatlon about R'\ oppor-
lumtles onered b
Johns Hopkins HospItal
"'AII,IE-
ADDRESS:
PHONE
SPECIALITY I"JTEREST
Do\TE AV'IIL'IBLE I
I_________________________________
67
,
68
Cancer Control Agency of
British Columbia
Associate Director for Nursing
This new agency has been established to develop a
comprehensive cancer program for Canada, West of the
Rockies. Programs of early detection, education including
nursing and paramedical, advanced therapeutics and
research are being initiated. Expansion of the role of the nurse
in each of these areas is needed, and innovative programs will
be developed. This is an exciting new position and carries
responsibilities for the co-ordinating of all nursing services
within the Cancer Control Agency (including a 56 bed hospital
unit, currently being expanded into 85 beds, an outpatient
clinic with 30,000 visits yearly) as well as an .active planning
program for extension of cancer nursing services and
education throughout the province of B.C,
Applicants should have university training suitable for an
appointment at the University of B.C., and proven competence
in supervision and nursing education and administration.
Send le"er of application, together with a detailed resume and
expected salary range to:
Thomas C. Hall, M.D.,
Director
Cancer Control Agency of British Columbia
2656 Heather Street,
Vancouver, B.C. V5Z 3.13
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 - IntEinsive Care Nursing and
Operating Room Technique and Management.
Apply to:
Recruitment Officer - Nursing
University of Alberta Hospital
112 Street and 84 Avenue
Edmonton, Alberta T6G 287
The Canadian Nurse March 1976
Supervisor-Surgical Suite
Rockyview Hospital
Applications are presently being accepted for a senior
nursing position which evolves around the
administrative and clinical responsibility of complete
Operating Room and Recovery Room staff and
procedures.
Candidates must be eligible for registration in the
Alberta Association of Registered Nurses, A degree in
nursing or Nursing Unit Administration course preferred.
Post graduate preparation in Operating Room nursing
desirable.
Applicants must possess recent senior experience in
Operating Room and Recovery Room care. Experience
in all specialities. Successful applicant must be able to
commence employment by at least March 1, 1976.
Interested applicants are asked to submit a wri"en resume to:
Hospital District No. 93
Personnel Department
940 Eighth Avenue SoW.
Calgary, A1berta
T2P 1 H8
I
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University of
Alberta Hospital
Edmonton, Alberta
o
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-Surgical" - "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
. Modern 700 bed non-sectarian hospital
. Excellent personnel policies
. Registered Nurses and Nursing Assistants
are asked to apply
The Canadian Nurse March 1976
69
657 bed, accredited, modern,
well equipped General Hospital,
rapidly expanding...
Saint John
jvd'{N
General U \ \V
GfloÆPital
ðaint'John,NB,
CANADA
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CJ{EQUIRES:
Genetã18taff /'t(yrses t:&
Registered Nursing Assistants
In all general areas: Medical, Surgical,
Pediatrics, Obstetrics, Chronic and
Convalescent, several Intensive Care
areas and Psychiatry.
. AClive. progressive in. service education program.
Speciel Attention to Orienlalion.
Allowance lor Experience end Posl Basic Preparelion
fOR flJllTHIJII INflJllMATION APPLY TO
ÇpERSONNEL DIRECTOR
aintfjohn General Hospital
p.o. BOX 1000 Saint John, New Brunswick ElL ofLl
If Paris appeals to you
. . . so will Montreal
. 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 1E2
70
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 salary
range, write to:
President .
Registered Nurses' Association
of Nova Scotia
6035 Coburg Road
Halifax, N.S. B3H 1Y8
The Canadian Nurse March 1976
Clinical Co-Ordinators
required for
Medicine Hat & District Hospital
This is the active treatment, rehabilitation and extendicare
portion of a 567 bed total health care complex in Medicine Hat,
Alberta - the energy city of the west.
A complete reorganization and major expansion of all facilities
of the 247 bed active treatment hospital is in progress with
concomitant nursing care programs. Medicine Hat & District
Hospital is involved in a number of pilot projects in Alberta.
Positions:
(1) Clinical Co-ordinator, General Medical - Surgical.
(2) Clinical Co-ordinator, Special Services - Acute Care.
Our Clinical Co-ordinators are both Clinical Nurse Specialists
and Administrators of his or her clinical area. Co-ordinators
report directly to the Assistant Executive Director of Patient
Services.
A cross appointment in the college nursing program may be
recommended.
Qualifications:
(1) A Master of Science Degree in Nursing, preferred.
(2) Advanced clinical knowledge and expertise.
Salary:
Minimum - $17,000.00
Position Open:
April 1 st, 1976.
Submit Resume To:
Mrs. Gwynneth Paterson
Assistant Executive Director - Patient Services
Medicine Hat & District Hospital
Fifth Street, South West
Medicine Hat, Alberta
Vancouver General Hospital
Invites applications for
Regular and Relief
General Duty
Nursing positions in all clinical areas of an
active teaching hospital, closely affiliated
with the University of B.C. and the
development of the B.C. Medical Centre.
For further information, please write to:
Personnel Services
Vancouver General Hospital
855 West 12th Ave.
Vancouver, B.C.
V5Z 1 M9
Sherbrooke Hospital
Sherbrooke, Quebec
invites applications from
Registered Nurses
General Duty
138-bed active General Hospital; fully accredited with
çoronary, Medical and Surgical Intensive Care.
Situated in the picturesque eastern Townships,
approximately 80 miles from Montreal via autoroute.
Friendly community, close to U,S. border. Good
recreational facilities. Excellent personnel policies,
salary comparable with Montreal hospitals.
Apply to:
Director of Nursing
Sherbrooke Hospital
Sherbrooke, Ouebec
Faculty Positions
1 Professor or Associate Professor of Nursing to
coordinate the Master's Program in association witl'"
the Director of the School. It is expected that the
candidate would have completed a doctorate, and
have had clinical, nursing education and research
experience. The appointment includes teaching in
the graduate and undergraduate programs, and
provides opportunity for research.
2 Because a number of our faculty will be leaving to
pursue further education at the end of this academic
year, there will be positions available for qualified
faculty. We are especially interested in candidates
with preparation in mental health and psychiatric
nursing. and in community health nursing.
The CanadIan Nurse March 1976
71
Nursing Coordinator
Responsible for coordination of all nursing activities to
the delivery of quality care in all nursing stations and
Harrington Hospital of the Lower North Shore of
Quebec. Must be bilingual.
Registered Nurses
to join our team on the Lower North Shore to Quebec
Dispensaries. Salary according to collective agreemp.nt
and M.A,S.
Advantageous benefits.
Isolation premium,
Residence accommodation.
Send complete resume to:
Director of Personnel
Hðpital Notre-Dame
Lourdes du Blanc Sablan
Duplessis, P.O.
Tel.: (418) 461-2144
Interesting developments for the future make Dalhousie
School of Nursing a challenging place in which to
contribute to nursing education and to further one's own
professional goals.
. new and modern quarters for the School are
planned
. our masters program is now in its first year
. some research projects are getting underway and
Dr, Margaret Scott Wright from Edinburgh, well
known in Canada and internationally,
will be our new Director.
Applications, with curriculum vitae, should be sent
to Muriel E. Small, Director, School of Nursing,
Dalhousie University, Halifax, Nova Scotia.
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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
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Telephone: (215) 649-1497
Gordon Tiffin
2 Tremont Crescent
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Telephone: (416) 444-4731
Member of Canadian
Circulations Audit Board Inc.
mE
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The Canadian Nurse
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Sizes 3-15
Pristine Royale
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White, Blue - 3 piece suit
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Sizes 8-16
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See our new line of Whites and Water Colours at fine stores across Canad1
Now there are two versions of
MILLER &:
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Encyclopedia
&: Dictionary
of Medicine
and Nursing.
EnCYclopø'
and Dictl
Medicine '
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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.
!!
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lTD.
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I
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I City
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On 30-day approval, please send me a copy of the Student Edition of
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o Payment enclosed, ship postpaid. 0 Bill me. 0 Send C.O.D.
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.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
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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
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A) Style No. 46276
Sizes 5-15
Rib Royale
100% Polyester Double Knit
White' About 533 00
B) Style No. 6224
Sizes 8-16
Rib Royale
100% Polyester Double Knit
White About 526 00
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A PROUD CANADIAN NAME
IN THE FASHION INDUSTRY
\
\
desilfner's
A h .
LIMITED C Olce
EDITION
AT YOUR FAVOURITE CAREER APPAREL STORE
,
6
The Canadian Nurse April 1976
I 11 I) tIt
A warm reception
I have just finished my January
1976 issue of The Canadian Nurse. I
like the new format very much and
particularly I enjoyed the
article "Crying."
Joan Pattie, R.N., Kentville, N.S.
If first impressions are accurate,
it's super. Certainly has impact via the
graphics, new type face, column
widths, etc. It really looks alille!
Congratulations!
Nancy Rideout, LIaIson Officer,
NBARN.
What is there to say about a
change in format as radical as the one
which faces readers of The Canadian
Nurse? I like it! There is something
deep beneath this new format which I
feel is brewing and about to mature
Into a much more informative journal.
Donna Grey, N., B.N., Montreal,
Quebec
May I take this opportunity to
commend you and the journal staff for
the realization of long-desired goals
for a professional magazine.
If Volume 72, Number 1 is any
indication we note a new expression of
our professional status.
Donna M. Wells, Dean, Nursing
Programmes, Seneca College of
Applied Arts and Technology,
Willowdale, Ont.
I
I am writing to tell you how much I
have enjoyed the first two issues in
1976 of The Canadian Nurse . The
cover is striking. and yet pleasing. The
articles are truly more personal. I feel
like some of the authors are sitting
across the table talking to me. Also
you look like you are having fun from
the manner of writing, the titles of the
articles. and the design of the
journal... I can proudly recommend this
journal to R.N. students.
Jeanette R. Linton, R.N., B. , SC.N.
teacher, Confederation College,
Thunder Bay, Ontario.
and criticism ...
For people like myself with rather
mild vision problems the type is too
s'nall for comfort. I find it a real strain to
read. Also - and I can't tell if it is the
type size, or line length - I find it
almost impossible to scan articles.
This means reading every word, rather
slowly, or just skipping it altogether.
Maybe we should have a rapid reading
specialist study it?
Best wishes in trying to improve
the journal.
Helen Eifert, University of British
Columbia, School of Nursmg,
Vancouver.
The editor replies: Our first "new look
issues" brought many compliments.
We're glad you think we're moving in
the right direction in the areas of both
design and content.
We're even more delighted that
so many of you were motivated to
write, phone or drop in to say "thank
you. " It's this kind of input from "you
out there" that is really at the root of
change. Please, keep the lines of
communication open.
"Frankly Speaking"
I read your commentary on UIC
in The Canadian Nurse December 75
with great interest. I was called for a
UIC interview just the next day.
This interview went along as your
article had forewarned me. The
interviewer tried to channel me out of
nursing, and convince me to seek
full-time employment- of which there
is little in this area since new
graduates are working casual
part-time. I have since received a
disentltlement which I am appealing.
With the present budget cutbacks
and the closing of hospitals, I see the
plight of nurses seeking employment
looking very dark indeed. Does the
government intend to deny claims to
all those part-time nurses who will
soon be unemployed? Where could
they all find full-time jobs anyway?
If all of us are going to be looking
for full-time employment in order to
collect a few UIC dollars the
Manpower list will remain crowded
with R.N.'s names for a long while.
Where do we go from here?
Glenna Lane, Kingsville, Ontario.
CNA member-at-/arge for social and
economic welfare, Glenna Rowsell,
indicates that this is one of many
similar letters received in response to
her December column, "Working with
you between jobs???"
For readers who experience
problems, she suggests: "Guidelines
for eligibility for UIC benefits are laId
down by federal statute. Any
problems that arise are caused by
local variations in interpretation of the
law and, therefore. the best approach
is at the local-provincial level. If you
have a problem, look first to your
provincial nurses' association for
assIstance.
Editor's note: see also page 9 this
issue (CNA Directors request UIC
officials to work with provincial
associations at local levels).
Nursing abroad
The article "Cross Canada
Registration" (The .Canadian Nurse,
January 1976) made me aware of the
services offered by CNA's nursing
coordinator.
I've been planning a trip abroad,
and have questions concerning the
licencing requirements and
procedures for Zaire. Could you
provide this information or an address
where I could procure the necessary
Information for myself?
Another question: Is there any
sort of International Nurses Licence? I
could be traveling in Africa for several
months, and have wondered about the
possibility of obtaining a licence which
would be valid in several countries.
Thank you again for the
informative article!
Joanne Buttery, Montreal, P. Q.
The article to which this reader refers
has resulted in a flood of enquiries to
the CNA Nursing Coordinator. Many
writers ask about "international
licensure" and other aspects of
employment abroad.
The Nursing Coordinator remmds
them that several factors should be
considered if you are thinking oftravel
and work abroad.
1. The ICN Nursing Abroad Program
applies only to Canadian nurses who
are members of CNA. This means that
to be eligible you must be a member
of a professional association such as
RNAO, ONQ, etc.
2. In order to nurse patients
effectively, you must be able to
communicate with them. Therefore,
you must be able to speak the
language of the country where you
plan to work..
3 You should expect to work for at
least six months, preferab:ya year, in
each place you plan to visit. Arranging
for positions and orientation is
expensive for the host country.
4. International licensure definitely
does not exist. In fact, it would seem to
be a long way off when you consIder
that there are still 10 registering
bodies in Canada.
What is it?
Some time in early January, the
December Canadian Nurse arrived in
my mailbox. This is a pleasure to
which I look forward monthly: all that
nursey news and medical knowledge,
keeping me up-to-date with my
profession. But - there was
something radically amiss with the
cover - it was wildly colored and
shaped; or rather it had no shape at all.
Someone had made a mistake and put
on another magazine's cover picture.
Perhaps it was The Canadian
Traffic Engineer: a schematic of a
traffic interchange for downtown
Toronto? (or Montreal, if you like)
Was it The Scientific American: a
spinning DNA molecule?
Or Rolling Stone: what you will
see with the effects of some
marvellous new psychedelic
substance that may be smoked,
sniffed, shot or swallowed?
Chatelaine: what the
well-dressed woman will wear this
spring.
PharmaceutIcal Journal: a
capsule, at last, that will cure the
common cold.
Arts Canada: the latest abstract
triumph by a current Canada Council
painter.
Maybe it is a design for the next
Canadian stamp in honor of Florence
Nightingale.
Finally I decided that it must be a
whirling Christmas tree photographed
as a time exposure with the little white
angel left off the top of the picture.
It's pretty, and I like it, but really,
what is it?
Sara M. Cooper, RN, BSN, Sardis,
B.G.
Theedfforreplies:Ourcorrespondent
wins the December guessing contest.
We hope she, and all our other
readers, appreciate the word of
explanation that now appears in each
issue telling them about the cover
photo and photof]'apher.
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Hollisters
[7[7
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 drainage away from the wound and
protects the skin. A dressing that lets you easily assess
and measure exudate.
Now someone makes such a dressing. The Hollister.
Draining-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 15 supplied sterile for qUick application In the
a.A., recovery. I.C.U. or patient's room. No messy. wet
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If you want to see what's gOing on at the wound site you'll
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c COPYRIGHT 1975 HOLLISTER INCORPORATED All fliGHTS RESERVED
8
The Canadian Nurse Aprol 1976
Ne\ys
.,.
..
..:..'-
"
.....
Proposed fee raise to be
submitted to general assembly
As anticipated at the last meeting,
members of the CNA Board of
Directors took measures at a February
meeting to cope with the Association's
financial problems. In addition,
concerns such as rape, cutbacks in
hospital beds and anti-inflationary
measures were discussed and acted
upon.
By the end of 1976, these
reserves will have been exhausted.
Steadily rising costs without offsetting
revenue increases, plus the need to
repay the mortgage that falls due this
year, have created this situation.
Faced with the prospect of great
financial hardship if the present level
of revenue is maintained, Directors
had no choice but to consider a raise in
fees. The present formula for
calculation of association member
fees is based on a $10.00 unit
assessed as follows:
1/2 unit - first 250 members
3/4 unit - 251 to 1000 members
1 unit - 1001 to 15,000 members
3/4 unit -15,001 to 25,000 members
1/2 unit - 25.000 members and up
Working capital & debt forecast 1976-1978
based on a $12. unit in 1977 and $15. unit in 1978
Minimal fee raise recommended
CNA Directors faced a difficult
situation at the February 1976 Board
meeting. Inherent in the $423.779
expected deficit for 1976 is the stark
financial reality that CNA is fast
depleting its cash reserves in order to
meet nsing costs.
$100,000
o
. .
. .
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.
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D J F ,-, .. Y J J ,. SON D J F
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1 J J ASOND J F M A M J J ADO N D
7
6
5
4
3
2
1
o
1
2
3
4
5
6
7
1976
1978
1977
Peaks represent maximum working capital during the year; valleys depict
increasing cumulative debt at the end of each year. This projection is based on
the assumptions that 1. membership will increase 4 percent per annum; 2. the
inflation rate will be 10 percent; 3. programs will remain at the 1976 budget level
and 4. the Testing Service will be self-supporting.
However the formula also stipulates
that "no one association will pay more
than one third of CNA fee revenue for
the preceding year"
Several fee proposals were
received. Serious discussion revealed
the concern of Directors over the
ability of member associations to pay
additional money. The unit finally
agreed upon was $12.00 for 1977 and
$15.00 for 1978. This would mean that
CNA would be receiving
approximately $10.00 in 1977 and
$12.50 in 1978 per ordinary member
via member associations. The net
effect of this would be to incur
additional debt of approximately
$400,000 in 1971 plus $250,000 in
1978. A unit fee of about $17.50 would
be required to break even in these two
years.
7
6
5
4
3
2
A clear-cut statement
on budgetary curtailments
In response to the budgetary
curtailments being imposed on health
care services in Canada, the CNA
Board of Directors Issued the following
statement:
"The cost of health care services in
Canada has become a national
concern. Nurses share that concern
and agree that steps have to be taken
to contain expenditures. The
escalation of these costs, however,
comes as no surprise, for the health
care system has relied on and was
indeed conceived around, the delivery
of acute care. Acute care is the most
costly type of care and is not
necessarily the best investment.
The Canadian Nurses
Association has repeatedly requested
that governments put forth some plan
to refocus the Canadian system of
care in order to expand services in the
areas of health education, health
promotion and primary care. Groups
of nurses across the country at the
present time are arguing that we need
to provide some realistic alternative to
our reliance on acute care.
Nurses protest when curtailments
are applied indlscnminately. Cuts in
the number of acute care hospital
beds in provinces across the country
could be understood and supported.
What is not understood nor accepted
is that:
o
1
2
3
4
5
6
7
1. in some cases, these curtailment
are being applied across the boa
d sc
that they affect alternate services a
well as acute services, and
2. the cuts In active beds are made
without consideration of the effect 01
remaining acute care facilities as we
as on existing alternate services.
CNA would like to emphasize that
reducing the number of hospital bed'
does not automatically result in bette
utilization. Similarly, curtailments of
alternate services - home care for
example - do not reduce costs.
Nurses have already made
concrete suggestions about ways 01
responding to the needs: home carE
use of the public health nurse,
transportation services to ambulator
t:enters, homemakers, facilities for
temporary placement of patients
cared for in the homes, tapping of
volunteer resources, drop-in centers
utilization of school buildings as healtl
and social centers, etc. These are a
few resources that could be expandec
at a low cost, without creating a nell
network of expensive facilities and
structures. We know that these
services respond to real needs of
people and would provide a good
return for the health care dollar.
Large segments of population
care needs can be met by nurSing
services. Acute care hospitals are no
nec;;essanly the ideal setting to meel
these needs. Home care services OffE
definite advantages in terms of
cost-effectiveness and support for thl
families.
Better use and availability of
alternate services would prevent
admission to acute care settings an,
would also help stop the" revolving
door syndrome" of our system, when
a patient is discharged only to be
re-admitted for lack of support in thE
home or community. Without these
services it becomes evident that a
growing older population will continuE
to crowd acute care facilities.
What is needed is an unbiased
assessment of these services in term!
of their relative low cost, effectivenes.
and social importance. This will
require a concerted and imaginative
effort by the consumers of care, the
health workers and government.
Nurses are willing to enter such a
partnership. "
I ne \...anaolan Nurse "pnl l!frÞ
.....
.
9
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jandards for nursing education
raft document prepared by the Ad
)C Committee to Develop Standards
NurSing Education will be
esented at the next meeting of the
ard of Directors.
This document will set forth a
tionale for the preparation of
'andards definitions of terms and
! atements on the various steps to be
ken by educational institutions in the
I ' annlng, Implementation and
Jaluation of nursing education
I ograms
Accompanying this document will
recommendations regarding ways
obtaining feedback on the
cument from Canadian nurses;
VISion and/or modification of the
ocument in the light of this feedback:
lechanisms for CIrculatIng It and
Itrategies intended to help educators
Ilake use of the standards
Members of this committee are
losephlne Flaherty (chairman), Helen
;emeroy (vice-chairman), Denise
)ionne. Helen Glass and Judith
Ibberd
ipecial Committee on Nursing
lesearch presents resolutions
1 report to the Board. the SpeCIal
'ommitee on NurSing Research
resented recommendations on ItS
)Ie relationship with CNA s
esearch and advisory services and
:NA.s role in the promotion of an
,rganization for nurse researchers.
Directors approved the following
tatement of policy on research
repared by the commitee:
. CNA shall use a variety of means
nd resources to collect data in order
) make deCisions. CNA shall utilize
search as one means of carrying out
s mandate.
. CNA shall encourage the research
ctlvlties of member associations.
Idlvldual practitioners and education
nd service agencies.
. CNA shall serve as a spokesman for
Ie profession in relation to research in
ealth services and promote the
rticulation of nursing research with
ther health care research
. CNA shall utilize expert advice on
olicies and activities related to
'searCh
The Board of Directors accepted
Ie committee s recommendation to
ubmlt a resolution proposing that
'NA develop a policy statement on
consumers' nghts In health care using
the Consumers Association of
Canada document. Consumer Rights
in Health Care. as a beginning point for
discussion.
The need for a social conscience
"We need to view rape, not from
Victorian cocoons, but as we view any
other assault." according to a Brief on
Rape prepared by the Provincial
Council of Women of Manitoba and
presented to CNA Directors by MAAN.
(See The Canadian Nurse March
1976 p. 8)
Directors endorsed the brief and
urged immediate action. As a result.
letters and copies of the brief will be
sent to CMA. CHA and other
appropriate associations as well as
member associations of CNA. CNA
will also send the brief to the MInister
of Justice and urge that
recommendations contained in the
brief be considered.
Definition of nursing practice
and development of standards
for nursing practice
In view of the commitment by
members of Ihe CNA Board. to
develop a definition of nursing practice
and develop standards for nursing
practice. member associations have
been asked to identify priorities among
clinical areas requiring urgent
attention. Responses were as follows:
general medicine general surgery,
extended care, psychiatry, community
nursing, emergency, rehabilitation
and obstetrics Member associations
have also submitted names of nurse
experts by clinical area, who may be
called upon to work with the project
director.
Further work on the project will
continue following appointment of a
project director. At that time, related
ongoing work in CNA and member
associations will be coordinated to
assure the efficient completion of this
project.
A resolution from the Board
proposing continuation of this project
will be presented for approval at the
Annual Meeting and Convention in
June.
...
,
\
"
.....
Ad hoc committee to study Bill C68
Directors took several steps in
response to Bill C68, "An Act to
Amend the Medical Care Act," in
relation to federal-provincial cost-
sharing. They recommended that:
1. an ad hoc committee be struck to
study the implications of Bill C68 on
the nursing professIon; 2. all member
nurses' associations be sent a copy of
the bill; 3. an open letter of concern be
sent to the federal-provincial
ministerial conference In April; and
4. CNA contact the CMA, CPHA, and
CHA in order to develop a joint
submission to the proposed bill.
Employment and
unemployment problems
Directors of several member nurses'
associations expressed concern that
nurses were being denied
unemployment insurance payments
or were being asked to accept
alternate employment. ThIs appeared
to be the result of variations in
interpretation of the regulations by
provinCial and local officials.
Directors recommended that
CNA inform the Unemployment
Insurance Commission and Canada
Manpower of problems that have
arisen and ask these agencies to work
in cooperation with member nurses'
associations to find pertinent
solutions.
Special interest groups
Margaret McLean, 2nd vice-president,
reported to Directors on the desire of
special Interest groups to enter into a
formal relationship with CNA. All
member nurses' associations and
most national nurses' associations
were contacted by McLean during her
survey
To date, two member nurses
associations have made provision for
liaison with special Interest groups
(RNABC and NBARN) and a third
(MAN) is studYing the matter. Two
special interest organizations - the
Canadian Association of Neurological
and Neurosurgical Nurses and the
National Committee of
Nurse-Midwives have shown
enthusiasm concerning a formal link
wIth CNA.
CNA liaison
CNA continues to maintain a close
liaison with allied agencies,
organizations and associations.
Several of CNA's liaison activities
were discussed at the Feburary Board
meeting.
The Canadian CounCIl on
Hospital Accreditation has invited
CNA to appoint a second nurse
representative to the Board of
Directors commencing In 1977-
Directors voted to accept the
invitation.
The Gir1 Guides of Canada have
asked thaI consideration be given to
having registered nurses complete
medical record forms for Guides
leaving for camp. Directors agreed
that the medical form should be
revised in the format of a health
assessment form to be completed by
registered nurses. This proposal will
be forwarded to the Gir1 Guides of
Canada.
A request from ICN urged that a
national association thaI sponsors the
entry of another country into ICN
develop a continuing relationship
beyond the act of sponsorship.
Directors agreed that CNA would meet
this request within the limits of
available resources
The Canadian Division of the
International AssoCIation of
Enterostomal Therapists has
requested CNA s viewpoint
concerning the " proposed practice of
enterostomal therapists in Canada
and recognition by the nursIng
profession. Directors will invite
representatives to attend the CNA
Annual Meeting when further
discussion and evaluation can be
sought. Other groups to be invited
include the National Committee of
Nurse-Midwives and the Canadian
Association of Neurological and
Nellrosurgical Nurses.
Instruction on
common tropical diseases
CNA Board voted to support the intent
of a resolution submitted by CPHA
regarding instruction on common
tropical diseases to all nursing ,ence.
students. CNA will encourage
ntreal
schools to integrate this subje drawn
curricula. The growing incic s
tropical disease in some r,tion,\UNSA
Canada has been noted anng 2 \hlp In
JY public health nurses. \
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inflation r..
and 4. the
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will amaze
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NOT SURPRISING.,. 'l'
RETELAST is so comfortable and g ives .
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such fast relief. Moreover. RETELAST
t'
costs up to 40% less than any other . ,
dressing or traditional bandage. i
@ [;1 @) 0 @ PHARMACEUTIQUES LTEE
PHARMACEUTICALS LTD
Laval, Que. Canada
DEMONSTRATION
AND FOLDERS
UPON REQUEST
e\YH
NANS publishes
uide for roles
I
the Registered Nurses ASSOcIatIon of
''\Iova Scotia has published a
eference manual for practisIng
nurses and educators to help clarify
I heir roles In communicating with
Jovemment, administrators and other
lealth professionals.
"A Framework for the Practice of
Nursing - GUidelines and Standards"
was prepared by a speCIal committee
of the RNANS. It is dedicated to "those
! nurses who are contributing so much
to Improving health care in Nova
,Scotia during a difficult period of
Itransition. to help them adjust to
Ichanging roles and expectations."
Work on the guide was completed
by a group of nurses representing
many areas of practice. It includes
advice and comments from the
general membership of RNANS and
contains statements on:
nursing obligations as a health service
in the seventies; what constitutes
nursing: the needs of
individuals/families that can be met by
the profession of nursing; nursing
activities necessary for meeting needs
of individuals/families: designation of
the nursing activities to appropriate
categories of nursing personnel, e.g.
Ihe baccalaureate nurse. the diploma
nurse and the certified nursing
assistant: nursing service standards
that would facilitate nursing practice.
The RNANS points out that "the
framework must not be considered
final, but as a stage for further review"
and hopes that it will be the basis for
other prOJects, such as explonng the
extended role of the nurse in Nova
Scotia.
Bilingual Nursing School
in New Brunswick
A new. nOnintegrated bilingual
institution, Ecole d Inflrmieres de
Bathurst School of NursIng, wIll
become the fifth school of nursing
opened by the New Brunswick
government sInce it began to phase
out hospital schools several years
ago
The Bathurst school is scheduled
to open its doors to 75 students next
September. It will offer two separate
diploma programs, one in English, the
other in French. Director of the school
will be Constance MOrrison, former
director of Chaleur General Hospital
School of Nursing. Assistant director
will be Sister Celine Doucet, a
graduate of Hotel Dieu School of
Nursing in Bathurst and the University
of Montreal, who has been teaching
community health at Universite de
Moncton and working at Foyer Notre
Dame de Lourdes.
The only remaimng hospital
school of nursing In New Brunswick
will graduate its final class this year.
Four other schools with two-year
programs (two English and two
French) are now in operation
Tips on bargaining
The link between collective bargaining
and quality of nursing care must be
recognized and understood by both
the nursing profession and the general
public. according to Toronto labor
relations consultant, Dr. Eric G.
Taylor.
Dr. Taylor was speaking at a
workshop on collective bargaining
sponsored by the Ontario Nurses
AssoCIation and held in Ottawa In
February. The Ottawa meeting was
one of seven similar workshops
organized by the ONA and also held in
London, Windsor, Toronto. Thunder
Bay, Hamilton and Sudbury.
Dr. Taylor. who is resource
person for the series, told Eastern
Ontario nurses that their goal should
be relationship bargaining rather than
adversary bargaining which is always
counter-productive and only results in
loss of public sympathy for the group
doing the bargaining.
He warned nurses at the
workshop that the only way to
successful negotiations is through
effective planning. "You should decide
on your pnonties and then prepare a
timetable. he said. 'Then you should
chart your plan of action as carefully as
you prepare your patient records."
The Ontario Nurses Association
is a province-wIde union set up two
years ago with the assIstance of the
RNAO for the purpose of collective
bargaining.
Students explore
"Images of the Nurse"
Representatives from 20 university
schools of nursing across Canada
were in Kingston, Ontario, February
6,7, and 8 to attend the annual
conference of the Canadian University
Nursing Students AssoCIation, held
this year at Queen's University.
CU NSA is a national organization
for Canadian nursing students in
baccalaureate programs. Their annual
conference is aimed at promoting
student interest in nursing activities,
and gives members an opportunity to
share their ideas and enthusiasm, and
keep up-to-date with the latest
advancements in nursing.
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This year the theme of the
conference was "Images of the
Nurse, . an attempt to answer an
important question for
students, "What can I do with my
B.Sc.N. when I graduate?" An
address by Elizabeth Logan,
Professor of Nursing at McGill
University, was followed by panel
presentations on Nursing Specialties,
Community Nursing, Northern
Nursing, Nursing Education, Nursing
Research and Nursing Administration.
I
After the panel discussions,
experienced nurses from the various
nursing speCIalties were available for
"Buzz Group" sessions.
A symposium on the Nurse
Practitioner, held on Saturday
morning. prompted many questions
Students asked if it were true that
discrepancies in licensing across the
country allow nurse practitioners in
rural areas of some provinces to
practice on their own, while a nurse
practitioner with the same
qualifications in another province is
required to be affiliated with a
physician. Questions were answered
by a panel of five that included M.
Callin, Director of the Family Practice
Nurse Program at McMaster
University. two nurse practitioners, a
lawyer and a family physician.
At the CUNSA business meeting
a new research committee was
formed to promote and index CUNSA
research. Also discussed were
methods of encouraging liaison
between CUNSA and CAUSN
(Canadian Association of University
Schools of Nursing) to promote the
fulfillment of their common goals.
This year's conference was
attended by 348 people and was
funded jointly by the proceeds from
student fund-raising projects the
Ontario ministry of health and the
ft
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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<e, $10,00.
A New Book!
BEHAVIOR AND HEALTH CARE:
A Humanistic Helping Process
This new interdisciplinary text can help students
understand the life-sustaining and life-enhancing
aspects of health care. Perceptive discussions ex-
amine the problems that arise between patients and
health care professionals. The authors define an
advocacy model of human helping to aid students in
coping with problems effectively.
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, $5.80.
iSJues and education
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. The authors provide a
simple, effective approach that shows how to: collect
data, identify patient problems, develop a plan for
nursing care, and evaluate progress. Exercises are
included to help students develop complete problem
lists and writé plans.
By Beth C. Vaughan-Wrobel, R.N., M.S. and Betty Henderson,
R.N., M.N. February, 1976. 152 pages plus FM I-XII, 7Y4" x 101f2",
19 illustrations. Price, $6.85.
New 3rd Edition!
CREATIVE TEACHING IN
CLINICAL NURSING
This new 3rd edition explores the concept of creativity
as an integral part of clinical nursing education.
Focusing on new developments in nursing education,
the text examines a wide variety of teaching ap-
proaches, technological advances, and educational
communication media. The authors explain new ways
for you to use available resources to provide students
with individual learning experiences,
By Jean E. Schweer, R.N.. B.S.. M.S. and Kristine M. Gebbie, R.N.,
M.N.January, 1976.3rdedition,216pagesplusFMI-VIII,7" x 10",
3 illustrations. Price, $8.35.
current practice s eries
A New Book!
CURRENT PRACTICE IN
PEDIATRIC NURSING
This volume of original articles examines the broad
spectrum of roles, theories, and tools of pediatric
nursing today. It discusses the most current therapeu-
tic strategies; specific family needs during fetal
development and early childhood; nursing care of
patients with special problems, and more.
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. 242 pages
plus FM I-XIV, 6%" x 9%", 13 illustrations. Price: $11.05 (hard
cover); $7.90 (paperback).
1:1
A New Book!
CURRENT PERSPECTIVES IN
PSYCHIATRIC NURSING: Issues & Trends
CURRENT PRACTICE IN
ONCOLOGIC NURSING
Thought-provoking original articles and editorial
commentary discuss trends, issues, and new perspec-
tives in psychiatric nursing. Many diverse views and
research findings are represented. Specific topics
include: nurse-physician relationship in terms of the
sexual stereotype; counseling the rape victim; 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, 1976.228 pages plus FM
I-XIV, 6:v.." x 9
4', 9 illustrations. Price: $11.05 (hard cover); $7.90
(paperback).
A New Book!
Outstanding contributors representing 14 cancer
centers in seven states examine new nursing roles in
cancer care - from detection clinic to terminal care at
home. Topics cover: professional awareness; screen-
ing and early detection; therapy; maximizing the
quality of life; and rehabilitation. The nursing process
is emphasized throughout, with pertinent assessment
guides preceding 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. 230
pages plus FM I-XVI, {W4" x 9
4', 2 illustrations. Price: $11.05
(hard cover); $7.90 (paperback).
A New Book!
CURRENT PERSPECTIVES IN
NURSING EDUCATION: The Changing Scene
Examining the dynamic changes and issues of
modern nursing education, this new text focuses on
accountability. Nationally known nursing educators
contribute seventeen stimulating articles that encom-
pass historical analyses and contemporary interna-
tional perspectives. Timely articles include how to:
prepare nurses for new, expanded roles while still
filling traditional roles; meet growing health care
needs while raising the level of education.
Edited by Janet A. Williamson, Ph.D., R.N.; with 18 contributors.
February, 1976. 188 pages plus FM I-X, 63,/4" x 9
4", 12 illustra-
tions. Price: $11.05 (hardcover); $7.90 (paperback).
A New Book!
CURRENT PRACTICE IN OBSTETRIC
AND GYNECOLOGIC NURSING
In this new volume, original articles cover contempor-
ary issues and patient care in community and hospital
settings. Specific topics include: psychological stress
in the last three months of pregnancy; genetic
counseling in maternity nursing; aspects of parent-
hood and the decision not to parent; abortion; and
psychodynamics of the hysterectomy experience,
By Leota Kester McNall, R.N., M.S. and Janet Trask Galeener,
R.N., M.S. February, 1976.254 pages plus FM I-XVI, 63,/4" x 9
4", 39
illustrations. Price: $11.05 (hardcover); $790 (paperback).
IVIOSBV
TIMES MIRROR
THE C V MOSBY COMPANY, L TO
B6 NORTHLINE ROAO
TORONTO ONTARIO
M4B 3E5
16
The Canadian NUI'se April 1976
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Nurses across Canada can expect to
hear more from their provincial
associations about good health and
fitness as a result of a
two-<!ay "Workshop on Fitness and
Lifestyle" at CNA house February 20
- 21. In connection with CNA's health
promotion prOJect, representatives
from all ten provinces and the
Northwest Tenitories attended a
training session that included
participation in fitness tests and
presentations on various aspects of
fitness as a method of disease
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prevention. Under the direction of
Richard Lauzon and Mal Peepre
Bishop from Recreation Canada, and
Lynn Craiq from the Non-Medical Use
of Drugs Directorate, participants took
part In and learned how to administer
..
the Health Hazard Appraisal
questionnaire and the Canadian
Home Fitness Test (step test) in
preparation for planning regional
workshops.
With this experience and the aid
of a grant from Recreation Canada,
representatives will set up a health
promotion program for nurses in their
home-provinces in the coming year.
Presentations included lalks on
fitness and lifestyle, nutntion, and
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fitness tests. In addition,
representatives visited the Human
Performance Laboratory at Ottawa
University and took part In a water
exercise program at Carleton
University.
CNA s health promotion project is
aimed at measuring the "health
status" of individual nurses and
assisting them to change their
lifestyles In a way to promote better
health.
Pictured dOing the step test (from
left to right) are: Brenda Kelleher,
ARNN; Janet Lindquiest, Program
Officer with the Department of Social
Development, Northwest Territories;
Peggy Bentley, RNANS: and Eleanor
Trutwin, RNAO. MUriel Guarette (left)
NBARN, and Dorenda Schoenhaels,
SRNA. take their pulses after the step
test, while Richard Lauzon looks on.
New CCHA guide
The Canadian Council on Hospital
Accreditation has announced
publication of A Guide to
Accreditation of Canadian Mental
Health Services. The Council
describes the publication as "an
essential guide to accreditation for
psychiatric hospitals, mental
evaluation centres and general
hospitals with established services for
mental heallh ..
The new guide replaces
Standards for Accreditation of Mental
Hospitals. Copies are available from
the Canadian Cou.ncil on Hospital
Accreditation, 25 Imperial Street,
Toronto, Ontario M5P 1C1. Cost is
$8.50 per copy or $7.75 for five or
more copies.
A French edition is expected to be
available In the Spring of 1976.
Cardiac '76
Marlelle Vinsant, clinical nursing
teacher from Denver, Colorado, and
co-author of "A Common Sense
Approach to Coronary Care." will be
one of the guest speakers at
Cardiology 76, the third annual
conference on cardiac care In Toronto
in May. Dr Ned Cassem, psychiatrist
from the Massachusetts General
Hospital In Boston, will give the
keynote address on the psychological
aspects of myocardial infarction. In
addition to speeches and workshOps,
the program will include lectures.
seminars, and discussion groups on
current trends in treatment and care.
Information on the program,
registration and accommodation, may
be obtained from Conferences and
Seminars Office, Humber College,
P.O. Box 1900, Rexdale, Ontario.
At every convention there's someone
who fears the chairman will call on him
to speak. At the end of every
convention there's someone who's
irked because he wasn t called upon.
Often it s the same person...
Frontier opportunity
Nurses who would like to work at a
fly-in nursing station In a remote area
of Canada, have until May 1 st to apply
for the 1976 Judy Hill Memorial
Scholarship. The successful applicant
will receive up to $3,500 to fund
postgraduate nurse training with
special emphasis on mldwitery and
nurse practitioner training.
The scholarship fund was set up
in 1974 to honor Medical Services
nurse, Judy Hill, who died as the result
of a plane crash that occurred while
she was escorting Eskimo patients
from her nursing station to
Yellowknife, NWT.
The scholarship is tenable In
Canada, the United Kingdom,
Australia and New Zealand.
Applicants should be fluent In the
English language, possess an RN
diploma or equivalent, and be willing to
work in the Canadian Arctic for a
period of one year after completion 01
their postgraduate work
The scholarship was won In 1975
by Beverley A. Robson, an employee
of the Medical Services Branch of
Health and Welfare Canada. Robson
is now completing a program in
midwifery in Edinburgh, Scotland.
Applications for the current year
should be submitted to Philip G.C.
Ketchum chairman. Board of
Trustees, Judy Hill Memorial Fund,
829 Centennial BUilding, Edmonton,
Alia.
CNF contribution
Money collected from professors anc
classmates of the late Judith Proctor
(R.N.. Vancouver General Hospital
school of nursing, B.N.. McGill
University) has been given in her
memory to the Canadian Nurses'
Foundation. Proctor, an honors
baccalaureate student in nursing
administration, succumbed to a fatal
illness last spring; her degree was
awarded posthumously. Her
professors and classmates chose to
honor her memory this year by
donating money to the Canadian
Nurses Foundation.
Applications for CNF
scholarshIps for the 1976-77 I
academic year must be received by
March 31st.
17
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Pampers construction
helps prevent moisture
from soaking through
and soiling linens. As a
result of this superior
containment, shirts,
sheets, blankets and
bed pads don't have to
be changed as often
as they would with
conventional cloth
diapers. And when less
time is spent changing
linens, those who take
care of babies have
more time to spend on
other tasks.
Keel)S
him drier
Instead of holding
moisture, Pampers
hydrophobic top sheet
allows it to pass
through and get
<<trapped" in the
absorbent wadding
underneath. The inner
sheet stays drier, and
baby's bottom stays
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cloth diapers.
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"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
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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
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The Canadian Nurse April 1976
21
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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
...
......."
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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
"
,
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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
<ample, a comprehensive
<amination for licensing, including an
sessment of the performance of
w graduates, a study of nurses
actisirl-ij in an extended role,
andards of nursing practice and
j UrSin g education; however, the
atients bill of rights remains to be
:Jmpleted. In addition, we must now
I
ke the initiative in responding to the
eeds and interests of members. This
ould entail promoting significant
esearch in nursing and in assuring a
ursing presence in all situations
Jhere decisions affecting nursing and
ealth care delivery are made.
I::;andidate:
:>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
..
}.
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t
i
.,
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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.
...
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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.
-
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--
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'
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,t''{) ,
"
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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
.
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",rdT"'E-:'
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_- 10"'''-
HØ6'TOc:...E1IO"I HØI'
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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
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Tha CanadIan Nwse April 1976
35
Canadian Nurses' Association
Annual Meeting and Biennial Convention
Program Highlights
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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
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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
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23
Photos: Nova ScotIa Commun,cabons
& In'ormabon Centre
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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
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01'5
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.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,
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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"""" ",""'''''' '" "'.
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'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 . .
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o.û""", s,,,,,sû eS _ce"':'
e"''' alSO c" "" ","., ",,,, dO. ",".,1\'"
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o ".,01 """caI\Oo 'so '"'S 's \0 P,oÒ,ct ",.,ds. \0'
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;:
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d'S"''''''''''' '" 'os",,,''',,'' ròo< '0 .ssoSs "'" ,".,
1". '0""'9'_ ar. '" fO< ,os,,,,,ce. e"'''
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;(;, 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""
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"",,'09 ",oieelS as
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s,,,,,,,'d s ,0< o,,'s'o "'. o",SO '0 ",e o><paI' Q\
",.0'-'" s"",., o
"..,," ",,,,,,01\00 proteel. ,
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cD>',SO. ,"e"" .,. b' c .
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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
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. '\918 E.\/ef' \n ls ,-
If' . . ht fold?
'ò,"?;
:.. 8M pcØ
:
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\'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><e. ,
".0"". s,,,,p,,. o",""s ,". p,act"'" 01 o",s"'% ""s
0""...." ,o""""c. "';.SS\OO' SO"'-..."" CO .
COf'\to\ \ne f'U tsl f'9 pt O
The Canadian Nursa April 1976
\
Directors ot CNA, when they met in February, decided to ask membership at the Association's annual
meeting in June 1976 to approve an increase in fees. Realizing that this request would raise questions,
The Canadian Nurse asked Helen Mussallem, Executive Director of CNA, for an assessment ot our
financial situation and an explanation ot the need tor an increase. Here, in question and answer form, is an
excerpt from that interview.
. I" il"
, associa
'O ....\e{'(\el"t
urses .\ to I{'(\Y
, tiOl"a\ I" ortul"l'J ce tn e
, \'Ja s 1"0 I"a \ò be 1"0 099 0u \Ò el"nal"ea\tn care.
I 1\ tn efe tnere \'J Ou . ects tn at \'J ote better n ou lÒ be 1"0
cal"a òa , al"ò prO' I"Ò 9W
tnere \'J ea\<.ol"
, 9r09r
{'(\s
l"ursl1"9 a ssociatlOI", I tn at cou\Ò s91"ee ò \or
....ractlCe 0 ....atiOl"al a tiOl"a\ le\le \Nnel" tn e \ \e\lel
Y. ut a ,. t"'e I"a' siol". :l.iOl"a.
\Nltn o . tiOI" at U' . 9 9 ro \es il"terl"a Ò to 9",e
;
,f
\i
r
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s;
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1"
l"urSl1"90tner 9 rO e sil"9 al"ò tn e u \'Jal"t al"o '? ?
arOse, 1"01"I"U r . .oo'J o . \or 'Jo
I nurse.
il"\or{'(\
tl'
ua\ l"urS
' sgea\<.11"9 indi,"du.a ce(\ail"I'J
tn e II"Ò",I 9ro\esSI
1" CNA to the e but it IS :I. Let's
tn e nea\t
....... p ortant IS òic t tne \uturce il" tn
9a
ð ear\'ý
HoW 10" to 9 re . ....o(\al" 50 s a ere
Q. . òi\\icult {'(\s 0\ t{'(\Y. tn e late òitiOI"S \'J
ura
a
le
":
l
or\<.
òc:aòer
:
i
niI"9
ta\<.e a \
rsiI"9 sa\
r
CNp..
r
a\ òat
il" eJ,,\{'(\atel'ý, a
60'S,. I" benil"ò. al"ò sta tlS ar9ail"l1"9' e ò al"Ò, as
\a99 1 1"9 assistal"
e co\\ecti\l
bia\\'ý_cel"te r l"òitiOI"S
"iÒ es , s 0\ O\lII"C . 9 cO
9'-' ocesse {'(\e 9 r Ò \'Jor\<.11" al"
tne 9 r {'(\ be ca . s al" ca{'(\e
tn iS 9r09r
ses' sa\a ne òucatiOI" be e CNt>.
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<?l"s s,.ne'ý sllOu ca9ab\e O b l e to satlS '1
aSs . tlOI". u\Ò be .\\ be a
ey-a{'(\Il"a . tne'ý silO. Ie al"ò S\I soci eW ' reatest
òirec\iOI", IÒ be\\eY-Ib berS al"ò f CNA's g 'ssu eS .
nOu
{'(\e{'(\ n e 0 uton I
\ne'ý sc\atiOl"s d o arlier that O d S p eaKing 0
eY-g e te e . 9 an :I. 01"
Y Ou sta V nicatln th is? ea\<. ou Ò
Q. mm on \ò s9 Itn al"
roles is c
u elabora
ciatiOI" sn
\eò to n ea e\ateÒ:o
co UI ? Y:l. Inis t>.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
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Uniforms. technical medical and
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CHARLENE HAYNES
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The Cenadien Nurse April 1976
I.J I)I-all-I) ['"I)(lal t...
15. Creighton, Helen. Law every
nurse should know. 3ed. Toronto,
Saunders, 1975. 327p.
16. Davis, A. Harvard. General
practice for students of medicine.
London, Academic, 1975. 111 p.
(Monographs for students of
medicine)
17. Delisle, Isabelle. J'ai Ie goût de
vivre Montréal, Editions du Jour,
c1975. 136p.
18. Donovan, Helen Murphy. Nursing
service administration; managing the
enterprise. St. LOUIS, Mosby, c1975.
271p.
19. Educational Design Inc. Pour
mieux comprendre /'hostilité. Rév.
Traduction française: Claire Catellier.
Québec (ville) Corporation des
Infirmières et Infirmiers de la Région
du Québec, rive-nord, Comité
d'Education, 1974. 31p. (C.I.I.A.Q.,
rive-nord, Enseignement programmé)
20. Forsythe, David P. L'action
protectrice de la Croix-Rouge dans Ie
monde d'aujourd'hui. Genève,
Comité conjoint pour la Réévaluation
du rôle de la Croix-Rouge, 1975. 62p.
(Comite conjoint pour la Réévaluation
du rôle de la Croix-Rouge. Document
de référence No.1)
21. Fuchs, VictorRobert,1924-Who
shall live? Health, economics, and
social choice. New York, Basic Books,
c1974. 168p.
22. Garb, Solomon. Undesirable drug
interactions 1974-1975. Rev. ed. New
York, Springer, 1975. 578p.
23. Hammonet, C. Abrégé de
reeducation fonctionnel1e et de
readaptation, par et J.N. Heuleu.
Paris, Masson et Cie, 1975. 242p.
24. Hardyck. Curtis D. Understanding
research in the social sciences; a
practical guide to understanding
socialandbehavioralresearch, by.
and Lewis F. Petrinovlch. Toronto,
Saunders, 1975. 224p.
25. Hawthorne, Mary E. Community
colleges and primary health care;
Study of Allied Health Education
(SAHE) report by. . and J. Warren
Perry. Washington, American
Association of Community and Junior
Colleges, c1974. 293p. (SAHE
annotated bibliography in allied health
and nursing education: p. 223-293)
26. Hennessy, Peter H. Teacher
militancy' a comparative study of
Ontario, Quebec and New York
teachers. Ottawa. Canadian
Teachers Federation, 1975. 80p.
27. Holdsworth, David J. L'action
d'assistance de la Croix-Rouge dans
Ie monde d'aujourd'hui. Genève,
Comité conjoint pour la Réévaluation
du rôle de la Croix-Rouge, 1975. 83p.
(Comité conjoint pour la Réévaluation
du rôle de la Croix-Rouge. Document
de référence No.3)
28. Hughes, James Gilliam. Synopsis
of pediatrics. 4ed. St. Louis, Mosby,
c1975 1070p.
29. Humanizing health care. Edited by
Jan Howard and Anselm Strauss. New
York, Wiley, c1975. 326p. (Health,
medicine and society)
30. Inman, Ursula. Towards a theory
of nursing care; an account of the
Rcn/DHSS research project "The
Study of Nursing Care". London,
Royal College of Nursing, c1975.
132p. (The study of nursing care
project reports. Concluding
monograph)
31. International Conference on
Alcohol, Drugs, and Traffic Safety, 6th,
Toronto, Sept. 8-13, 1974. Alcohol,
drugs, and traffic safety;
proceedings Ed. by S. Israel starn and
S. Lambert. Toronto, Addiction
Research Foundation of Ontario.
c1975. 939p.
32. Lachèze-Pasquet, Pierre.
Administration. Légis/ation Paris,
Masson, 1975. 71p. (Cahiers de
I'infirrT)ière, 1)
33. Laframboise, Josette. Une
question de besoins. Ottawa, Conseil
canadien de Développement social,
c1975. 529p.
34. --. A question of needs. Ottawa,
Canadian Council on Social
Development, c1975. 497p.
35. Management information systems
for public health/community health
agencies; papers presented at
workshops sponsored jointly by the
National League for Nursing and the
Division of Nursing, Bureau of Health
Manpower, PHS, DHEW, Winter
1974-1975, Omaha, Nebraska;
Boston, Mass., San FranCIsco, Calif.
and Atlanta, Ga. New York, National
League for Nursing, c1 975. 69p. (NLN
Pub. no. 21-1595)
36. Matthews, Vincent L Smoking
behavior and attitudes among
members of the Canadian Public
Health Association, by .. et al.
Saskatoon, Sask., Dept. of Social and
Preventive Medicine, College of
Medicine, Univ. of Saskatchewan,
1975. 70p.
37. Microforms in libraries; a reader.
Ed. by Albert James Diaz. Weston,
Conn., Microform Review, c 1975.
428p.
38. Missen, Janet. Principles of
intensive care for nurses London,
William Heinemann, c1975. 227p.
39. Motivating personnel and
managing conflict. A reader
consisting of eight articles especially
selected by The Journal of Nursing
Administration editorial staff. 1 ed.
Wakefield, Mass., Contemporary
Pub., c1974. 45p (Articles reprinted
from The Journal of Nursing
Administration)
40 National League for Nursing.
Division of Community Planning.
Quality assessment: programs and
process. Presentations from the
March 1974 and March 1975 forums
for nursing service administrators in
the West. Sponsored by the Western
Regional Assembly of Constituent
Leagues. New York, c1 975. 47p. (NLN
Pub. No. 52-1598)
41. --. Division of Public Information.
Health policy making in action: The
passage and implementation of the
National Health Planning and
Resources Development Act of 1974.
Papers by the NLN Summer Study
Fellows in Public Policy. New York,
c1975. 58p. (NLN Pub. No. 41-1600)
42. Nursing clinics of North America.
Toronto, Saunders. 1975. 409p.
Contents: - Restructing maternity
care. - The child with development
disabilities.
43. The Nursing Council of Jamaica.
Report submitted to Minister of Health
and Env/fonmental Control Covering
the period 1st April, 1974 to 31st
March, 1975. (Nurses and Midwives
Act, 1964, Secllon 8(1)). 27p.
44. Nursing Digest review of
maternal-child health, 1975. Ed. by
Eileen Callahan Hodgman. Wakefield,
Mass., Contemporary Publishing,
c1975. 177p.
45. Open Curriculum Conference, 3,
New York, Nov. 7-8,1974.
Proceedings. Edited by Lucille Notter.
A project of the NLN Study of the Open
Curriculum in Nursing Education. New
York, National League for Nursing,
c1975. 250p. (NLN Pub. No. 19-1586)
46. Operation threshold: the first
grassroots manual on the prevention
of alcohol problems. Tulsa, Okla.,
United States Jaycees, 1974. 55p.
47. Order of Nurses of Quebec.
Annual reports, 1974-1975. Montreal,
1976. 58p.
48. Ordre des infirmières et infirmiers
du Québec. Rapport annue/.
1974-1975. Montréal, 1976. 61p.
49. Organisation de Coopération et de
Développement Economiques. La
formation aux professions de santé:
nouvelles orientations adaptees a
/'évolution des sysremes de soins.
Paris, 1975. 101p.
50. Organisation mondiale de la
Santé. Rapport d'un comlté d'experts
de rOMS, Geneve, 9-14 déc. 1974.
Les effets du tabac sur la sante.
Genève, Organisation mondiale de la
Santé, 1975. 108p. (Organisation
mondiale de la Santé. Séne de
rapports techniques 568)
51. Organization for Economic
Co-operation and Development. New
directions in education for changing
health care systems. Paris, 1975. 93p.
52. Parkins, A.A. The basis of clinical
diagnosis, by... and G.D. Pegrum.
New York, Arco, 1975. 290p.
53. Pédiatrie pour tous Par un groupe
de professeurs du département de
pédiatrie de runiversité Laval.
Québec, Les Presses de I'Université
Laval, c1975. 495p. (Enseignement
médical permanent)
54. Peterson, Carol Willts. Teachmg
and evaluating synthesis in an
associate degree nursing program-
a developmental experience, by . . . et
al. New York, National League for
Nursing, c1975. 86p. (NLN Pub. no.
23-1573)
55. Pugh, Eric. Second dictionary of
acronyms and abbreviations; more
abbreviations in management,
technology and information science
Harnden, Co., Archon Books, c1974.
410p. R
56. Reid, Ian. L 'évolution de la
Croix-Rouge. Genève, Comité
conjoint pour la Réévaluation du rôle
de la Croix-Rouge, 1975. 52p. (Comité
conjoint pour la Réévaluation du rôle
de la Croix-Rouge. Document de
référence No.2)
57. Safdie, Moshe. For everyone a
garden. Cambridge, Mass., MIT
Press, c1974. 1v.
58. Schurr, Margaret C. Nurses and
management: what is it all about?
London. English Universities Press,
1975. 83p.
59. Symposium on the Role of Social
Insurance Institutions in Preventive
The Cenadlan Nurse April 1976
51
ledicine, Nancy, 1973. The role of
cial insurance institútions in
eventlve medicme: report on a
IJropean symposium convened by
e Regional Office for Europe of the
orld Health Organization. Nancy
)-26 October 1973. Copenhagen,
egional Office for'Europe, World
'ealth Organization, 1974. 53p.
'0. Talbot, Dianne Bisanti.
.troducing trustees to the modern
Jrsing home. Minneapolis, Minn.,
Ister Kenny Institute, c1975. 27p
1. Textbook of basic emergency
ledicine. edited by Robert H. Miller.
1'1. LoUIs. Mosby, c1975. 233p.
2. Thompson, John D. The hospital:
I social and architectural history,
'y.. . and Grace Goldin. New Haven,
, 'onn.. Yale University Press, c1975.
.49p. R
,;3. Tilkian, Sarko M. Clinical
l1pJications of laboratory tests, by .
Ilnd Mar,! H. Conover. SI. Louis,
osby, c1975. 232p.
ì4. Vleux. Norbert. Manuel de
ecourisme, par. . . et Pierre Jolis.
aris, Flammarion. c1970. 1975.
i47p.
:ì5. Vinsant, Manelle Ortiz. A
;ommonsense approach to coronary
'are: a program, by .' et al. 2ed. SI.
...ouis Mosby, c1975. 228p.
56. Virenque, Christian. Aide
l1edicale urgente. Paris, Librairie
Arnette, 1975. 229p.
67 Williams, Preston P. Obstetrics
3nd gynecology. New York, Arco,
c1975.218p.
68 Yett, Donald E. An economic
3nalysis of the nurse shortage.
Lexington, Mass., D.C. Health, c1975.
324p.
f:ì9. Zlotnicki. Boleslaw, ed. Lexicon
rnedicum: Anglicum, Russlcum,
Gallicum. Germanicum, Laticum,
Polonum. Warsaw. Polish Medical
pub., 1971. 1603p. R
PAMPLETS
70. Amencan Nurses' Association.
Accreditation of continuing education
Drograms preparing nurses for
expanded roles. Kansas City,
American Nurses' Association c1975
23p.
71. Brenton, Myron. Playmates: the
Importance of childhood friendships.
New York, Public Affairs Committee,
c1975 24p. (Public affairs pamphlet
no. 525)
72. Choquette, Gaston. Medecine
preventive et activite physique.
Centre EPIC. Premier centre
canadien de mèdecine préventive et
d activité physique. Montréal,
Fondation EPIC, 1975. 10p.
73. Colloque national sur la politique
d'immigration, 22-24mai 1975.
Immigration 1975-2001. Rapport
du. , Toronto, I'Assoclatlon
canadienne pour I education des
adultes, c1975. 44p.
74. Dionne, Denise Comportemenrs
relies a ['expression verbale de
malades aphasiques de broca a
['occasion d'activltes nursmg.
Conférence presentee au Congres
canadien des infirmlères en nursing
cardiovasculalre, Montreal, 22
ct.,
1975. Montreal, 1975. 34p.
75. National Conference on
Immigration Policy. May 22-24, 1975.
Immigration 1975-2001. Report of
the. . . Toronto, Canadian Association
for Adult Education, c1975. 41 p.
76. National League for Nursing.
Scholarships, fellowships,
educational grants and loans for
registered nurses. New York, c1975.
9p. (NLN Pub. no. 41-408)
77. --. Scholarships and loans for
begmnmg education in nursing. New
York, c1975. 13p. (NLN Pub. no.
41-410)
78. -. Biennial Convention, New
Orleans. May 18-22, 1975. Quality
assurance - a Joint venture: papers
presented at an Open Forum
sponsored by the Council of
Baccalaureate and Higher Degree
Programs, The Council of Home
Health Agencies and Community
Health Services, and the Council of
Hospital and Related Institutional
Nursing ServICes at the N.LN.
Convention, New Orleans. New York,
National League for Nursing, c1975.
20p. (NLN Pub. no. 15-1595)
79. National League for Nursing.
Depl. of Associate Degree Programs.
Selected bibliography on associate
degree nursmg education 1975-1976.
New York, c1974, 1975. 16p. (NLN
Pub. no. 23-1369)
80. Patients Rights Association.
Constitution. Zephyr, Ontario, 1975,
15p.
81. Registered Nurses Association of
British Columbia. Readership survey
of RNABC news: summary of
findings. Conducted by Aidan
Ballantyne. Vancouver. 1975. 13p.
82. Shiller, Alice. Drug abuse and
your child. New York, Public Affairs
Committee, c1970. 28p. (Public affairs
pamphlet no. 448)
83. Sister Kenny Institute,
Minneapolis, Minn. About stroke.
Minneapolis. Minn., c1975. 38p.
(Sister Kenny Institute Rehabilitation
pub. no. 724)
84. Tiedt. Eileen. Concept framework
curriculum for nursing education: a
systems model for curricular design
and management. A paper presented
at the workshop Conceptual
Framework: a model for nursing
education. Wayne State University,
February 22, 1975. 16p.
85 United Nations. General
Assembly. Special Session, Seventh,
Tropical
and
Parasitic
Diseases
t -12th Sept. 1975. Issues and
background. New York, United
Nallons, The Centre for Economic and
Social Information/OPI. 1975. 43p.
86 Walsh Margaret E. Why nursmg
education programs should be
accredited. New York, Division of
Nursing, National League for Nursing.
c1975. 12p. (NLN Pub. no. 14-1597)
87. Yura, Helen. One decade of
accreditation statistics 1964-1974.
New York, Depl. of Baccalaureate and
HIgher Degree Programs, National
League for Nursing, c1975. 28p. (NLN
Pub. no. 15-1577)
GOVERNMENT DOCUMENTS
California
88. Wine AdvIsory Board. Uses of
wine in medical practice. ged. San
Francisco, Wine AdvIsory Board,
1975. 72p.
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 the 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 below, or telephone (416) 494-8900.
t;jIIIW SENECA COLLEGE
=' OF APPLIED ARTS AND TECHNOLOGY
,.., -
Il';').!rIoHfPpo\RI) .\\I'lJI t-\S,1 \\1110\\1)..\11 O,I.\IUO ""
tl.lI:l
S2
The Canadian Nurse Apñl 1976
I.J I).. ill.!J [".)(1 il t t>>
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.
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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-
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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
,
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: 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
':
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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<lered Ptolonged use 01 antoboot,cs may resub ., the
OYergrowth of nonsuscePht?le orgarusms. InCludmg fungi
Appropnate measures ShOuld.1?f? taken If thIS occurs
Do811118' A slngla layer 10 be applied d..eclly 10 Ihe wound
and covered with an appropnate dressang It e
udatlve
dressings ShOUld be changed a1 laast da.y In case 01 leg
ulcers cut dressing accurately to sIZe of ulcer and when
.,Iecled stage has cleared. replace by non-rnpregnaled
dressong
Supplied, A "ghrw"'gnr. par a"'" gaUl" d.essong rnpreg
naled wnh 1'16 Iramycebn SUlphate B P Sotra-Tulla alSO
contains anhydrous lanolin 9 9596 Avadable tn 2 Sizes. 10
em b
10 em sler.e Single unIts canons ot 10 and 50. to
em by 30 em sterile single units cartons of 10 Store at
controUed room temperature
62
l"
When you are
asked about
nursing care...
Health Care Services Upjohn
Limited can assist you and
your patients by providing
qualified Health Care Person-
nel for:
. Private Duty Nursing
. Home Health Care
. Staff Relief
We are a reliable source of
nursing care with whom you
can trust your patients. Our
employees are carefully
screened for character and
skill, then insured (including
Workmen's Compensation),
bonded and made subject to
our high operating code of
ethics.
Your patients' care and well-
being are our business.
If you would like more informa-
tion about our services, call the
Health Care Services Upjohn
Limited office nearest you.
l:!:J
It
Health Care Services
Upjohn Limited
(Operating in Ontario as
HCS Upjohn)
Victoria. Vancouver. Edmonton
Calgary. Winnipeg. Windsor. London
St Cathannes. Hamilton. Toronto west
Toronto East. Ottawa. Montreal
Trois R iVleres . Quebec. Halifax
The Canadian Nurse Apnl 1976
Co-ordinator
Co-ordinator required for a 340-bed acute
care hospital in Central British Columbia
to be responsible for the related services
of the a.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
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 NAB.C. Contract:
Salary per RNABC Contract.
Shift differential
Apply to:
Director of Nursing
Prince George Regional Hospital
Prince George, B.C.
REGISTERED NURSE
required for general and operating
room duties at small, general
hospital.
Apply in writing to;
Miss Catherine McFarlane
Paddon Memorial Hospital
International Grenfell Association
Happy Valley, Labrador
AOP 1 EO
-----
I
...... l
.A
.
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Don't be afraid of me
even if you are not a
psychiatric nurse
(You can learn
to be one!)
If you are interested in finding out
about a speciality that is different,
challenging and very worthwhile, you
may be the person we are looking for
and you are invited to join a 9 month
POST-GRADUA TE course in
Psychiatric Nursing.
Our programme is designed
especially for R.N.'s, whether you
desire a stepping stone or further
expertise in Mental Health.
The course includes theory and
clinical experience in hospital and
community settings with stress in the
primary therapist concept,
successful completion leads to
eligibility for licensure with the
R.P.N.A.M.
Our Nursing is progressive and
challenging, with a deserved
reputation for professionalism. There
are wonderful opportunities for
nurses at every level of care. . . . The
top education and practice for people
like you.
Successful candidates may apply for
financial assistance through various
bursary systems.
Our countryside is unbeatable with
beautiful lakes and parks. Summer
and winter sports are readily
accessible.
For further information please write
no later than June 15, 1976 to:
Director of Nursing Education
School of Nursing
Brandon Mental Health Centre
BRANDON, Manitoba.
R7 A 5Z5
MANITfiBA
CIVIL SERVICE COMMISSIO
The Princess Margaret Hospital
A leading centre for cancer treatment and research in central
Toronto is now inviting applications for an opening in Spring,
1977, for the position of
Director of Nursing
This is a senior administrative position requiring someone with
organizational skills, sensitivity to the special needs of cancer
patients, and an innovative approach to patient care.
Responsibilities include planning for an expanding nursing
service and the directing of a staH of approximately 200.
Applicants should be university graduates with Ontario
registration, a minimum of four years' clinical experience in
Nursing, and a proven background in Nursing Administration
Please write in confidence, outlining background and
qualifications, to
G.H. Hayley
Administrator
The Princess Margaret Hospital
500 Sherbourne St., Toronto, M4X 1K9
THE COMMUNITY HEALTH DEPARTMENT
OF The Hospital of Hauterive
REQUIRES A NURSE TO ASSUME
RESPONSIBILITY FOR THE EXECUTION
OF ITS PROGRAMS IN PUBLIC HEALTH
Area to be served
Kegaska to Blanc-Sablon (Lower North Shore of the Gulf of the St
Lawrence)
Base Chevery
Principal Duties
. Determine the specific needs of the Lower North Shore with the
intention of setting up new programs in public health or modifying
those already in existence;
e Collaborate with colleagues at the Community Health Department
of Hauterive in setting up new programs in public health or
reorganizing already existing programs;
. Supervis
and evaluate the execution of those programs in
progress in the assIgned area;
. Evaluate the education needs of the nursing personnel of Lower
North Shore dispensaries and contribute to setting up continuous
training programs as well as orientation programs for new
employees.
Requirements
. A strong interest in public health;
. Experience in out-post nursing;
. A sense of leadership, teaching skill, and ability to work well with
others;
. Ability to direct group work;
e A good sense of organization and steady work habits;
. Fluency in French and English.
Salary
According to the norms of the Ministry of Social Affairs Vanous
premiums and bonuses.
Write and send cu"iculum
ltae to:
Service du Personnel,
Hotel-Dieu de Hauterive,
635, boul. Joliet. Hauterive, P.Q, G5C-1P1
'"e {;ana(]lan Nurse Apnl1976
Ii;!
UNIFORMS
When visiting Vancouver, B.C.
image uniforms inc.
"Professional Career Apparel"
We feature a complete collection
of sizes and colors for men and women
2 stores to serve you
or write:
734 West Broadway, Vancouver, B.C.
Tel: 604-879-3315
Cariboo Shopping Center
435-J. North Rd.,
Coquitlam, B.C.
Tel: 604 - 939-4555
Chargex
Master Charge
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 M
dical or Surgical
General Wards, or in some of the
Pediatric Specialty areas.
They abound in our clinics and their
numbers increase daily in our
Emergency.
If you do not like working with children and
with their families, you would not like it
here.
If you do like children and their families.
we would like you on our staff.
Interested qualified applicants should
apply to the:
Director of Nursing
Montreal Children's Hospital
2300 Tupper Street
Montreal 108, Quebec
64
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health
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with Canada's
federal public
servants.
. * Health and Welfare Sante eI Blen-etre social
Canada Canada
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,---------------
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 career I
I opportunities in this serVice I
I Name: I
I Address: I
City: Prov: _
_______
_______J
The Canadian Nurse April 1976
Index to
Advertisers
April 1976
Burroughs Wellcome & Company
Department of National Defence
Designer's Choice
East African Travel Consultants
Equity Medical Supply Company
Hampton Manufacturing (1966) Limited
Health Care Services Upjohn Limited
Hollister Limited
ICN Canada Limited
Image Uniform Inc.
J.B. Lippincott Co. of Canada Ltd,
MedoX
The C.V. Mosby Company Limited
Nordic Pharmaceuticals Ltd.
Proctor & Gamble
2
55
5
52
53
18
62
7
43
63
31,32,33.34
54
12, 13, 14, 15
10
17
Reeves Company 49
Roussel (Canada) Limited Cover IV, 61
W.B. Saunders Company of Canada 1
S eneca C ollege o f Applied Arts & Technology 51
Uniforms Specialty Cover III
Uniform s Registered 48
White Sister Uniform, Inc. 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.
1m.;]
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The Canadian Nurse
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Sizes 7 - 15
Royale Corded Tricot
White, Mint, 3-piece. . . . . .about $32
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Royale Seersucker
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White, Mint. . . . . . . . . . . . .about $2!
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See our new line of Whites and Water Colours at fine stores across Cana
New
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Oan-Gard is really two preparations
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treatment and a rich, pleasantly
scented deep cleansing shampoo.
Oan-Gard contains an exclusive
combination of ingredients in a
formula so well balanced it can be
used as a regular shampoo leaving
your hair soft and manageable.
New Oan-Gard in the handy
finger-grip bottle is available at your
drugstore. Try it.
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For full product information, see page 55
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NT
NE.
Only ACTIFED combines pseudoephedrine HCI
with triprolidine HC!. the potent antihistamine
discovered in The Wellcome Research Laboratories
Orally effective, ACTIFED reaches areas nose
drops can't-for long-term symptomatic relief of
allergic and vasomotor rhinitis, the common cold,
hay fever and allergic asthma.
ACTIFED. The different one for initial treat-
ment; the different one for patients who've grown
tolerant to other antihistamine combinations.
the year-round way to stop
sneezes and sniffles
ACTIFED
Tablets/Syrup
Triprolidine HCI/Pseudoephedrine HCI
o
"
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576
Input 6
News 10
Calendar 16
Names and Faces 41
What's New 42
Research 48
Books 50
Library Update 52
The Canadian Nurse
The official journal of the Canadian
Nurses' Association published
monthly in French and English
editions.
Volume 72 Number 5
Transport of Neonates:
A Matter of Prevention
The Handmaiden Is Not Dead
What Does the Quality
of Life Mean to You?
Habitat: Quality of Life
On a Global Scale
12-Hour Psychotherapy
Why?
living with Cystic Hygroma
M Johnson
J Gash 19
F.J.O. Logan 25
Marie-Andrée Bertrand 26
G Rowsell, L Besel 27
Claire Marcus 28
S. Hill, M. Hoch 30
Anonymous 35
C. Brown 37
.
---
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A dramatic moment in the life of a
newborn baby is caught by a
photographer from The Hospital for
Sick Children in Toronto and featured
on this month's CanadIan Nurse
cover. The nurse in the picture is
Janice Gash, co-author of Transport
of Neonates: a Matter of Prevention.
--
,.
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 Drrveway, 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 provinciall
territorial nurses association where
applicable. Not responsible for
journals lost in mail due to errors in
address.
Postage paid in cash at third class rate
Montreal, P.O. Permit No. 10,001.
eCanadian Nurses Association
1976.
...-
4
.......81)...(.1 i ,.(-
The Canadian Nurse May 1976
I
They didn't look much like butterflies...
especially in the heavy coats and high
boots that go along with a late spring in
Ottawa. Many of them were young; at
least one had solved her baby-sitting
problem by bringing the youngest
member of the family along. Their
faces reflected concern and, when
they spoke, there was emotion in their
voices, They looked like people who
might get up while it is still dark to work
an eight-hour shift or go off to work in
the evening when everyone else is
getting ready to call it a day. They
looked like people who spend
weekends as well as weekdays caring
for other people.
That's why it was startling to hear
one of the more than 700 nurses at a
mass rally in the national capital warn
her colleagues that they should
beware of turning into "color-coded
butterflies who have neither names
nor titles." On second thought,
however, the warning was both timely
and appropriate. The meeting had
been called to discuss cutbacks in
spending in the health care field in
Ontario and the effect of these
measures on the nursing profession.
The 'butterfly warning" was based on
the observation of one of the nurses
present that. in at least one local
hospital, there were Indlcalions of a
trend towards the identification of
different categories of health workers
only by color-keyed badges designed
to indicate their respective levels in the
hospilal hierarchy.
The speaker pointed out that if
everyone responsible for patient care
- nurses, nursing assistants,
technicians, technologists, dietitians
and therapists - dressed in look-alike
pastel uniforms, with no visible
symbols of their occupation, it would
be difficult for a patient to decide just
who to ask for what.
The problem goes deeper than
the relatively insignificant issue of
what the well-dressed nurse should
wear to work, or even the attempt
declare the traditional cap and pin
obsolete. There seems to be a
growing need for nurses to protect
their professional identity in other
ways as well- to recognize and
reflect their unique contribution to the
health care system.
As budgets become tighter it
seems inevitable that the status
nurses have worked so hard to
achieve will be increasingly
threatened by inadequate staffing
patterns and that pressure will be
exerted on RN's to delegate some of
the responsibilities their experience
and education have prepared them to
accept. Already, there are hospitals in
Ontario that have published lists of
medications that may be admin Istered
by RNA's. The notion that RN's no
longer have the time to provide the
direct patient care involved In
"bedside nursing' has become
increasingly common among
members of the general public.
Is the role of the nurse to be further
eroded by pragmatic solutions to
budgetary problems?
It seems to me that unless nurses,
through their professional
associations and bargaining Units
make the hospital administration
aware of their absolute rejection of this
kind of solution to demands for
reductions In health care costs, they
are In danger of losing their
professional identity and of
contributing to lower standards of
nursing care.
-MAH.
.......... i 11
Next month. a nurse whO has
worked closely with many victims of
breast cancer talks about the role of
the health care worker in the detection
and treatment of the number one killer
of Canadian women in the 35 to 50
age group.
Author Ada Butler, an assistant
professor at the school of nursing,
University of British Columbia, says
that the nurse who responds in a
sensitive and rplevant way can do a
great deal to improve the length and
quality of life of patients who are
threatened by this disease. In next
Editor
M. Anne Hanna
Assistant Editor
Carol Thiessen
Production Assistant
Mary Lou Downes
Circulation Manager
Beryl Darling
Advertising manager
Georgina Clarke
CNA Executive Director
Helen K. Mussallem
month's feature article, she gives
some helpful advice on understandin
the common problems faced by
women with breast cancer.
A Toronto pedialrician claims "a goo
incubator and a specially trained
nurse can make all the difference
between life and death or between
healthy or defective individual later
life," Dr. Graham Chance told the
Clinical Research Society in that ci
recently that a study of newborn
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babies under four pounds admitted t
the Hospital for Sick Children has
shown conclusively that ex pert care i
transporting these babies from one
hospital to another can save lives,
avert permanent injury and reduce
time in hospital by half. Two nurse:
from the Hospital for Sick Children
describe the planning and techniql
involved in this expert care on page I
of this issue of The Canadian Nurs
I
Your patients
will amaze
you . . .
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Your patients will be back to normal in no \'",
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time and ready to start their activities as if ""
' Jr. , .
nothing happened, .,.,!,
'
NOT SURPRISING ,,'
RETELAST is so comfortable and gives : 1 . J I '
such fast relief. Moreover, RETELAST
t'
costs up to 40% less than any other j : ,
dressing or traditional bandage, I
@ ru @) 0 @ PHARMACEUTIOUES LTEE
PHARMACEUTICALS LTD
Laval,Oue. Canada
DEMONSTRATION
AND FOLDERS
UPON REQUEST
...-
6
The Canadian Nurse May 1976
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.
111))u1
The caring profession
I wish to comment on two articles
in your journal of January, 1976. Joy
Ufema must be a wonderful nurse who
doesn't have to hide behind a uniform
to keep her self-respect, but can be
simply a 'caring' human being by
sharing her tears with a patient.
A nurse may not really learn how
to give complete care to a dying
patient until she has gone through a
death of a loved one and/or analyzed
her own feelings. After I nursed my
terminally ill mother, I was more able to
assist my patients who were dying or
had lost a loved one.
May I also congratulate the
authors. McGreevy and Van
Heukelem for their excellent essay,
"Crying: The Neglected Dimension."
Their statements ring true from
personal expenence: some patients
tend to recover after crying. And
therapeutic crying, considered
'unprofessional,' is not usually in
nursing school curriculae.
I couldn't agree more that the
nurse must help the patient maintain
self-esteem. Naturally, it is easier for
the nurse to identify the unmet
physical or emotional needs of the
patient that result in crying. But how
difficult for a nurse to Identify a
patient's unmet spiritual needs.
On the admitting sheet of our
charts, there is a line to fill.n: does the
patient wish his minister to be notified?
Once I was very happy to see how
beneficial this visit was to an anxious
FURS MUCH BELOW
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Cut down the high cost, avoid
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BUDGET if you wish at no
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Manufacturers of
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119 Spadina Avenue
Toronto, Onto
M5V 2L 1
Tel.: 363-7209
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teenager undergoing surgery the next
day. Normally that surgical procedure
is quite painful but her minister's talk
and prayer did more for that patient in
getting well faster, than a whole week
of narcotic pills so easily handed out
on order.
- Yvonne Birrell, R.D.H, R.N.,
Stayner, Ontario.
R.N.'s - Obsolete?
A pharmacy department in one of
our local hospitals recently published
a list of approved medications that
Registered Nursing Assistants will be
allowed to administer to patients.
I believe that this decision is a
portent of things to come: Registered
Nurses will become obsolete.
R.N.A. 's are often hired now in
preference to R.N.'s, mainly because
of budget, but, R.N.'s had a
stronghold. Many procedures (one of
which was giving medication) could
only be performed by R.N.'s. Now with
R.N.A.'s being able to give
medications (no matter how
insignificant they are and no
medication IS insignificant), R.N. 's are
losing their expertise or their "raison
d'être."
Why should one bother to spend
the time and money to become an
R.N. when, with less time and money
-<>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
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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
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physiology and the role of DNA and RNA In heredity and life-functions.
Tissue structure. appearanæ and function are described: each of the
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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
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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-
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on observation oj anxiety. assessing the miheu. theoretical approach. crisis
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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
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By Thora Kron. RN. BS Aboul290 pp llIustd Solt cover Aboul $5.15 JUSI Ready
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PRACTITIONER
This brand new text is ideal for developing your skills in interviewing,
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By Dee Ann Gillies. RN, EdD. Asst Dlreclor 01 the Dept 01 Educabon Health and
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Falconer. Patterson & Gustafson: CURRENT DRUG
HANDBOOK 1976-78
You'li find the most recent clinical information on about 1.500 drugs in
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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
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From chemical conversion of food-to modem diet planning. purchasing
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appendix includes an alphabetical listing of modified diets (A Teacher's
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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
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New 3rd Edition
Designed to equip the student aide with a working knowledge of good
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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
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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.
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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
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LISTER BANDAGE SCISSDRS
3V," MIIt-lCissv. Tiny, handy, slip into
uniform pocket or purse. Choose ,ewelers
L loid or Ileam'III chrome plate finish
No. 35OO3W' Mini........ 2.75
No. 4500 4h" size. Chrome only. ..2.95
No. 5500 5 11 2" size, Chrome only. . . 3.25
No. 702 7V." size, Chrome only. ..3.75
For enlnved initials add 50, per Instrument
5Yz" DPERATING SCISSORS
Polished Sta,nl... Sleel, stra'lht blodes
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No. 706 Sharpl Sharp points. . . 2.95 '
No, 71041'2" IRIS Scis., StraiBht. . . 3.75
For enenved initials aIJd 50, per instrument
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So handy for every nurse! Ideal for clamping
NO.o
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MEDI-CARD SET Handiest reler
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Nurses' POCKET PAL KIT
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Handiest for busy nurses. InGludl!s white I
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plus handsome little pen light . aU silwer
fimshed Change compartment key chain
No. 291 Pal Kit. . . 6.50 ea.
Initials enlnved on shurs. add 50..
? TIMEX Pulsometer WATCH
Dependable T,me. Nurses' Pulsometer/Calendar Watch.
Moveable ooter ring compules pulse rile Vate calen-
dar, wh.te numerals, sweep-second hand. blue dial.
lumtnous, white strap. Stainless back. water InCI dust-
resistant. Gift-bored. I year warrantee. limais en,TDd
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No. 237761 Nurses' Watch, , . , . 17.95 ea.
PIN G U A R D Sculptured c.....eus, cham ed '" :;:,
to your profess,onal letters. eact! with pinbackl _ -
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No. 3420 Pin Guard. . 2.95 ea,
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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?
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Mail to: The Canadian Nurse, 50 The Drivewav, Ottawa K2P 1 E2
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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 '
---
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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
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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
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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
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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.
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.
,
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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'
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Glenna Rowsell
"
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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
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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
,,
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-
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.
--
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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.
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satisfied you may return them within 15 days for full credit.
Prices subject to change without notice.
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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,
, '.
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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.
-
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"', -. 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
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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)
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The Canadian Nurse May 1976
Catherine Brown
37
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Every mother must from time-to-time cope
with illness in her child - part of her is always
a nurse. For this mother of a child with special
health problems, nursing is a 24-hour a day
challenge. In this personal account she
describes some of the feelings of parents who
have to cope with this type of nursing care.
A few weeks ago, I was talking with other
mothers about an endlessly absorbing topic:
our children. We were discussing our fears
about illness. One woman said, "I know it's just
a superstition. but I put an evil eye in my baby's
bed, just to help ward off sickness." Another
confessed, "Sometimes I think of all the
horrible accidents that might happen to my
baby, and I just shudder!" "Yes," everyone
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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
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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
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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.
'-
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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
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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
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Toronh Ontario M ;-
N'11111es
Tha Canadian Nurse M8y 1 g76
1111(1 Faces
41
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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.
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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.
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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.
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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.
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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
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coupon.
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STETHOSCOPES
'I R"FS STETHOSCOPES", S
COWvTl. Ezceptionalaovnd
Ira......i..l0... od]1Ulable
lightweighl bina..raú:
replacemenl part. avadable
in Dmadß. 1I
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Gold, 1I
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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
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IJ.ne ofGerman,,'s/tnest
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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.. ,
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."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),
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:\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
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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.
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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.
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Send your order today!
Enns and Gilmore
2276 Dixie Road
Mississauga, Ontario,
Canada l4Y lZ5
(416) 274-2575
9.0
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P_II. RII'\ 72ti-"_ ßRII{'I\ \ III'" "' T. 1\6\ 5\ S.
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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
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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
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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"
\
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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<ed Bodice
90% Polyester. 10% Nylon
Colours: White only
Sizes: 3,t9
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Give students ·
the kind of lealnlng that lasts.
. .
Supplement your instruction with new Mosby texts that
answer questions on every facet of nursing from fundamental
concepts to specific care techniques
I
fundamentals/basic science
New 7th Edition! AN INTRODUCTION TO PHYSICS IN
NURSING. By Hessel Howard Flitter, R.N., Ed.D,; with 1
contributor. This updated edition applies fundamental princi-
ples of physics to patient care, therapeutic procedures,
equipment. and more. May, 1976. Approx. 320 pp., 180 illus,
About $8.95.
A New Book! NATURAL AND SYNTHETIC ORGANIC
MEDICINAL COMPOUNDS. By 0, LeRoy Salemi, Ph.D.
Defining medicinal chemistry in an easily understood manner,
this well-organized text examines both physiological
mechanisms and practical applications. March, 1976,328 pp.,
28 iIIus. About $10.45.
47
MOSBY
medical/surgical
New 2nd Edition! REVIEW OF HEMODIALYSIS FOR
Nt:RSES AND DIALYSIS PERSONNEL. By C. F, Gutch,
M.D. and Martha H, Stoner, R.N., M,S. In a question-and-
answer format. this new edition presents the most current
information on dialysis techniques. standards. equipment.
etc. June. 1975, 276 pp" illustrated. Price, $8.95.
A New Book! CLINICAL LABORATORY TESTS: A Manual
for Nurses. By Marcella M. Strand, B.S .N" R.N. and Lucille
A. Elmer, B.S. in M.T., M.T. (A.S.C.P.). This new manual
will help students transcribe physicians' orders, explain tests
to patients, collect laboratory specimens, etc, March, 1976.
126 pp. Price, $5.50.
A New Book! PATIENT CARE STANDARDS. By Susan
Martin Tucker, R.N., BoSoN., P.H.N. et ai, This first-of-its
kind book presents Patient Care Standards to help nurses
plan. implement. and evaluate nursing care. More than 400
Standards are included. September. 1975. 442 pp., 71 iIIus.
Price, $13.55.
maternal/child
Ne.... 2nd Edition.' TEACHING CHILDREN WITH DE-
VELOPMENT AL PROBLEMS, A Family Care Approach. By
Kathryn E. Barnard, R.N.. B.S.N" M.S.N., Ph.D. and
Marcene L. Erickson, R,N., B,S.N., M.N, This new edition
presents the rationale and process of nursing care of disabled
children. March. 1976. Approx. 184pp., 16illus. About $6.35.
family nursing
Ne.... 2nd Edition! FAMILY NURSING: A Study Guide. By
Ð'elyn G. Sobol, R.N" A.M. and Paulette Robischon, RoN.,
Ph.D, Updated discussions and new case studies help
students explore clinicaJ application of family nursing
techniques, June, 1975. 196 pp. Price, $7.90.
critical care
New 3rd Edition! THE HUMAN HEART: A Guide to Heart
Disease. By Brendan Phibbs, M.D" F.A,C.P., F.A.C.C.; with
5 contributors. This practical text describes essential facts
about the heart: how it works, what makes it beat. what that
beat accomplishes. etc. July. 1975. 294 pp., 180 illus. Price,
$8.35.
A Ne.... Book! PSYCHOLOGICAL ASPECTS OF MYOCAR-
DIAL INFARCTION AND CORONARY CARE. Edited by W.
Do}'le Gentry, Ph.D. and Redford B. Williams, Jr., MoD,;
....ith 8 contributors. This new text covers psychological
aspects of myocardial infarction from symptom onset through
rehabilitation, June. 1975. 176 pp.. 8 iIIus. Price, $7.30.
A New Boo!"! CARE OF THE CARDIAC SURGICAL
PATIENT. By Ouida M, King, R.N.: with 6 contributors,
Emphasizing pre and post-operative care. this concise text
offers complete information on cardiac disease - from
physiology to specific nursing techniques. August, 1975. 292
pp., 175 ilIus. Price, $13.60.
Nel'.' 3rd Edition! COMPREHENSIVE CARDIAC CARE: A
Text for Nurses, Physicians, and Other Health Practitioners.
By Kathleen G, Andreoli, R,N., B,S,N., M,S.N. et al.
Updated and expanded. this new edition continues to stress
prevention of cardiac arrhythmias and early rehabilitation.
September, 1975. 368 pp., 959 illus. Price, $7.90.
TIMES MIRROR
Issues, ttends & admlnlsttatlon
A New Book! CREATIVE HEALTH SERVICES: A Model for
Group Nursing Practice. By Rothlyn Zahourek, RoN" M.S.;
Dolores M. Leone, R,N., M,S.; and Frank J. Lang, R.N.,
M.S. This unique new book recounts the experiences of a
group nursing practice; and offers guidelines and evaluations.
May, 1976. Approx. 144 pp.. 2 illus. About $6.85.
A Ne.... Book! QUALITY ASSURANCE PROGRAMS AND
CONTROLS IN NURSING. B
' Doris J. Froebe, R,N., Ph .D.
and R, Joyce Bain, R,N., Ed,D, Based on systems and
management principles. this current text thoroughly
examines control and evaluation <;ystems used in nursing.
September. 1976, Approx, 192 pp.. 63 iIIus. About $6.55.
A New Book! MANAGEMENT FOR NURSES: A Multidiscip-
Unary Approach. By Sandra Stone, M,S.; Marie Streng
Berger, M.S,; Dorothy Elhart, M.S.: Sharon Cannell Firsich,
M.S.: and Shelley Baney Jordan, M,N. This new text
discusses leadership/management concepts from various
disciplines (business. behavioral science, etc.), January,
1976. 292 pp., 24 ilIus. Price, $8.70.
New 6th Edition! RIGHT ANDREASON: Ethics in Theory and
Practice. By Austin Fagothey, S.J. In this new edition.
throught-provoking material examines contemporary ideas
on women's roles; education; environmental responsibilities:
death; and trade, March, 1976.500 pp.. I illus. Price, $13.15.
behavioral science
APPLIED BEHAVIOR MODIFICATION. Edited by W.
Doyle Gentry, Ph,D. Covering both physicaJ and mental
disorders. this uni.:jue text examines different behavior
modification techniques applied to a variety of settings. 1975,
180 pp., 4 iIIus. Price, $6.60.
practical nursing
New 5th Edition! STRUCTURE AND FUNCTION OF THE
BODY. By Catherine Parker Anthony, R,N., B.A., M.S. and
Irene B. Alyn. R.N.. Ph.D. Revised and expanded, this
popular text includes new chapters on cells, tissues, organs,
and systems; fluid and electrolyte balance; and acid-base
balance. April. 1976. Approx. 240 pp.. 118 illus.. 31 color figs.
About $8.35 (hardcover); about $6.05 (paperback).
IVIDSBV
TIMES MIRR:JR
THE C V MOSBY COMPANY, L TO
86 NORTHLINE ROAD
TORONTO. ONTARIO
M48 3E5
48
The Canadian Nurse May 1976
Resumés are based on studies placed
by the authors in the CNA l.Jbrary
Repository Collection of Nursing
Studies.
l\eseal-C)1
Reid. Una Viviene, A Survey of
Resources for Continuing
Education In Nursing in
Northeastern Ontario.
Vancouver, B.C., 1975. Thesis
(M.S.N.) University of British
Columbia.
This descriptive study focuses on
resources for continuing education in
nursing in Northeastern Ontario and is
concerned with the establishmenl of a
continuing education program for
nurses In that area within the
framework of a regional plan.
An extensive literature review
supports the approach of establishing
such a program on a regional basis.
Available resources for a
program of conlinuing education in
nursing in Northeastern Ontario were
identified using the descriptive
survey research method.
Based on the 72 percent
response, the major findlOg of the
survey is that on a regional basis
human and physical resources and
educational matenals are inadequate
in terms of number of institutions or
agencies possessing such resources.
An overall assessment of the
adequacy of the resources indicated
disparity between districts in all
currently available resources. Within
districts availability of resources also
varies. Some districts are without
certain categories of resources.
The survey also reveals that
there is a high level of interest (91
percent of respondents) in continuing
education in nursing within the region.
An overall plan of continuing
education in nursing must pay special
attention to filling these inadequacies
in order to ensure an effective
program.
Rakoczy, Mary, The thoughts
and feelings of patients in the
waiting period prior to cardiac
surgery - Montreal, Que. 1975.
Study (M.Sc. (Applied) McGill
University).
This study examined the thoughts
and feelings of patients in the waiting
period pnor to cardiac surgery. The
waiting period was defined as the
three days (72hours) prior to surgery
The methodological approach to
the study was grounded theory, using
unstructured interviews with patients
on a cardiovascular surgical ward.
The research questions that
directed the study were:
1. What is the patient's attitude toward
cardiac surgery?
2. What kinds of thoughts and feelings
emerge in the waiting period prior to
cardiac surgery?
3. Are there identifiable patterns of
thoughts and feelings at different
points In time?
4. What meaning do these thoughts
and feelings have for nursing care?
The types of thoughts and
feelings revealed by patients tended to
occur in particular groupings in an
identifiable lime period and sequence.
A composite profile of these clusters
and their sequence of occurrence
formed phases of the waiting period
and the conceptual model for data
analysis. Most patients made
statements that reflected a passage
through each phase. The phases
labelled in order of their occurrence,
were: Confrontation, Self-Reflection,
Resolution, and The Countdown.
Findings include:
1. In the initial "confrontation" period,
patients (a) were often in a state of
shock, or disbelief; (b) felt they had no
alternative but to have surgery.
regardless of the duration of
symptoms; (c) expressed concerns
centered around feelings of
helplessness and fear of impairment;
(d) generally had little knowtedge
about the impending surgery and did
not request information; (e) talked
about their families and stated they
4'Vere interested in having them
present to talk with; and (f) referred to
the importance of seeing or hearing
about a successful patient.
2. In the "self-reflection" period
patients indulged in apparent self-pity
or grieving, suffered feelings of guilt,
and mourned their loss of control.
3. The "resolution" period was
characterized by expressions of hope
of recovery, rebuilding of confidence
and self-esteem, and the final decision
to undergo surgery.
4. In "the countdown," patients were
often "talked out" and were nrost
interested in visible signs that
indeed "the countdown" had begun
e.g. the presence of the family was
sufficient in itself.
5. Generally, patients who progressed
throuQh all the phases or from
"confrontation" to "self-reflection" had
good outcomes. Those who went
directly from "confrontation" to "the
countdown" had poor outcomes.
6. An overall finding, which initially
prompted this study, was that these
patients were often alone, and that
there appeared to be limited
nurse-patient interacllon.
Pope, Marion. Canadian health
services used by Korean
immigrants and their
perceptionli of the helpfulness of
those services. Toronto, Ont.
1975. Thesis (M.Sc.N.) U. of
Toronto.
The study was undertaken to
describe the Canadian health services
used by Korean immigrants, the
reasons for which they used the
services, and their perceptions of the
helpfulness of those services. The
purpose was to contribute to the
understanding of how Korean
immigrants try to meet their health
needs through the health care
services in the community. It was
hoped this understanding would help
health professionals work more
effectively with Korean immigrants.
The investigator used a family
interview schedule in Korean 10 the
homes of 30 respondents drawn
proportionately by lot from 90 heads of
families registered in 2 districts, one
suburban and one inner city.
Responses to non-structured
questions, designed to elicit free
expression of opinions, were
organized into classification schemes
of reasons for use and perceptions of
helpfulness.
The group of 106 persons used a
narrow range of health services with
which they had been familiar in Korea.
Over 50 percent of all services were
used for acute physical illness. Official
government services were used for
health supervision, but almost always
on the initiative of the public health
nurse. The group lacked information
about community health services that
had not been available in Korea. The
most frequently cited reason for
helpfulness was effecllve treatment.
Services were not helpful or nc
used because of lack of informatior I
and language problems, and becau
of inconvenience, mostly conflict wit
the working hours of the head of th
family.
Implications from the findings
include the need to encourage
initiative by both members of the
Korean community and health
professionals in providing informatiol
interpreting and adapting services' l
and in using Korean immigrant
representatives as resource person. ,
Anderson, Joan Madge. The
concerns and coping behavior I
of the single mother with a chil
aged Six months to eight years'
Vancouver, B.C. 1973. Thesis
(M.Sc.N.). University of British
Columbia. I
This study was designed 10 elic
information about the concerns anc
coping behaviors of the unmarried I
mother.
Twenty unmarried mothers we I
interviewed in their homes, using a i
semi-structured questionnaire. The'
ranged in age from 20 to 36 years, an
had from grade 7 to 12 education. Fill,
were employed full time, 4 were ful
time st
ents, 14 received social
assistance, and one, a full time
student, supported herself and her
child on a student loan.
Mothers' concerns were relate-
to finances. child care facilities,
housing, job training, and adequate
information from agencies concernir
services available to mothers on SOCI
assistance.
Ofthe mothers (45%) whose I
scores on an emotional health statl
scale indicated some emotional I
impairment, many also perceived
themselves as having a high numb
of socioeconomic problems.
Forty-seven percent of the mothers
who felt a need for consultation abOl:
a specific concern sought profession
help. However, many preferred to ta:
with friends and/or relatives about I
their concerns. Only among 15 t
percent of the mothers did the child I
father provide any emollonal suppo I
The CanadIan Nurse May 1976
49
What the well-bandaged
patient should wear=
Bandafix is a seamless round-
woven elastic "net" bandage,
composed of spun latex
threads and twined cotton.
Bandafix does not change in
the presence of blood, pus,
serum, urine, water or any
liquid met in nursing.
Bandafix has a maximum of
elasticity (up to lO-fold) and
therefore makes a perfect
fixation bandage that never
obstructs or causes local
pressure on the blood vessels.
-
Bandafix saves time when
applying, changing and
removing bandages; the same
bandage may be used several
times; it is washable and
may be sterilized in an
autoclave.
Bandafix is not air-tight,
because it has large meshes; it
causes no skin irritation even
when used for the fixation of
greasy dressings. The mate-
rial is completely non-reactive.
{
Bandafix is an up-to-date
easy-to-use bandage in line
with modern efficiency.
Bandafix stays securely in
place; there are eight sizes,
which if used correctly will
provide an excellent
fixation bandage for
every part of the
body.
--&4/
, Bandafix replaces hydrophilic
gauze and adhesive plaster.
is very quick to use and
has many possibilities of
application. It is very suit-
able for places that othen\ ise
are difficult to bandage.
...
( '(
/
.. Bandafix is economical in use,
not only because of its rela-
tively low price but because
the same bandage may be
used repeatedly.
".-
Bandafix does not fray,
because every connection
between the latex and cotton
threads is knotted; openings
of any size may be made with
scissors or the fingers.
""
Bandafix*
Dish-ibuted by
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peel-open packages
IONi
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ORegu.te..ed t..odemo..k of Continental Phonno,
50
The Canadian Nurse May 1976
Ilooks
Contemporary Community
Nursing edited by Barbara
Walton Spradley. 467 pages.
Boston, Little, Brown and Co.,
1975.
Reviewed by Patricia E. Ridge,
former instructor, Dept. of Allied
Health, Selkirk College,
Castlegar, B. C,
The editor has skillfully selected
articles by well-known authors that are
relevant, realistic, stimulating, and
readable. Most of the articles were
published orginally during the 1970's.
Together they form a comprehensive
overview of community health nursing.
The editor has included every basic
and important aspect of the field today,
in an attempt to present a framework
that is easy to understand.
The articles are organized into
eight chapters. Each article seems a
logical follow-up of the one preceding
it, and many examples of actual
situations are included. Some of the
many examples are American
experiences, but are applicable to
other situations.
The book begins by defining
community nursing and its goals in the
present day. The community nurse is
defined as a "generalized specialist."
She has the responsibility to plan and
implement health care and is often the
key person in the process. The
humanistic approach to community
nursing is a constant theme
throughout the book. The editor states
that community nursing must change
as society and its demands for health
care change
The last part of the book deals
with the nurses need to know the
community, to be able to assess its
needs, and to participate in planning
for the betterment of its level of health.
Donald C. Klein's conceptual
framework for understanding a
community is presented and
Madeleine M. Leininger's model ofthe
open health care system, that
provides readily accessible
personalized care, is described.
The many and various roles of the
community nurse are presented in a
thorough and exciting manner. Sandra
Henry Kosik's comments on "Patient
Advocacy" are interesting and
Leonard Stein talks about the
doctor-nurse game, vestiges of which
are still present.
One chapter contains articles that
describe the use of the nursing
process in community health nursing
and how members of a family or a
community can be involved in it.
Application of Dr. Lawrence Weed's
problem-oriented medical record
system to community health is
described and Marlene Mayer offers
some assessment criteria for more
systematic evaluation of nursing care
Different views on the value of the
nursing audit, to evaluate the quality of
care in a community by M. Phaneuf
and A. Donabedian, are included.
Spradley has devoted a chapter
to stress the importance of the ability
of the community health nurse to
communicate skillfully with all kinds of
people, One study presented reveals
that nurses tend to be nurse-focused
not patient-focused in interviews
during home visits. An essential
element in communication, empathy,
is discussed by Beatrice J. Kalisek.
The concept of contracting with
families to assist them in using their
own strengths in dealing with health is
described.
The editor presents material that
the nurse should understand about the
family in community nursing: the
Influence of its members on health and
illness: the effect on family roles when
a member is a patient: and how the
nurse can stimulate a family to help
itself. There is a good article by Ruth F.
Stewart on identifying families that fail
to thrive and therapeutic intervention.
Jayne Antilla Tapia's model for family
nursing, which involves assessing the
family's level of development and
functioning and using appropriate
nursing actions is presented.
The sociocultural aspects of
family nursing are considered and
examples of different cultures are
supplied. The importance of the
nurse's use of herself as a tool to
produce change is also emphasized in
this chapter.
Spradley states that this book "is
writ1en primarily for nursing students,
and their instructors, but has
considerable relevance for practicing
community nurses as well." This
reviewer agrees with her and
recommends this book for reading.
How to Keep Your Family Fit
and Healthy by Bonnie Prudden.
273 pages. New York, Reader's
Digest Press, 1975. Canadian
Agent: Toronto, Clarke, Irwin and
Co.
Reviewed by Ellie Robson,
Health Services Division,
Douglas College, New
Westminster, B. C. An exercise
physiologist and a
physiotherapist offered their
comments about the book..
On reading the book, How to
Keep Your Family Fit and Healthy, one
catches the contagious spirit that
better-fitness could be for me. and not
as difficult as thought.
The comment, "stay fit at all costs
so that you may retain two things: Your
independence and your dignity," adds
a note of the importance to this pursuit.
The physical fitness goal, ". . to feel
as good as possible and to perform
well in many activities," is suggested
in the book. This can be sustained by
striking a balance between strength
and flexibility.
The book deals with fitness for the
young and old. We are asked to take
an inventory of ourselves and then to
rate ourselves against the outlined
tests. If we fail, or need improvement,
corrective exercises are prescribed.
Comments: A great deal of
emphasis is given to fitness of the
young, and considerably less to the
other age groups, however those
suggested are good.
The Kraus-Weber test for
minimum muscular fitness is
suggested for use by all groups, but a
word of caution needs to be added
regarding the upper and lower back
test. Most physiotherapists do not
approve of such movement for older
people or those with a history of back
problems.
Mention should be made in the
book thaI it may be impossible for
people with long legs, and short arms
and trunk to accomplish the Flexibili
test. These people may still have ve i
good flexibility in hips and back, bl
will never, because of their body
structure, be able to touch their tOE I
nor should they be encouraged to c I
so. I
Most experts agree that there a I
3 aspects of fitness: flexibility,
strength, and cardiovascular
endurance or stamina. The book
contains excellent sections on
strength and flexibility, but practlca
ignores cardiovascular fitness, witt- I
only one-and-a-half pages on joggil
and a few suggestions for other "c- I
activities, e.g., like walking to work
Since heart disease is the number 01
killer for men over forty and is rising é I
a threat to women, at least equal I
emphasis, if not more, should be
placed on aerobic conditioning.
The test for vital capacity is no
good guide to better fitness. Vital
capacity does not change very
noticeably in the average person w
undertakes a conditioning program
What does improve is the
oxygen-carrying capacity of the blo
and the distribution of blood throu
the capillaries during exercise. A
simpler, but better indicator of
cardiovascular function is the reCOVE
rate of the heart after exercise, I
This reader dislikes the author
discussion and suggestions for I
treatment related to medically defin,
conditions as fibrositis, bursitis, an' l
tennis elbow. The diagnosis of suc
conditions is beyond that of the la}
competence. Most physiotherapist
would agree that a dangerous
precedent would be set if some peoJ;
used the author's suggestions of I
treatment, e.g. a coolant spray for
muscles in spasm, exercise past a
person's pain response, and deep
massage for tension areas.
Nevertheless, I do recommenc
this book. Prudden is a motivator wI"
has been able to reach the genera
public and give leadership to people
move toward better health.
Particularly to nurses who are
interested in strengthening their roll
as health promoters, this book willI
resourceful.
The CanadIan Nurse May 1976
51
\
Medical Surgical Nursing 6ed.
by Kathleen N. Shafer, Janet R.
Sawyer, Audrey M. McCluskey,
Edna L. Beck, and Wilma J.
Phipps. 1032 pages. Saint Louis,
TheC. V. Mosby Company, 1975,
Canadian Agent: Toronto,
Mosby.
Reviewed by Julilf D. Quiring,
Associate Professor, School of
Nursing, University of British
Columbia, Vancouver, B.C
The six1h edition of Medical
;urgical Nursing has been greatly
Improved in format and is fast
)ecoming a true reference book in
I)oth physical (it is getting heavier) and
'ontent sense.
Phipps, primary revision editor,
ndicates that many changes have
aken place "in medical and health
-are, and in the practice of nursing."
This edition has been developed to
eflect these changes by placing an
ncreased emphasis on physiological
:1eviations from the normal and on the
ole 0: assessment. One specific
ddition has been a chapter on
'Ecology and Health." Two chapters
n edition five have now been
:ombined into one on musculoskeletal
njuries and disorders and the
neurology chapter has been updated.
It is definitely apparent that the
lerms assessment and intervention
have been utilized, though not
consistently in every chapter. The use
and identification of assessment detail
In the chapter on neurologic
assessment is useful, though new
pictu;es of some specific positive and
negative findings might make it more
useful. Sections denoting some
aspects of the nursing role are
indicated in various chapters, and this
does clarify some specific nursing
activities and interventions. Though,
as is common in textbooks, the
specified nursing activities are quite
conventional.
The chapter on ecology presents
pertinent information related to health
concerns, e.g., water pollution and
radioactivity. Some detail specifying
the entry site as body surface (for
radioactivity), digestive tract (for food
additives), and respiratory tract (for
inhaled chemicals) provides useful
intormation. This chapter would be
improved, if the number of line and bar
graphs and other schemata were
reduced, and a section that included
illustrations showed how the use of
assessed data or potential health
hazards could be used by the nurse
either in health teaching or in health
promotion/restorative activities. One
section in this chapter is titled
"Perspectives for Human Health,"
however, the content included here is
so general that it is difficult to dissect
specifics as to what the role of
individual nurses is in promoting
ecologic health.
The chapter modifications in this
edition seem fairly minor. The
neurology chapter has been
expanded and can be used as a
general reference. Combining
musculoskeletal injuries and disorders
does not substantively change the
content.
This book should be primarily
useful as a reference book for those in
hospital settings. The organization of
the book continues to follow a body
systems pattern. Though the authors
express concern for reflecting health
aspects, following the medical (illness)
model necessitates the major thrust
toward restorative aspects of health
care.
"-
,
IS
.
?;.. <:"'G
..
4(
9 HOW TO
PROTECT AND INSPECT
A DRAINING WOUND
AND NEVER
TOUCH WET GAUZE
Man, Microbes and Matter by
Bartley C. Block. 801 pages. New
York, McGraw-Hili, 1975,
Reviewed by Mr. David Khokhar,
Halifax Infirmary School of
Nursing, Halifax, N.S.
Finally there's a better alternative to absorbent
dressings, one that offers you more convenience
and the patient greater protection than gauze. It
brings together a sterile Karaya Blanket that pro-
tects skin from wound drainage... a transparent
Collector that confines fluid discharge and odor.
and an Access Cap which can be removed from the
Collector to advance the drain tube or treat the
wound, No more need for time-consuming and
traumatic dressing changes, so post-operative care
will be simpler and generally less expensive. Sup-
plied sterile for quick application in surgery,
recovery, ICU, or patient's room Write for complete
information.
Man, Microbes and MaNer
seems to excel its predecessors. It
achieves its objectives from the
learning perspective.
The subject mat1er is adequately
treated, and one is particularly
impressed with the fact that this text
contains many areas that are often
omitted, e.g., detailed descriptions of
the periodic table of elements and the
incorporation of integrated scientific
facts from all branches of basic
sciences.
The main points in each chapter
stand out and are clearly and
conCisely explained; this facilitates
DRAINING-WOUND MANAGEMENT SYSTEM
HOLLISTER
'
HOLLISTER LIMITED, 322 CONSUMERS RD . WILLOWDALE, ONT. M2J 1PB
52
The Canadian Nurse May 1976
11()()liS
I,
both learning and teaching. Applicable
to nursing and the allied health
professions, is a discussion of the
latest basic chemicals, biochemicals,
and microbiological principles.
Excellent illustrations are offered but,
at times, are too complicated.
As this textbook is intended to
satisfy all basic science requirements
of university freshmen in health
programs; it is far too advanced for the
2-year diploma nursing course, or any
other courses offered to paramedical
personnel in a hospital set1ing. It is too
complicated in its explanations,
phraseology, and terminology.
However, it would be an asset as a
reference book.
Appendices, glossaries, brief
introductions to chapters, and "search
and reason" items that require
students to independently search out
information, are not included.
On the whole, this is the best
integrated basic science textbook that
one could find for a particular use i.e.,
integrated courses offered in the
health professions. The material is
sufficient and presented in an
interesting way, generating student
interest and motivation.
Nurses and Management by M.
Schurr. London, The English
Universities Press Ltd., 1975.
83 pages.
Reviewed by Gwen Greig
(Cornthwaite), Director, Nursing
Education, Grace General
Hospital, Winnipeg, Manitoba.
This book is designed to
teach nurses management skills. It
would be a practical book for teachers
of nursing and head nurses who are
concerned with teaching managment
or with the actual day-to-day
management of a unit.
Of benefit to the teachers of the
subject, three chapters are presented
as introduction, explaining the
meaning of management, why it
should be a part of nursing and how
learning can take place by good
management.
The remaining chapters are
situations to be studied and
discussed by the group of learners.
These chapters are most helpful, as
they deal with organization and
planning, resources, presentation of a
case, implementation of change,
commUnication and personnel
management.
The book definitely has a British
point of view and this could be a
Lil)letll e !] lT 1 )(ltl1e
Publications recently received in the
Canadian Nurses' Association Library
are available on loan - with the
exception of items marked R - to
CNA members, schools of nursing,
and other institutions. Items marked R
include reference and archive material
that does not go out on loan. Theses,
also R, are on Reserve and go out on
Interlibrary Loan only.
Requests for loans, maximum 3
at a time, should be made on a
standard Interlibrary Loan form or by
letter giving author, title and item
number 10 this list
If you wish to purchase a book,
contact your local bookstore or the
publisher.
Books and documents
1. Barrère, Igor. Le dossier
confidentiel de /'euthanasie, par... et
Étienne Lalou. Paris, Editions Stock,
1975, c1962. 182p.
2. Bonney, Virginia. Nursing
diagnosis and therapy; and
instrument for evaluation and
measurement, by... and June
Rothberg. New York, National League
for Nursing, 1963, 100p. (League
exchange no. 64) (NLN Pub. no.
20-1085)
3. Brundage, Dorothy J. Nursing
management of renal problems. Saint
Louis, Mosby, 1976, 204p.
4. Bullough, Bonnie ed. The law and
the expanding nursing role. New
York, Appleton-Century-Crofts,
c1975. 211 p.
drawback, as some of the situations,
terminology and government
references might be foreign to
Canadians. However,this does not
distract from the overall content of the
book.
Appendix II offers examples of
programs for management courses
and appears to be most helpful to
head nurses or directors of staff
training.
This book would be best used as
a reference tool rather than a text
book.
Public Health and Community
Medicine 2ed. by Lloyd Burton
and Hugh Smith Baltimore,
Williams and Wilkins, 1975.
572 pages.
Reviewed by P. Y. Abraham,
Assistant Professor, School of
Nursing, University of Windsor,
Windsor, Ontario.
The health maintenance of
an individual is his own responsibility
but the health maintenance of a
community is the responsibility of the
health professionals including
governments, voluntary and private
organizations (community health
5. Clyne, Douglas George Wilson. A
concise textbook for midwives.
London, Faber and Faber, c1975.
448p.
6. Community health administration; a
reader consisting of twenty-one
articles especially selected by The
Journal of Nursing Administration
editorial staff. Wakefield, Mass.,
Contemporary Publishing, 1975.
128p.
7. Dorolle, Pierre M. Sociétés
nationales de la Croix-Rouge: Santé
et Bien-être social. Genève, Comité
conjoint pour la Réévaluation du rôle
de laCroix-Rouge, 1975. 59p. (Comité
conjoint pour la Réévaluation du rôle
de la Croix-Rouge. Document de
référence No 4)
8. Essoka, Gloria C. Pediatric nursing
continuing education review; 530
essay questions and referenced
team). The prime concern of this
health team is to maintain and
promote the wellness of the
community. This can be achieved
through preventing and/or minimizin
the effects of community problems
related to health.
In public health, problems are n
longer restricted to infectious
diseases. Public health deals with ar
problems that affect the health of a
community, This book discusses nc
only the possible problems, but alsc
the community, its resources and
environment, and their importance
maintaining health. Chapter four
explains the health indices, and oth.
tools that are used 10 public health.
A closer look at the contents 0
this text indicates that it is not writte
for a specific group of health
professionals, e.g., nurses, doctors
and epidemiologists. The topics in
each chapter are adequately
discussed without the intricate detail
Yet for those who are interested in
details, a bibliography of references
given at the end of each chapter.
This book can serve as an I
introductory text for a community
health service course or as an upda
for those who are already in public
health.
answers, by... et al. New York,
Medical Examination Pub. Co., c197
280p.
9. Fundamental issues in nursing; ,
reader consisting of sixteen article.
especially selected by The Journal.
nursing administration editorial sta
1ed. Wakefield, Mass., Contemporé
Publishing, c1975. 95p.
10. Geriatric care in advanced
societies. Edited by J.C. Brocklehun
Baltimore, Md., University Park Pre
c1975. 160p.
11. Guion, Jean. Nos enfants et
I'orthographe. Paris, Centurion,
c1973. 119p.
12. Hamilton, William P. Decision
making in the coronary care unit, b}1
and Mary Ann Lavin. 2ed. St. Loui
Mosby, 1976. 158p.
...'111''''.................,_ .........r .
....
'3_ Hinaut, G. Pneumologie
-uberculose. Paris, Masson, 1976,
I 26p. (Cahiers de l'infirmière 16)
14. Jacoby, Florence Greenhouse.
iJursing care of the patient with burns.
!ed. Saint Louis, Mosby, 1976. 185p.
15. Kaiser, Joan E. A comparison of
,;tudents in practical nursing
Jrograms and students in associate
1egreeprograms. New York, National
_eague for Nursing, 1975, 78p.
I League exchange no, 109) (NLN
pub. no. 23-1592)
16. King, Ouida M. Care of the cardiac
purgical patient. St. LOUIS, Mosby,
11975. 276p.
,17. Kyes, Joan J. Soins infirmiers en
Jsychiatrie, par... et Charles K.
Hofling. Supervision du texte français
par Hélène Berthelot. Montréal,
Renouveau Pédagogique, c1976.
466p.
18. Labour relations; a reader
consisting of sixteen articles
especially selected by The Journal of
Nursing Administration editorial staff.
Wakefield, Mass., Contemporary
Pubhshing, 1975. 48p.
19. Lombard, Olive M. Biostatistics for
the health professions. New York,
Appleton-Century-Crofts, c1975.
223p.
20. Magat, Richard. La Croix-Rouge
tellequ'on la voit: opinions recueillies.
Genève, Comité conjoint pour fa
Réévaluation du rOle de la
Croix-Rouge, 1975. 56p. (Comité
conjoint pour la Réévaluation du rOle
de la Croix-Rouge. Document de
référence No 6)
21. Management for nurses; a
multidisciplinary approach. Edited by
Sandra Stone et a!. Saint Louis,
Mosby, 1976. 280p.
22. Moroney, James. Surgery for
nurses. 13ed. Edinburgh, Churchill
Livingstone, 1975. 654p.
23, National Conference on Nursing
Research, Edmonton, Nov. 3-5,1975.
Development and use of indicators in
nursing research. Proceedings.
Edmonton, University of Alberta
School of Nursing, 1975. 220p.
24. Norris, Walter. A nurse's guide to
anaesthetics, resuscitation and
intensive care. Donald Campbell. 6ed.
Edinburgh, Churchill Livingstone,
1975. 159p. (Livingstone nursing
texts)
25. Nursing clinics of North America,
vol. 10, no. 3, September 1975.
Toronto, Saunders, 1975. 642p.
Contents. - Care of the patient with
renal disease, Mary I. O'Neill editor.
Human sexuality. Fern Mims, editor.
Herpesvirus genitalis: a nursing
perspective, Jean D. Nelson.
26. Nursing Digest focus on care of
the elderly. 1ed. Wakefield, Mass.,
Contemporary Publishing. c1975.
113p.
27. Nursing Digest focus on health
maintenance and prevention of
illness. 1ed. Wakefield, Mass.,
Contemporary Publishing, c1975.
136p.
28. Nursing Digest focus on
professional issues. 1 ed. Wakefield,
Mass., Contemporary Publishing,
c1975. 143p.
29. Nursing Digest focus on the work
environment. 1 ed. Wakefield, Mass.,
Contemporary Publishing, c1975.
139p.
30. Nursing Digest review of
community health. 1 ed, Wakefield,
Mass., Contemporary Publishing,
c1975. 287p.
31. Nursing Digest review of
psychiatry and mental health. Ed. by
Eileen Callahan Hodgman. 1 ed.
Wakefield, Mass., Contemporary
Publishing, c1975. 161p.
32. Only when it hurts; being a curious
collection of old fashioned remedies
and dissertations on matters of health
and hygiene. Compiled by Phyllis
Mortimer. London, Wolfe, c1974.
118p.
33. Organisation mondiale de la
Santé. Cinquiéme rapport sur la
situation sanitaire dans Ie monde,
1969-1972. Genève, 1975. 334p. (Ses
Actes officiels no 225)
34. Organization of nursing care; a
reader consisting of eight articles
especially selected by The Journal of
Nursing Administration editorial staff.
1 ed. Wakefield, Mass" Contemporary
Publishing, c1975. 47p.
35. Orsoni, Paul. Soins pre et
post-opératoires: à I'usage des
infirmiéres. Paris, Masson, 1976.
124p,
36. Private monies for nursing
research. Compiled by Rosemary G.
Campos. Boulder, Co., Western
Interstate Commission for Higher
Education, 1974. 66p.
37. Prudden, Bonnie. How to keep
your family fit and healthy. New York,
Reader's Digest Press. distributed by
Dutton, 1975. 273p.
38. Queen's College, Flushing, N.Y.
New Human Services Institute.
College programs for
paraprofessionals: a directory of
degree-granting programs in the
human services. New York, Human
Sciences Press, c1975. 135p.
39. Renou, Philippe. Appareil
cardio-vasculaire. Paris, Masson,
1975. 148p. (Cahiers de l'infirmière 3)
40. Russell, Robert D. Health
education. 6ed. Washington, National
Education Association, 1975. 251p.
41. Sagebeer, Josephine Evans.
Maternal health nursing review. New
York, Arco, 1975. 20Bp.
42. Schweer, Jean E. Creative
teaching in clinical nursing, by... and
Kristine M. Gebbie. 3ed. Saint Louis,
Mosby, 1976. 216p.
43. Standard nursing care plans, vol.
2. Stockton, Ga., KIP Co. Medical
Systems, c1975. 1 v. (unpaged)
44. Tansley, Donald D. Rapport final:
un ordre du jour pour la Croix-Rouge.
Genève, Comité conjoint pour la
Réévaluation du rOle de la
Croix-Rouge, 1975. 139p.
45. The teaching of human sexuality
in schools for health professionals
Edited by David Robert Mace et a!.
Geneva, World Health Organization,
1974. 47p. (World Health
Organization. Public Health Papers
no 57)
46. Vaughan-Wrobel, Beth C. The
problem-oriented system in nursing: a
workbook, by... and Betty Henderson.
St. Louis, Mosby, 1976. 152p.
47. Verderese, Maria De Lourdes. The
traditional birth attendant in matemal
and child health and family planning;
a guide to her training and utilization,
by... and Lily M. Turnbull. Geneva,
World Health Organization, 1975.
111 p. (WHO Offset publication no. 18)
48. Western Council on Higher
Education for Nursing. Newly initiated
and completed research in WCHEN
schools of nursing: vol. 2, June
1973-August 1974. Boulder, Co.
1974-1975. 1v. (unpaged)
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49. World Health Organization.
Guidelines for evaluation of drugs;
report of a WHO Scientific Group.
Geneva, World Health Organization,
1975. 59p. (Its Technical report series
no. 563)
Pamphlets
50. National League for Nursing.
Dept. of Home Health Agencies and
Community Health Services.
Coordinated health services for the
aged: experiences of The Visiting
Nurse Association of Cleveland. New
York, National League for Nursing,
c1976. 25p. (League exchange no.
110) (NLN Pub. no. 21-1606)
51. Ozimek, Dorothy. The nurse
practitioner: the current situation and
implications for curriculum change
New York, National League for
Nursing, c1976. 15p. (NLN Pub. no.
15-1607)
52. Registered Nurses' Association of
Nova Scotia. A framework for the
practice of nursing in Nova Scotia:
guidelines and standards. Halifax,
1975. 25p.
53. United Nations. Food and
Agriculture Organization. Food
production and population growth on
a country basis, 1950-1970. Paris,
1974.
54. World Health Organization.
ForesIght prevents blindness. World
Health Day, 7 April, 1976. 9pts. in 1.
Government documents
Canada
55. Assurance-Chðmage Canada
Avec vous... entre-temps. Ot1awa,
Information Canada, 1974. 12
brochures.
56. Commission du système
métrique. Bibliographie de la
conversion au systéme metrique. 1v
(non paginé)
57. Dept. of External Affairs.
DiplomatIc corps and consular and
other representatives in Canada.
Ottawa Information Canada, October,
1975. 85p. R
58. Health & Welfare Canada.
Provincial organizational patterns for
health manpower development, by
Beverly M. Du Gas. Ottawa, 1975.
28p. (Health manpower report no.
2-75)
59. --. Hospitals and the elderly:
present and future trends, by Mary K.
Rombout. Ottawa, Long Range Health
Planning Branch, 1975. 34p. (Canada.
Health and Welfare Canada. Staff
papers. Long range health planning
75-2)
60. --. Immunization. A guide for
international travellers. Ottawa,
Information Canada, c1975. 21p.
61. --. The supply of physicians in
Canada by William S. Hacon and
Jawed Aziz. Ot1awa, 1975. 19p.
(Health manpower report no. 3-75)
62. --. Health Protection Branch.
Dietary standard for Canada. Ottawa,
Information Canada, 1975. 110p.
63. Laws, statutes etc. Anti-inflation
act regulations kit. Ottawa,
Anti-inflation Board, 1976. 4pts. in 1.
64. Lois, statuts etc. Loi anti-inflation
Réglement. Paquet. Ottawa,
Commission de lutte contre !'inflation,
1976. 4pts. in 1.
65. Metric Commission. Bibliography
on metric conversion. Ottawa, 1975.
1 v (unpaged)
66. A research study on science
communication, by Orest Dubas and
Lisa Martel. Ot1awa, Ministry of State,
Science and Technology, 1975. 394p.
(Media impact, vol. 2. Science mass
media and the public)
67. National Library of Canada.
Report 1974/75. Ottawa, Information
Canada, 1975. 98p.
68. Parliament. Special Joint
Committee on Immigration Policy.
Report, third. First Session, Thirteenth
Parliament 1974-75. Ottawa, Queen's
Printer, 1975. 142p. (Its Minutes of
proceedings and evidence issue no.
53, Nov. 6, 1975)
69. Santé et Bien-être social Canada.
Les effectifs médicaux du Canada,
par William S. Hacon et Jawed Aziz.
Ot1awa, 1975. 21p. (Main-d'oeuvre
sanitaire rapport no 3-75)
70. --. Direction générale de la
planification à long terme. Les
hòpitaux et les personnes âgees:
tendances acutelles et futures.
Ottawa, 1975. 39p. Ses Notes de
recherche. Planification à long terme
75.2)
71. --. Immunisation. Guide du
voyageur international. Ottawa,
Information Canada, c1975. 21 p.
72. --. Organigrammes provinciaux
de perfectionnement de la
mam-d'oeuvre sanitaire, par Beverly
M. Du Gas, Ottawa, 1975. 28p.
(Main-d'oeuvre sanitaire rapport no
2-75)
73. --. Les personnes âgées au
Canada, par J.A, Clark et N. E.
Collishaw. Ottawa, Direction générale
de la planification à long terme, 1975.
27p, Ses Notes de recherche.
Planification à long terme 75.1)
74. --. Direction générale de la
protection de la santé. Standards de
nutrition au Canada. Ottawa,
Information Canada, 1975. 118p.
75. Unemploym!!nt Insurance
Canada. Working with you - between
jobs. Ottawa, Information Canada,
1974. pam.
United States
76. Dept. of Health, Education and
Welfare. Public Health Service. The
challenge of cancer nursing.
Bethesda, Md., 197? 28p. (U.S.
DHEW Pub. no. (NIH) 76-760)
77. National Bureau of Standards.
Metric Study Group. The consumer.
Interim report. Washington, U.S.
Gov't. Print. Off., 1971. 139p. (U.S.
National Bureau of Standards. Special
Pub. no. 345-7)
78. --A metric America. Washington,
U.S. Gov't. Print. Off., 1971. 170p.
(U.S. National Bureau of Standards.
Special Pub. no. 345)
79. National Institutes of Health.
British national health service
complaints procedures, by Alonzo S.
Yerby. Bethesda, Md., 1975. 65p.
(U.S. DHEW Publication no. (NIH)
76-988)
80. --. New health practitioners. A
conference sponsored by The John E.
Fogarty International Center for
Advanced Study in the Health
Sciences and the Association of the
Teachers of Preventive Medicine,
National Institutes of Health,
Bethesda, Maryland, May 14-15,
1974. Edited by Robert L. Kane.
Bethesda, Md., 1975. 156p. (U.S.
DHEW Pub. no. (NIH) 75-875)
81. National Committee on Vital and
Health Statistics. The analytical
potential of NCHS data for health care
systems. Rockland, Md., Department
of Health, Education and Welfare,
1975. 26p.
Studies Deposited in CNA
Repository Collection
82. April, Yvette. Rapport final de
I'analyse de dix-huit soms infirmier l
Montréal, 1975. 216p. R
83. Béliveau, Denise. Urgence
psychiatrique et intervention políC/é
Communauté urbaine de Montréa/.,
Étude d'intérêt po/icier, médical,
légal. Montréal, Centre de
Consultation Psychiatrique, Institut
Philippe Pinel de Montréal, 1975.
109p. R
84. Faerber, Doris R. Construction.
an instrument for the evaluation of tt
charting performance of student
nurses. Buffalo, N.Y., 1959. 52p.
(Thesis (M.Sc,) - Buffalo) R
85. Fontaine, Louise. Approche
expérientielle dans la formation de
I'étudiante infirmiére. Montréal, 197
148p. (Thèse (M. Nurs.) - Montréé
R
86. Gascon, Louis. Évaluation des
services aux malades mentaux
chroniques dans un centre de sanl
mentale communautaire, par.. Mar
F. Thibaudeau, Richard St-Jean et
Francine Gratton-Jacob. Montréal,
Centre de Santé Mentale
Communautaire et Faculté de
Nursing, Université de Montréal,
1975. 200p. R
87. Jackson, Marion R. Setting
standards for patient care (based c
nursing research) by... and Eleanor
Heieren. Saskatoon, Sask., 1976.
153p. R
88. Monette, Marcelle. Réactions
d'enfants punis par l'infirmiére lors (
manifestations de non conformité a L
traitement. Montréal, 1975. 106p.
(Thèse (M. Nurs.) - Montréal) R
89. Overton, Peggy. A technologic.
description of nursing units.
Edmonton, 1975. 129p. (Thesis
(M.H.S.A.) - Alberta) R
90. Saskatchewan Registered
Nurses' Association. Survey of
inactive nurses 1975-1979. Regina
1975. 64p.
91. Ray, Marilyn Dee. A descriptivE
study of the perceptions and attitude
of the affluent society toward healtl
and illness. Denver, 1969. 17p.
(Thesis (M. Sc.) - Colorado) R
Meet summer head-on
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56
The Canadian Nurse May 1976
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.
.. As 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
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 \'Oil, or else you'll
eventually want 10 drop out".
"That's why Medox has so much
to offer a nurse today". "You see,
at Medox, we supply quality nurs-
ing staff on a temporary assignment
basis to hospitals, clinics, doctors'
offices, nursing homes and private
residences. We're a part of the
world-wide Drake International
group of companies and we operate
in major cities across Canada, the
U.S. U.K. and Australia".
.. As far as you're concerned,
however, the key phrase is "Tem-
porary Assignments". Because, as
you can see by the chart above, you
can choose just about any working
condition, or shift, or professional
discipline you want". ..It comes
down to this: if you want more from
nursing than you're getting now,
talk to Medox ".
"Write to me, Virginia Hintoft,
R.N., Staff Supervisor. Medox, 55
Bloor St. W., Toronto, Ontario, or
call the local Medox office"
[M)ì
DoX]
a DRAKE INTERNATIONAL campan...
If you care for people,
you're Medox.
'll1ssi 11(>>(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-be<j hos,
)Ital. with two Medical and one Dental Staff Accommodation available
n Residence II single. To commence dulles July 1. 1976. Apply to'
dmlnlstrator, Klpting Memonal Union Hospital. Box 420, Klphng.
>ask 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
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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
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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
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INVOLVED.
WITH THE
CANADIAN
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FORCES.
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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
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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
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657 bed, accredited, modern,
well equipped General Hospital,
rapidly expanding...
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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
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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,,: _
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The CanadIan Nurse May 1976
Index to
Advertisers
May 1976
Burroughs Wellcome Limited
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The Canadian Nurse
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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?
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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
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Min: cholesterol was' ,.: letary program
fish I sota. It included :,rted from the U to reduce
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. F
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Important stud a complete r
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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
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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.
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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.
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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..
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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."
--
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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
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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
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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
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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!
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The Canadian Nurq June 1976
17
thorities estimate that at least 25,000 Canadian women are walking around today
\A:h a breast cancer at some stage of growth*. This rl}alignancy will probably not be
dtected until 1977, 1978. 1979 or even later. The stage at which it is detected, the
s bsequent quality and length of life of these women, depends, to a great extent,
L,on the help and support they are able to obtain from health professionals.
f
,
I"
ia Butler
r east cancer is a leading killer of Canadian
::>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.
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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.
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=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
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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.
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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
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>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 ..
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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).
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The Cenadian Nur&& June 1976
23
tection centers are an important aspect of the North American program to
pJmote earlier diagnosis and treatment of breast cancer. One such Canadian
enter is the Thermography Unit of the Royal Victoria Hospital in Montreal Monica
Elcon, who is the nurse in charge of this unit, describes mammatherm, 1 the breast
tl3rmography technique in use there.
atherm
weapon in the fight against breast cancer
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lonica Bacon
arly detection continues to be the
omerstone on which the Canadian Cancer
.ociety rests its claim that cancer can be
eaten. At the present time, detection
pproaches used in the discovery of breast
ancer include physical assessment,
adiological examination (mammography),
1ermography (mammatherm) and, if
ldicated, breast biopsy, Ofthese, only breast
liopsy is considered a proven method of
liagl"'osis but each of the other techniques
Iffers the consumer certain advantages and,
)gether, they now provide women with the
Inly known way of reducing the death toll from
,is disease. Although most nurses, and many
'onsumers, are aware of the detection
echniques and principles involved in breast
òelf-examination and mammography, many
Ire not yet familiar with the use of another
òcreening procedure - thermography - a
leat detection technique that locates warmer
'ssue in the breasts.
What is thermography?
Thermography is, essentially, a scanning
echnique used to detect infrared heat. It has
:ome to play an important role in many
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scientific fields, including medicine, where its
possible uses are numerous. Probably the
most widely known and recognized of these
uses relates to the area of breast tumor
screening.
A mammatherm is a picture of the surface
of the breasts using infrared scanning to
detect and indicate thermal activity
(physiologic function) below the skin by the
coinciding emissIon of heat. This produces a
"hot and cold" pattern on the pIcture showing
areas of increased and decreased heat
generation. Interpretation of these pictures
serves to alert the doctor to possible
abnormalities below the skin requiring further
investigation.
Since breast tumors are known to
generate large amounts of heat and to alter
vascular 2 patterns, especially during the early
stages of mitosis, thermograms can assist the
doctor in breast examinations. Repeated
annually, they may also serve to detect
otherwise unremarkable functional changes,
All women, regardless of breast size, age.
medical history or family background, could
(and perhaps should) be candidates for breast
thermography, It should be noted however that
accuracy appears decreased during the
menstrual phase of the patient's cycle due to
vascular engorgement and ductal changes at
that time. 3
Procedure
The procedure is painless, simple, quick
and harmless. The patient disrobes to the
waist and waits approximately ten minutes in a
"cooling" area with arms held away from the
body. Generally the cooling area is maintained
at a temperature of 68
F (20 c C) and is kept free
of drafts and interfering warmth (such as
sunlight). This encourages more accurate
adjustment of the body surface temperature
and promotes individual infrared heat
emission. During the mammatherm the patient
is positioned with chest erect and arms
elevated. Pictures are taken frontally and
laterally.
Technique: untrained, inexperienced or
careless operators of thermographic
equipment can lead to faulty procedures and
poor quality pictures.
Primarily, the focusing must establish a
well-defined image avoiding shadows and
unrelated sources of temperature
interference. Ranges of gray leading to
extremes of black and white represent the
temperature scale, Of this, the middle gray is
considered the "middle temperature" and is
individually established after clarification of the
image. The axillae, sternum and/or
inframammary folds are usually warmer by
approximately 2 0 C than the average normal
breast tissue.
The pictures should Illustrate contrasts
between areas which are "hotter," "colder," or
"equal to" the background or middle
temperature by the black-gray-white pattern
Opinions vary regarding the use of black
or white as an indication of increased heat but,
either way, the areas emitting infrared heat
become obviouS,4 Differences are also found
in the choice of apparatus and film. But again,
the basic purpose of discovering possible
abnormalities is the prime objective, with the
degree of efficiency as well as expense a(so a
consideration.
Interpretation: Accurate interpretatiop of
mammatherms also depends upon a high
degree of training, experience and
competence. If this is lacking, even the best
quality pictures can be misread and important
features overlooked.
The initial assessment requires an overall
view of all pictures in search of areas
illustrated as warmer than the recorded middle
24
The CanadIan Nurse June 1976
Mammatherms
Illustrations are frontal pictures from a series of five
(frontal and lateral) for each patient Interpretations
based on entire series
Fig. 1: 43 years old.
Normal warm breasts.
Symmetrical hypervasculanty
0,1
(t
o
AG
4 '
- ð .. 2
temperature. This enables observations to be
made regarding the temperature and vascular
patterns of the breasts. Whether superficial or
deep, the vascular pattern shows itself as
somewhat warmer than breast tissue and can
usually be considered sparse, normal or
hypervascular. Similarly the breast tissue may
appear completely cool (fatty) or warm (dense)
but rarely hot throughout. Using the middle
temperature level as a baseline, comparative
recordings are made of the locations and
temperatures of any "hot spots" thus exposing
an asymmetric pattern indicative of
abnormalities. Asymmetry in the number,
temperature and/or caliber of the vascular
patterns also equires notation. The nipples
and areolae are usually the coolest aspects. It
may also prove helpful to record the
temperature difference between the hottest
and coldest readings in each breast.
Irregularities such as size differences,
deviated contours, or nipple inversions, which
may prove pertinent to the overall breast
examination, are also noted at this time.
Value: As indicated, mammatherm is not
in itself a means of diagnosis. Rather, it is a
method of assisting the doctor in completing a
diagnosis as well as an annual check for
indications of changes within the breasts. The
question remains as to the degree of
Fig, 2: 50 years old.
Normal cold breasts.
Symmetrical sparse vasculan1y
0.1
0.2
o.
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.4
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, I I f
.&
dependable assistance it provides and what
eventual diagnostic uses it may offer.
Theoretical answers are numerous and
varied. Two of the most common are:
. Mammatherm is of value only when
performed in complementary conjunction
with thorough clinical examination and
mammography (breast x-ray). 5 In this case
further investigation and treatment are
instituted mainly on the basis of reported
positive findings from the other two checks,
although a positive mammatherm is
considered supportive.
. A combination of positive mammatherm
and clinical examination is sufficient basis for
investigation. 6 Mammography is
recommended but its questionable or
near-normal report does not deter the
investigation.
Patient histories
Patient A: A 32-year-old woman, with no
previous history of manifestations of cancer
but whose mother had had the disease, found
tenderness In her right breast. Her
gynecologist referred her to our clinic for a
thermogram, which revealed an area of
suspicious warmth in the upper quadrant of
Fig. 3: 57 years old.
Suspicious increase in
temperature and vasculari1y
in right breast with coinciding
increased areaolar temperature.
o.
02
, t.
f
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II I
4
her right breast. She then had a mammogram
that indicated density in both breasts, with
scattered calcifications in the right breast, and
a benign nodule in the left. The patient went on
to have a biopsy. Results disclosed the
presence of infiltrating duct cancer in the right
breast. She underwent a radical mastectomy,
and is doing well nine months after surgery.
Patient B: A 50-year-old woman
complained to her doctor of a lump in her left
breast. There was no family history of cancer,
nor had she herself had any other symptoms of
the disease. On being referred to our clinic,
she had a thermogram which showed
increased heat and vascularity in the upper
outer quadrant of her breast.
Because malignancy was suspected,
further testing was recommended. A
mammogram revealed only dysplasia and a
possibly benign nodule. However, the patient
went on to have a biopsy, which gave evidence
of infiltrating duct cancer of the left breast. She
then had a modified radical mastectomy. A
year later, she is still well.
In this patient's case, the mammogram
gave no definitive proof of the heat activity in
her system that had been apparent on the
thermogram.
!he CanadIan Nurse June 1976
2S
g. 4: 60 years old.
Jspicious increase in
isculari1y of left breast
ith coinciding increase in
mperature of nipple
01
0.2
o
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2 4
- ß +
Conclusion
It is impossible, at present. to declare a
jefinite proven protocol for diagnosis of breast
:ancer. Mammography, since it is an x-ray
echnique and causes exposure to radiation,
cannot be performed repeatedly over short
periods of time, nor on certain individuals. It is,
however, a proven diagnostic tool, although
producing occasional "false negative"
reports. Thermography is harmless and
simple but it is not considered diagnostic and
more likely to indicate "false positive" findings
It is obvious that clinical examination is
necessary and a tissue biopsy is still the only
definite and proven means of dIagnosis of
carcinoma of the breast.
Monica Bacon, R.N.,(Royal Victoria Hospital
school of nursing, Montreal), received her
training as thermography technician and
interpreter at Jefferson Medical College
Breast Diagnostic Center, Philadelphia. She
is the nurse in charge of the Thermography
Unit at the Royal Victoria Hospital. She ;s a
member of the American Thermographic
SocIety, as well as an active member of the
Board of Directors of the Royal Victoria
Hospital Nurses' Alumnae Association. Her
nursing career has included practIse in the
areas of hemodialysis, endocrine research
and a community health clinic.
Fig. 5: 60 years old, post-
mastectomy. Slight increase in temperature of right
upper outer quadrant. (Mastopathy later clinically
diagnosed).
0.1
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2
References
1 lsard, Harold J. The mammatherm, by... and
Bernard J. Ostrum. RadIOlogic Clin. North Amer.
12:1'167 passim, Apr. 1974.
2 Barash, I.N. Quantitative thermography as a
predictor of breast cancer, by... et al. Cancer
31:4:769-76, Apr. 1973.
3 Jones, Colin H. Thermal pat1erns of the
healthy female breast. Bibliotheca Radio/. no. 6, p.
57-64, 1975.
4 lsard, Harold J. Breast thermography after
four years and 10,000 studies, by...et at. Amer. J.
Roentgenology Radium Therapy and Nuclear Moo
115:811-21, Aug. 1972.
5 Atsumi, Kazuhiko ed. Medical thermography.
Portland, Or., Int. Scholarly Book Serv., 1973.
6 Dodd, Gerald D. Breast thermography, by...et
al. Current Problems In Radiology 3:6:1-47,
Nov.lDec. 1973
Note: A bibliography is also avaifable on request.
...
CTIFED*
Tablets/Syrup
Triprolidine HCl/Pseudoephedrine HCI
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Indications: The prophylaxIs and
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serous otitis media with eustachian tube
congestion, oerotitis media, croup and
similar lower resplrotory tract diseases:
in allergic conditions which respond to
antihistamines including hay fever.
pollenosIs. allergic and vasomotor
rhinitis, allergic asthma.
Precautions: Use with caution in
hypertensive potlents and in potients
receIving MAO Inhibifors. Pahents should
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hazardous machinery until their response
to the drug has been determined. Since
the depressant effects of ontlhistamines
are additive to those of other drugs
affecting the central nervous system.
potlents should be cautioned agaInst
drinking alcoholic beverages or taking
hypnotics. sedatives psychotherapeutic
agents or other drugs with CNS
depressant effects dunng antihistaminic
therapy. Rarely, prolonged therapy with
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dyscrasias.
Adverse Effects: None senous. Some
patients may exhibit mild sedation or
mild stimulation.
Dosage: Adults & children over 6 years
2 teaspoonfuls of syrup or 1 tablet 3 times
dOIly. Children 4 months to b years
1 2 adulf dose. Infants up to 4 months,
1 2 teaspoonful of syrup 3 times daily.
Supplied: Syrup, Tablets: Each white,
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code number WEllCOME M2A on same
side as diagonol score mark or each
10 ml of clear lemon-yellow syrup
contains triprohdine HCI 2.5 mg and
pseudoephedrine HClbO mg_
The syrup IS available in 115 225 ond
2250 ml bottles: tablets are available in
pockages of 12 and 24. and battles of
100 and 500.
I Burroughs Wellcome Ltd.
--In. laSalie Que.
.Trade Mork
W .1
26
The Canadian Nurse June 1976
The ICN Code of Ethics states that the need for nursing care is universal, and is not
restricted by race, color, creed, sex, etc. Yet prejudice does exist in nursing and may
even be fostered by the social structure of most hospitals. The author explores the
effects prejudice can have on the nurse's ability to help her patients, and suggests
approaches for reducing prejudice. -
I
x.
I
.
Nora J Briant
"
The traditional image of the nurse is one of a
warm, caring person who provides all her
patients with the physical and emotional
support they need. Since many of us who
entered the nursing profession did so with a
genuine desire to help, we work hard to meet
this ideal. Still, there are few nurses who have
not encountered situations where they found it
difficult to care for a particular patient. Many
will admit that this difficulty stems from their
own feelings or attitudes towards the patient's
problem. How many more cases exist where
"prejudice" goes unnoticed in ourselves and
yet proves to be an obstacle to the kind of care
we want to give?
Table 1
Question: Have you found it difficult to give
optimal care to any of the following?
Female Male
nurses nurses
replied replied
yes yes
Drug addicts 41% 40%
- -
Alcoholics 34% 29%
Homosexuals 29% 21%
Criminals 25% 16%
Attempted suicides 21% 16%
Very old persons 16% 21%
Welfare patients 7% 11%
Minority group members 3% 7%
(from: Nursing EthicS A Survey Report . Nursmg 74
September 1974. pp 35-44 I
..
1
in nursing
What is prejudice?
Prejudice is a universal phenomenon; it
occurs;n society as a whole and in individuals.
The word is most often used to mean hostile
attitudes towards racial or other groups,1 but
there is a larger meaning than is generally
intended in conversation. Sociologist, David
Popenoe, says that "prejudice consists of
judging - people, things, or situations - on
the basis of preconceived stereotypes or
ç:jeneralizatiðns. A prejudice may be either
positive. . or negative..."2
Prejudices are learned attitudes. No one
is born prejudiced. Social experiences from
the time of birth determine what prejudices a
person wîll have. Discrimination occurs when
these attitudes are reflected in action.
To understand prejudice further, it must
be realized that "in many cases it can be a
necessary condition for social interaction."3 A
stockpile of previous experiences allows a
nurse to make many prejudgments throughout
the day. She or he may assume that the dietary
department will provide meals, that a porter
will help carry heavy objects when asked, and
that when she or he says "How are you?" to
co-workers in the hall they will reply "fine
thanks," but patients may not. It would be
socially exhausting if a person could never
make decisions founded on a preconceived
idea. It is important to be able to make
generalizations based on stereotypes. This
kind of prejudice is not the problem. "Rather it
is the failure to discard a prejudgment in the
light of additional evidence,"4 or the failure to
seek out evidence contrary to the
prejudgment.
Prejudice is not limited to race or ethnic
origin. Any characteristic a person may have
can count as a mark against them in someone
else's book. Some common targets of
prejudice in nurses are alcoholics,
"hypochondriacs," dying patients, doctors,
obese people, and homosexuals.
Effects of Prejudice
What is the official stand taken by the
nursing profession with regard to prejudice?
The International Council of Nurses Code of
Ethics reads, "The need for nursing is
universal...lt is unrestricted by considerations
of nationality, race, creed, color, age, sex,
politics, or social status."s
Are the words and the deeds of nurses
consistent? Evidence indicates that they are
not. Surveys have found that many nurses are
indeed prejudiced and that their attitudes can
affect their ability to provide care.
1 The nurse will not give optimal individual
care: It is difficult to measure good care or bad
care and even more difficult to cite definitely
the cause of it. A survey done recentl y 6 links
prejudiced attitudes to quality of care by
inquiring into the feelings of nurses. The
question posed was, "Have you found it
difficult to give optimal care to any of the
following?" and eight groups of patients were
listed. The responses of more than 11,000
nurses are summarized in Table 1, A large
number of respondents admit that prejudice is
affecting the quality of care they give.
2 Problems may be overlooked or
misinterpreted: This can be effectively
illustrated by part of a study done on "Value
differences between nurses and low-income
families. "7 Nurses were asked to grade a list of
statements once according to their own values
and once according to the way they thought
low-income families would respond (see
Tables 2 and 3), It is interesting to see how
similar the nurses' values were to those of the
low-income mothers. Yet the difference
between the mothers' values and the nurses'
perception of the mothers' values indicates
how little the nurses understood their patients.
The sample forthis study was drawn from
the roster of a maternal and infant care
program which was troubled with poor
attendance, It is possible that these nurses
considered the mothers' values to be an
important factor in nonattendance. The
evidence does not support this view, however,
and shows how easily behavior can be
misinterpreted. As this case demonstrates, the
real causes of a problem may be overlooked
because of prejudice,
3 Prejudice spreads by labeling: A.M.
Davidites says that labeling is often caused by
role conflict. B "Members of the medical team
- doctors, nurses, socIal workers, and
ancillary personnel - have specific role
expectations of themselves as well as for
patients...Patients who do not meet the role
expectations of the medical team create a
state of disequilibrium."9 She suggests that
one of the coping mechanisms frequently used
by hospital staff is to label the patient abnormal
and request a psychiatric consultation. "Thus
The Canadian Nurse June 1976
27
the problem is defined as existing within the
patient."10 It is not acknowledged that the
problem could be within the staff or within the
system which causes the roles to be in conflict.
As a member of a psychiatric consulting team,
Davidites noted that patients who act
abnormally but do not disrupt the social order
are not labeled. No psychiatric consultation is
requested. As long as they do not cause
conflict patients are not considered to be
mentally ill.
A patient who has been labeled is much
more likely to be treated in a stereotyped
manner ll with little or no consideration given
to individual characteristics, needs or
problems. This will not only affect future
associations but may also affect the
interpretation of past behavior. For example, if
someone is labeled "hysterical." their past
legitimate calls for help will be seen in
retrospect as unnecessary and hysterical. ) )
Table 2
Percentage of nurses, nurses' perceptions of
famifies, and mothers' responses to health
statements as important (I). somewhat
important (5), or unimportant (U)
Health statements:
1. My family and I should have immunizations.
2. I should follow the doctor's advice in raising
my children.
3. I should know about many home remedies
to use when my family IS sick.
4. I should take the child to the doctor
whenever he is sick.
5. I should have a yearly physical
examination.
6. I should expose my children to childhood
diseases early.
7. I count on luck to help me stay well.
Statement Nurses' Nurses' Mothers'
response perception response
I 5 U I 5 U I 5 U
- 5 0
1. 100 0 0 10 85 5 95
2. 52 48 0 5 82 13 50 25 25
3. 14 56 30 73 17 10 65 20 15
-
4. 60 40 0 22 73 5 65 30 5
5. 86 14 0 0 10 90 80 10 10
-- - 25 60
6. 17 14 69 39 39 22 15
7. 0 22 78 95 5 0 25 25 50
(trom Diana Manon linton, .Value Differences Between
Nurses and Low-Income Families. . Nursmg Research,
Jan.-Feb 1972. pp. 46-52)
28
The Canadian Nurse June 1976
I
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In cases where the patient has been
labeled, effective care will not be resumed until
the patient's individuality is recognized and
reinforced.12 13
How does this destructive labeling
persist? It can and very often does occur
innocently during report. A nurse, who has
never seen the patients before will hear
opinions instead of facts from the nurse going
off duty. In an attempt to be helpful the nurse
will include in her report that "Mr. Smith is a bit
of a hypochondriac...Ms. Jones was very
demanding all shift...and Mr. Brown was a pain
in the neck." And so prejudice is spread by the
use and repetition of labels. A fresh, unbiased
nurse, if she accepts these judgments, has
become prejudiced. This is one of the insidious
causes of prejudice. 14
4 Decreased communication: Prejudice
can have a very detrimental effect on
communications; in many cases, what is
actually said may be colored by what the
listener expects to hear. This kind of
inter1erence not only affects patient-nurse
communications, but may be found in
nurse-supervisor, nurse-nurse and
interdepartmental exchanges as well, A floor
nurse may think that the supervisor does not
have a realistic understanding of the situation
and so discount what she says. Another nurse
may judge a co-worker on the basis of that
nurse's educational background rather than
on per1ormance.
Van Dersal outlines some rules for
listening. He says, "You cannot listen
effectively if you are overawed or impressed
by the speaker's title, name, rank, degree,
uniform, wealth or position."15 The reverse
Table 3
Graph illustrating correlation
between Nurses' attitudes and
Mothers' attitudes
% considering statement
important
100 " 0
0
90 "
80 0 0
70 0 0
60 "
50 "
0
40 0
30 0
20 " 0 "
0
10 0 0 0 "
1 2 3 4 5 6 7
Statement number
X - Nurses
o - Mothers
o - Nurses perceptIon of mothers
also holds, that you cannot listen effectively if
you have a low opinion of someone because of
their title, rank, degree, etc.
The topic of communication deserves a
great deal of specific attention but a
generalization can be made with regard to
prejudice. Preconceived ideas distort meaning
and may even prevent a person from wanting
to communicate.
I
5 Permanent damage to egos of
indivIduals: Being the target of discrimination
can cause personality damage and mental
illness. This is a sad and far-reaching effect of
prejudice that may not be noticed directly in the
hospital but infects society at large. Nurses
who are not aware of their own prejudices are
adding fuel to the fire.
For example, homosexuals as a group
are the target of many prejudices. In an article
on homosexuality,16 an experiment is
described which tests the assumption that
homosexuality is an illness. The subjects
consisted of two groups - a group of
homosexuals who did not wish to change their
sexual orientation and were not seeking
psychiatric help, and a group of heterosexuals.
A wide battery of psychological tests were
administered and results were evaluated by
experts who did not know the sexual
orientation of the subjects. Just as many
homosexuals as heterosexuals were rated
well-adjusted and the experts were unable to
distinguish between heterosexuals and
homosexuals from the tests. It was found that
some of the traits and attitudes regarded as
typically "sick" homosexual behavior are
really characteristics of rejected minority
group members. It seems that traits called
"sick" may be caused by rejection - not by
homosexuality.
Don Kilhefner, Executive Director of the
Gay Commumty Services Center of Los
Angeles, gives a moving description of this
plight When you find yourself constantly
being called abnormal and sick it ruins your
self-esteem and erodes your humanity. We
have looked into the eyes of society and seen
that we are considered repulsive undesirable
people. Many of my brothers and sisters have
internalized these values and hate
themselves. They are ashamed, guilt-ridden
and afraid. 17
6 Loss of patients' trust: Patients who feel
discriminated against by health care
personnel will think less of the care they
receive and may be less likely to seek help
again. There is a greater possibility that this
problem will arise when patients differ from
health personnel in race, socioeconomic
background, values etc. In some cases, the
patients' condition may be prejudged and the
patient may not feel he or she has been given a
proper "hearing."
One young woman described such a case
in the following way: In the fall of 1974, when
Mrs. Ford's and Mrs Rockefeller's
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mastectomies were widely reported in the
media, she noticed a painful area in one
breast. After a few weeks, when the soreness
did not go away, she decided to see a doctor.
The treatment she received at the doctor's
office was adequate but she was bothered by
an attitude she sensed. The doctor seemed to
imply there could not possibly be anything
wrong, because the patient's complaint was
probably triggered by the news stories. It
seemed that the examination was done in a
somewhat patronizing manner to humor the
patient. Whether or not this was the case, the
woman felt prejudged and was certainly not
reinforced to practice preventive medicine.
Such attitudes will cause people to avoid
health care workers, in some instances
jeopardizing lives.
Approaches for Reducing Prejudice
To reduce prejudice nurses must first _
learn to recognize it in themselves and then
seek changes in the social structure that
permit the existence and spread of prejudice.
1 Recognizing prejudice: The above
examples illustrate that prejudice can find its
way into every action, every thought, every
word. Because prejudice is such a prevailing
influence, guarding against it is no easy
matter. Nurses must be aware of its presence,
and understand the causes and outcome of
prejudiced thinking. Although prejudice is
learned, "there is no point in criticizing our
parents for passing their prejudices on to us. A
more constructive approach is to be aware of
them, modify our thinking and feeling if we are
able and to understand how prejudice may be
operating in our interpersonal relations."18 By
understanding what prejudice is and does, we
can work as individuals or in groups to identify
hidden prejudices. "Most of them tend to have
judgmental overtones. In fact, the moralistic
aspects of them are apt to conceal the fact that
they are basically prejudices. "19
2 Changing the social structure: In trying
to understand why prejudice occurs, it is only
useful to a point to recognize it as an individual
failing in oneself. It is even less useful to point it
out in someone else, since this will not be met
with enthusiasm. It is more productive to look
at the system.
What is it in the social structure of our
work situation that promotes prejudice:? It all
has to do with status. Most modern health
professionals espouse the view that all
members of the health team are equals, each
with different talents and functions. For some
time, nurses have been concerned with raising
their own status on the health care team to
coincide with this view of equality. But what
about the status of patients? This is usually
glanced over quickly by saying thatthe patient
must also be considered part of the health
team. This is a popular attitude, but is it
achieved?
The Canadian Nurse June 1976
Why is it that nurses sometimes do not
. give optimal individual care?
Why is it that patients' problems can be
overlooked or misinterpreted?
Why is it that prejudices about patients
spread among nurses?
Why is it that distortion occurs in
patient-nurse communications?
Why is it that patients' egos are pushed
towards weakness instead of strength?
Why is it that patients lose trust and don't
return for needed health care?
One answer to all these questions is that
patients are not treated as individuals with
equal status, in spite of the fact that it is their
bodies, their minds, their lives. They occupy a
different and lower position on the health care
team. The nurse is accustomed to being in
control of the patient. and her role is a very
active one. She must make good decisions
about patient care based on her education and
experience. The patient's role is passive- to
receive care cooperatively, Patients are not
expected to step out of this role and take an
active part in determining their care unless
they are invited to do so by the nursing staff,
and it is always well-understood that this is a
liberty granted to the patient by the nurses.
When the patient's status is not equal, he
or she is in a position where decisions are
being made for him on the basis of
assumptions and he does not have the
opportunity to correct misconceptions. In such
cases, the patient not only may feel helpless,
but prejudice and stereotyping on the part of
the nursing staff will tend to increase.
There is a technique for reducing
prejudice which may be useful to look at as a
possibility for changing the social structure in
hospitals. This is called "shared coping," and it
involves cooperation to achieve a common
goal. "One of the essential characteristics of a
shared coping situation is that individuals find
themselves in the same situation as equal
status partners."20 The effectiveness of this
technique is borne out by experiment 21 and by
experience. For example, there are fewer
incidents of racial tension in combat zones,
where cooperation is critical, than in zones
free of crisis.
By approximating a shared coping
situation in the hospital it would be possible to
raise the status of patients and eliminate
situations in which prejudice is fostered. One
change that will further this aim is to
automatically include patients in conferences
about them. 22 Their temperatures, test results
and medication orders should be familiar to
them, and their feelings and opinions should
be consulted in setting realistic goals for
nursing care plans. It is a waste of time and
effort to make a plan based on goals the
patient does not share. Dr. Kübler-Ross writes
29
))
30
sensitively about the question of whether or
not to disclose the diagnosis to a patient, "I
personally feel that this question should never
come up. The question should not be 'Should
we tell...?' but rather 'How do I share this with
my patient?,"23 If patients choose not to
enquire about the seriousness of their illness,
that is their prerogative, but keeping this
decision out of their hands is a self-protective
device of doctors, nurses and relatives.
The second suggeston for reducing
prejudice is to implement walking rounds at
each change of shift. Giving reports in a
secluded office or corner permits and
promotes labeling. In a private talk, the nurse
gOIng off duty IS likely to unload many
frustrations of the past eight or twelve hours
onto the shoulders of the oncoming staff. The
man who has been labeled "demanding
patient" is not there to tell his side of the story,
so naturally the nurse's view is adopted.
There are some difficulties presented by
walking rounds, but the rewards could far
outweigh them. Ifthe report takes place quietly
at the bedside of each patient it will contain a
greater percentage of fact than opinion. The
report will be short and concise. The oncoming
nurse receives the benefit of being able to
connect the name and information to a face,
and at the end of report she will already have
completed a survey round. Lastly, but most
important, are the benefits to the patients.
Seeing that information is passed on to the
new staff will increase patients' confidence in
staff. Also, the patient's status will be elevated
to that of team member - one who can take
part in the exchange of information.
If nurses can convey to patients that they
are important and well-regarded individuals
with a rightful place on the health care team,
then patients can accept this status and take
the active, useful role that goes with it. The six
effects of prejudice that have been discussed
could all be reduced if patients were allowed
and encouraged to accept this new role,
Conclusion
Prejudice, whether it involves
discrimination against a certain race or simply
the stereotyping of a particular patient, has no
place in nursing. I believe that the social
structure of most hospitals promotes prejudice
and discrimination, and encourages a
distance between patient and nurse that
hinders the provision of optimal care. It is up to
us to confront our own prejudices and take the
initiative to raise the patient's status to that of
partner rather than pawn.
The Canadian Nurll8 June 1976
Nora J. Briant (R.N., Montreal General
Hospital, Montreal, Quebec) has worked in
several areas of nursing in Quebec, Or'9gon
and Newfoundland. She is presently studymg
for her B. N. at the University of New
Brunswick and is working this summer in the
Intensive Care Unit of the Victoria Public
Hospital in Fredericton.
e
a
r
References
1 Aronson, Elliot. Social psychology. In
Mussen, Paul Henry. Psychology: an introduction,
by. . . and Marl< R. Rosenzweig. Lexington, MA,
Heath, 1973. p. 110.
2 Popenoe, David. Sociology. Englewood Cliffs,
N.J., Prentice-Hail, 1974. p. 319.
3 Ibid., p. 319.
4 Ibid., p. 319.
5 ICN code for nurses: Ethical concepts applied
to nursing, Canad. Nurse,69:8:9, Aug. 1973.
6 Nursing Ethics: The admirable professional
standards of nurses: a survey report. Nurs.
'74 4:9:35-44, Sep. 1974.
7 Brinton, Diana Marion. Value differences
between nurses and low-income families. Nurs.
Res. 21:1 :46-52, Jan./Feb. 1972.
8 Davidites, Rose Marie. A soCIal systems
approach to deviant behavior, Amer. J. Nurs.
71:8:1588-9, Aug. 1971.
9 Ibid., p. 1588.
10 Ibid., 1588.
11 McNall, Scott G. The sociological
experience: A moaern introduction to sociology
Boston, Little, 1974. p. 174-5.
12 Dolan, Marion B. Shelley was angry. So was
the staff. Nurs. '74 4:6:86-8, Jun. 1974.
13 Battersby, Jane. Ms. Battersby...A nurse
who became a demanding patient. Nurs. '73,
3:7:18-19,Dec. 1973.
14 Aronson, op. cit, p. 125.
15 Van Dersal, William R. How to be a good
communicator - and a better nurse. Nurs. '74
4:12:57-64, Dec. 1974.
16 Braverman, Shirley J. Homosexuality. Amer.
J. Nurs. 73:4:652-55, Apr. 1973.
17 Ibid., p. 654.
18 Burton, GenevIeve. Personal, impersonal
and interpersonal relations: a guide for nurses. New
York, Springer, 1964. 292p.
19 Ibid., p. 280.
20 Aronson, op. cit., p. 118.
21 Ibid., p. 112.
22 Radtke, Maxine. Team conferences that
work. Amer. J. Nurs. 73:3:506-8, Mar. 1973.
23 Kübler-Ross. Elisabeth. On death and dymg.
New York, MacMillan, 1973. p. 25."
j
egg-Perthes disease is a hip disorder that primarily affects young boys.
:s symptoms are often deceptive. Although the prognosis is extremely
'ariable, treatment measures in current orthopedic practice attempt to
nsure that the children have a good hip joint to carry them into adult life.
len
w
:I:
l-
ce
W
c..<t
..J
diephysis -
prime", centre of
ossification
õ
<.>
.!J:!
ã5
ü
Mrs. White was worried about her fìve-year-old
son, John. For six months he had intermittently
complained of pain In his right knee and he had
developed a limp. Initial examination of his
knee by the family doctor showed nothing, and
for a few months Mrs. White dismissed John s
complaints as "growing pains." Finally she
decided to consult the doctor again and ask for
x-rays of John's knee. She was surprised
when he ordered x-rays of the hips as well, and
even more surprised when the doctor told her
John's symptoms were caused by a disease
affecting his hip joint, called Legg-Perthes
disease.
This type of bone disorder occurs in fewer
than one in 800 young boys about the age of
John. Mrs. White had never heard of the
disease and both she and her son needed a
great deal of support and information in order
to cope with the resulting changes in their
lifestyles.
When treatment was begun. the nurse
caring for John was able to offer valuable
emotional support to the entire family and over
the next few years, until treatment was
successfully completed, the Whites came to
rely on her as an important member of the
team concerned with his care.
moderlltll
ebduction
"
intllrnlll
rotlltion
.:Jt4
TREATMENT IN A BRACE
M llpiphysis fllltte""d
-loss of bontty _ss
DISEASED FEMUR (/ neck of femur
A ND HIP JO I N T -thickened
Illustration courtesy of Sh"ley Mohyudden
The Disease
Definition: Legg-Perthes disease is
one of a group of self-limiting disorders of the
bone known as osteochondroses in which a
boney epiphysis undergoes aseptic avascular
necrosis. This is a series of pathological
events beginning with an initial loss of blood
supply, and progressing to death of the bone
and gradual replacement of dead with live
bone. Legg-Perthes disease is
osteochondrosIs of the femoral head.
Known also as coxa plana,
osteochondritis deformans juvenilis, and
Legg-Calvé-Perthes disease, it was first
described in 1910 by Legg, Calvé and
Perthes as a self-limited. nontuberculous hip
lesion in children. In 15 percent of all cases the
lesion is bilateral; the rest occur in one hip only.
It occurs most commonly in young boys
between the ages of four and eleven years; the
incidence is 1 :750 for boys compared with
1 :3,700 for girls. 1 The exact cause of the
disorder is not known but five percent of
children who have suffered the relatively
benign condition of transient synovitis, or
nonbacterial inflammation of the synovium of
the hip joint, develop Legg-Perthes disease. It
is generally thought that increased hydrostatic
pressure within the hip joint, resulting from a
traumatic or inflammatory synovitis, occludes
the precarious blood supply of the femoral
head, inducing the avascular necrosis
Signs and Symptoms: The signs and
symptoms of Legg-Perthes disease are
usually insidious and are often lacking in the
early stages. The onset of pain occurs acutely
in only one quarter of cases. 2 Pain in the knee
and/or anteromedlal aspect of the thigh and
groin of the affected leg. and a protective limp
are the complaints most commonly reported
by parents.
Pathophysiology: There are two types of
Legg-Perthes disease. The whole head type,
the most common and the most severe.
involves the entire femoral epiphysis; the
partial head type affects only the anterior one
third to one half of the femoral epiphysis.
The disease spans a period of two to eight
years, depending on the age of onset and the
continued on page 34
CD THE PRACTICE OF EMERGENCY
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based on a colleague relationship between physician
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Features include: anatomy, physiology, and pathophysi-
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389 Pages/lllustrated/1975 $8.95
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A superbly useful tool for nursing education and practice, this
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LITTLE, BROWN
529 Pages/1974 $8.95
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of individuals in periods of health as well as illness. What
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psychological adaptation.
By BERNARD D. STARR, Ph.D. and HARRIS S. GOLDSTEIN,
M.D., 0, Med. Sc.
SPRINGER
436 pages/1975 $10.50
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313 pages/illustrated/2nd edition/1974/paperbound $8.75
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III., \"anBPIBn ....ur5e ..rune 11:1110
type of femoral head involvement, and
progresses through four stages. 3
1 Early necrosis and avascularity - there
are few signs and symptoms at this stage.
2 Revascularlzation with old bone
resorption and new bone deposition - during
this stage, which lasts one to four years, 4 the
new bone has a "biological plasticity" and,
depending on the forces that act on it, can be
molded into a normal or abnormal shape.
3 Boney healing - eventually the dead
bone is resorbed and the new bone gradually
ossifies; biological plasticity persists during
this stage.
4 Residual deformity - once the process
of healing is complete, any residual deformity
will not be remodelled, and may result in
degenerative joint disease in later life.
Treatment: The treatment of
Legg-Perthes disease aims to preserve a
useful weight-bearing joint for adult life. The
resultant hip joint is affected by several factors:
the age of the child (the younger child has a
better prognosis); the type of femoral
involvement: an early diagnosis; and the type
and adequacy of treatment.
Two main principles are followed in
treatment: 1) The femoral head must be
maintained in the acetabulum in a position of
moderate abduction and internal rotation to
prevent abnormal molding forces on the
biologically plastic head; 2) The stress of body
weight must be eliminated from the avascular
femoral head as much as possible.
Current treatment varies considerably
with the physician. Young children with the
partial head type of Legg-Perthes disease can
be managed by avoidance of vigorous
activities only. Children over the age of four, or
with the whole head type, need active
treatment.
The child is usually treated initially with
Buck's extension or split Russell traction, with
abduction gradually being increased until full
range of hip motion is obtained.
When full range of motion has been
established, the child may be placed in
abduction casts or braces, e.g. A-frame,
Bobechko Toronto, or trilateral socket braces,
until there is radiological evidence of boney
,
Standing (anterior posterior) VIew,
showing Legg-Perthes disease, right
hip. Note the changes of avascular
necrosis and revascularization; the
flattening and appearance of
"fragmentation" of the femoral head
(due to boney resorption and
deposition); the subluxation
tendency; and the slightly broadened
metaphysis (femoral neck).
reconstruction, and no new areas of bone
resorption are seen. This lasts approximately
two years, but IS variable, and during this time
the child must visit his doctor every two or
three months for examination and x-rays.
Surgery may be performed before a
deformity has developed to prevent or correct
subluxation of the femoral head in the child
with a poor prognosis. Examples of such
operations include a high subtrochanteric
(femoral) osteotomy, an innominate
osteotomy and a salvage osteotomy. An
adductor tenotomy may be done to increase
range of motion prior to bracing or surgery.
The outcome of the different treatments
for this disorder is extremely variable and
ðepends on the four factors mentioned
previously.
ï
...
, .
Nursing Care
Because the treatment of Legg-Perthes
disease is such a lengthy one, its success
involves continued coordination of the efforts
of the orthopedic team, including the surgeon,
the physiotherapist, the nurse and the parents.
To provide the necessary support, the
nurse must extend her care and understanding
to include the whole family. A previously well
child has suddenly developed a serious
disorder that will require lengthy treatment and
has a variable prognosis. With attention to the
needs of the child and his family, the
experience can be a time of growing. If It is
poorly handled, the child may develop a
crippled personality and family relationships
may become seriously damaged. Thus,
emotional support of the child and his family
represent an important aspect of the total care
plan.
In the hospital: When the child is first
placed in traction the nurse must keep in mind
the fact that he and his family have usually just
received the shock of diagnosis. Her care,
then, must combine an awareness of
emotional needs with knowledge of the basic
principles of traction care and an
understanding of Legg-Perthes disease.
The young child may understandably
react negatively to his enforced traction, Used
to being healthy and active, he will find it
difficult to lie in bed constantly, and it will tax
the ingenuity of parents and staff to keep him
lying down without constant nagging. Traction
can be made more attractive for the child by
decorating the area with stuffed animals, the
child's art work or get well cards. In addition,
support from parents and staff, understanding
of his frustration, and planned diversionary
activities, such as transporting him in his bed
to the children's play area, will help him to
cope with his feelings.
The child in traction must maintain the
correct posture, as deterrni ned by the doctor. It
is a good idea to affix a sketch of the desired
posture over the child's bed so that anyone
entering the room can check it.
As with all patients in traction, the traction
cord needs to be checked regularly for fraying
and correct position in the pulley track.
Weights should be hanging freely,
Neurovascular status of the leg(s) in traction
should be checked every four hours if possible
(at least every eight hours), paying attention to
warmth, color, capillary filling and response to
pin prick of toes.
If adhesive straps are used for traction,
the surrounding skin should be checked for
signs of irritation such as rash, blisters and
complaints of itching. If nonadhesive straps
are used, they should be removed every four to
eight hours for skin care. The bandage should
be rewrapped each time from the ankle to the
knee and should be loose enough to Insert a
finger underneath. The skin underthese straps
should be observed for 20 - 30 minutes for
redness that does not disappear; this could be
a sign of tissue necrosis. Neurovascular
assessment should be done one half hour after
bandages are re-applied. as a measure of
tightness or looseness.
Good skin care should be given to the rest
of the child's body, paying dose attention to
boney prominences.
While in traction, the child may be
measured for his brace. Some doctors initially
place the child in abduction casts, so that by
the time his braces have been made they
present a very attractive altemative to him.
With gentle but firm support most children
adjust fairly well to their braces.
Before the child leaves the hospItal the
nurse must ensure that he and his parents
have enough knowledge and understanding of
home care so that the child can live as normal a
life as possible without discomfort,
Most braces used for treatment of
Leff-Perthes disease are wom on both legs'
and children must use crutches to walk. Most
learn to use a swing-through ga.t. swinging
both legs through the crutches at the same
..
..\
-
....
time. The nurse should be sure that the
parents and child understand the use of
crutches as taught by the physiotherapist, or
offer definite guidelines if the latter is not
available. She should also stress safety
measures in the home, such as daily checking
the crutches for loose screws and worn crutch
tips. and modifying the home environment for
crutch usage, e.g. taking up scatter rugs.
The nurse should also review with
parents, some special care aspects of the child
in braces, For example: 1) Daily skin care with
alcohol should be given to boney prominences
in contact with the brace: the use of alcohol will
toughen the skin against irritation, whereas
lotions soften it and powders cake. 2) At the
same time. skin should be checked for areas of
irritation. 3) The plastic molds of the braces
should be cleaned daily with soap and water,
and the leather cuffs cleansed with leather
rubbing compound.
The child should not experience pain
while in his braces. The braces will need
adjustment as the child grows and parents
should watch for indications such as a tight cuff
. The exception is the trilateral socket brace which is
worn on the affected leg only. With this type, the
child can eventully manage without crutches.
'"',
-
Pictured on opposite page is a
six-year-old patient in abduction
casts; above. another patient in an
A-frame brace demonstrates the
stance of the swing-through gait.
36
The Canadian Nurse
June 1976
,
or brace jOints incongruous with the child's
joints. Adjustments are made by the doctor or
orthotist.
Braces are removed daily. At this
time, the child may have an exercise program
to do with his parents, assigned by the
physiotherapist and/or doctor. Some parents
find that evening, before or after the child has
gone to bed, is the easiest time for exercising
as he is usually more relaxed at this time.
Certain activities may be recommended
by the doctor, including such things as tailor
sitting and sitting or lying prone with legs in
abduction. Swimming is sometimes permitted.
light touch weight-bearing with crutches is
often preferred to non-weight-bearing which
can increase the tendency towards flexion
contracture. These and other specified
activities shouló be reviewed by the nurse to
be sure the rationale is understood and to
answer any questions.
If surgery has been necessary,
posoperative care of the child with
Legg-Perthes disease will vary with the
surgery performed. Often a cast will be
employed, in which case the principles of good
cast and skin care should be followed.
\
\
Public Health Aspects: Often it is the
public health nurse in the community who
provides the ongoing home support for the
child with Legg-Perthes disease and his
family. Thus, to meet the total needs of this
family, it is important that good communication
exist between hospital or clinic nursing staff
and the nurse in the community. The latter
should also maintain contact with the child's
teacher and school nurse, whose
understanding of the disease can be beneficial
for the child and his peer group relationships.
The public health nurse should have a
good general knowledge of Legg-Perthes
disease to be able to answer questions, clarify
information and help solve problems that occur
at home. She needs knowledge of brace care
and of when to call the doctor in case of
problems. It is helpful if she understands the
principles behind the exercise plan and sitting
postures in order to reinforce the doctor's
and/or physiotherapist's explanations.
Emotional support from the community
nurse can help the parents, the afflicted child
and his siblings to cope with the inevitable
frustrations imposed by this disease. Listening
and empathizing are important to ensure the
emotional well-being of the child and his
family.
In addition, the public health nurse has an
important role to play in the early detection of
Legg-Perthes disease. She should encou
age
medical examination of young boys with
complaints of knee pain and limping, and
ensure that radiological studies include the hip
as well as the knee.
In conclusion, the nurse involved in the
treatment of Legg-Perthes disease is in a
,
position to give the child and his family
continuing support. Her knowledge and
understanding of the disease and its
treatment, combined with this continuity of
care, are important in ensuring the child's
emotional health and minimal disruption to the
lives of himself and his family.
References
1 Tachdjian, Mihran O. Pediatric orthopedics.
Vol. 1. Philadelphia, Saunders, 1972. p. 384.
2 Ibid. p. 399
3 Salter, Robert B. Textbook of disorders and
injuries of the musculoskeletal system. Baltimore,
Williams & Wilkins. 1970. p. 272-5.
4 Ibid. p. 274..,
Celia Nichol (B. Sc. N., Ottawa University) has
worked in a variety of publIc health settings.
As a student she did volunteer work for
community service organizations (including a
"well baby clinic" and an "after-four project"),
and worked a Fisher River Indian Hospital in
Hodgson, Manitoba. When she graduated in
1973 she became Public Health Nurse for
Renfrew County and District Heath Unit.
Since 1974, she has been on the staff of the
new Children's Hospital of Eastern Ontario in
Ottawa, as Public Health Nurse in the
Orthopedic Outpatient Department. The clinic
serves children with a variety of orthopedic
groblems such as congential hip dislocation,
Legg-Perthes disease, muscular dystrophy,
scoliosis, etc., as well as providing follow-up
care after orthopedic surgery or fracture.
Nichol believes nursing care must reach
beyond the acute care setting, and says, "I
like working with people, particularly in the
context of the home environment where the
person actually has to cope with his
problems. In the clinic, I try to equip the
patient and his parents with the knowledge
and skills to cope at home, keeping in mind
not just the patient's physical needs but his
emotional needs as well. "
.....
.
,
'.
""",.I
"\
The author would like to thank Dr. W
Mcintyre, head of the Orthopedic
Department, Children's Hospital of Eastem
Ontario, for his many patient explanations and
answers to questions.
I
The CanadIan Nurse June 111ft>
37
Four nurse teachers (the authors), from four different
schools of nursing, tell how they achieved their goals
when charged with the responsibility of developing a
clinical evaluation tool for student nurses enrolled in a
newly developed Community College Program.
A clinical evaluation tool
for student nurses
June Morton, Ann Stinson, Jan Wagstaffe, Marie Yakimoff
Background
The process of transferring nursing
education in the province of Ontario from the
traditionally homogenous diploma school of
'nursing to the heterogenous college, is now
complete. Nine years of organizational conflict
and growth were required to make this
transition a reality. Traditional beliefs about
learning, teaching, and nursing were
challenged, in particular, the notion of
"feedback" became an extremely relevant
I concept in nursing education. CUrriculum
effectiveness, it was realized, could only be
, assessed by comparing student performance
,with predetermined behavioral objectives. To
I enable teachers and students to evaluate
clinical performance, more reliable methods of
collecting behavioral data were needed to
identify the elements upon which fairly
accurate judgments could be based.
At the request of the chairman of the
I department of nursing of one of these
,community colleges (Mohawk College,
i Hamilton, Ontario), the authors undertook to
develop a clinical evaluation tool that would
assist teachers in obtaining this information
about their students. The initial
recommendation came from the college
faculty Task Group on Student Evaluation for
the Department of Nursing. As a preliminary
step, the authors identified and accepted a
specific short-term goal: "To have an effective
Clinical Evaluation Tool for Semester 1 of the
new school year, available prior to the
summer vacations"
and a long-term goal: "To have similar
evaluation tools developed for each of the
following five semesters, at least six weeks in
advance of the time they would be needed (to
allow time for printing)." The strategies they
utilized to achieve these goals follow.
Input from other sources
Prior to establishing the "design criteria"
and the "performance goals" for our system,
we obtained input from numerous sources,
including:
. The school philosophy, because our tool
had to refleCt its concepts. These included:
- promotion of growth, development, and
self-actualization of the student,
-learning involving the whole person;
- dignity and worth of the individual;
- the preparation of a competent beginning
nurse practitioner who would be able to assess
patient needs, plan, implement, and evaluate
her nursing care;
- System's Theory as the conceptual
framework for the curriculum.
. Our views and those of our colleagues
about the purpose of clinical evaluation. Words
like "growth-promoting," "ongoing,"
"feedback," "systematic," "fair," "the total
person," "dignity," and "cooperative process,"
kept creeping in We agreed that even though
the evaluation we were considering involved
student output, the process also allowed for
increased growth for the teacher.
. The Task Group on Student Evaluation for
the Department of Nursing. The chairman
outlined the "raison d'être" of this committee,
what it had accomplished, and how it saw our
role. In addition, the members discussed with
us our responsibility in remaining within the
general College framework of evaluation, i.e.,
students were to receive marks of 1 to 4 for
clinical performance. Collaboration with the
Task Group saved us a great deal of time,
since its members had already done
considerable research on evaluation,
particularly at Mohawk College.
. The course outline for Semester 1. We
familiarized ourselves with the expected
behaviors in the new curriculum, and noted the
levels at which they were to be performed.
. The evaluation forms that had been used
by the four campuses prior to entry into the
College system. In addition, we reviewed the
evaluation form used by the local university for
their student nurses.
. Journals of Nursing, to seek data related
to rating scales. Our readings indicated that:
- between 1959 and 1964, four major
researchers (Tadlock, 1 Palmer,2 Rhines, 3 and
T ate 4 ) developed rating scales and used these
in certain select clinical areas quite
successfully;
- in 1967 at Wayne State, Slater 5 developed
a rating scale that measured individual
characteristics and actions rather than skills;
- in her article "A Problem That Won't Go
Away," Vivian Wood 6 saw a place for rating
. scales in clinical evaluation. However, she
cautioned that most faculty require more
education to use these effectively.
The committee felt that the qrading
system established by Mohawk College could
be supported by rating scales.
. Jurgen Ruesch's four postulates
regarding "General System's Theory and the
Observation of Behavior"7. What impressed
us most was his ability to prove mathematically
that evaluation was always subjective.
. Fivars and Grosnell'sNursing Evaluation:
The Problem and the Process, 8 and
Flanagan's Clinical Experience Record for
Student Nurses - Instructor's Manual. 9 We
were impressed by the research that
eventually led to their "Clinical Performance
Record" and "The Critical Incident."
. Counsel was sought to discuss the legal
aspects of student evaluation and related
documentation, in view of the fact that in some
provinces:
- Students and/or their guardians have
access to all personal records;
- the student has the right to obtain legal
counsel to represent him/her at meetings
related to termination etc. Obviously
evaluation forms must supply accurate,
relevant information. This would only be
possible if performance goals were clearly
stated.
. Faculty members attending graduate
school and persons who had attended recent
workshops.
Design criteria:
After compiling our data on current
evaluation theories and programs, we were
able to formulate the design criteria forourtool
These were:
I Evaluation to be effective must be based
upon specific behavioral objectives.
II Evaluation should be a co-operative,
ongoing process involving student and
teacher.
III E valuation should occur in an atmosphere
of mutual respect and should promote
growth in teacher and student.
IV Evaluation designed along the lines of the
nursing process should be relatively easy
for the student to apply.
V Clinical evaluation must be based upon
the objectives identified by the curriculum
committee in the course outline.
VI Concepts of evaluation need to be
presented to the student so that emphasis
is on "growth" and'learning."
38
The Canadian Nurse June 1976
Organization of Format
Based on criterion IV, the Clinical
Performance Record developed by the
committee contains ten major areas of
behavior to be evaluated. These correspond to
the stages Involved in the Nursing Process
They are:
- attitude to learning
- observing, data gathering, assessing
- communicating
- identifying patient needs
- developing a plan of care
- implementing a plan of care
(physical-psychosocial)
- evaluating and revising the plan of care
- accepting nursing responsibilities
- adapting to new and stressful situations
- integrating and self-appraisal.
Within each of these areas or
subsystems, the behavioral objectives specific
to that subsystem are identified for the level for
which the tool is to be used. In other words, the
specific objectives are determined by the
objectives in the course outline(See Figures
1.1 and 1.2).
\
J
,
Procedure
The Clinical Performance Record. it was
decided, would be filed in the Learning
Resource Centre, and students would be
allowed to see their own file on request.
Initially, the students were to receive their own
copy, but cost made this impractical. Instead,
each student was provided with a guideline
listing all specific clinical behaviors on which
he/ she was to be evaluated during the
semester (See Figure 2). Whenever a student
rotated to a new teacher (every six weeks), the
teacher would prepare a new Clinical
Performance Record for him/her. The student
would receive a new guideline with the
appropriate objectives at the beginning of each
semester.
The committee recommended that the
Clinical Performance Record not form part of
the student's permanent record, but rather that
two Summary Records of "strengths" and
"weaknesses," completed by both the student
and the teacher be used for that purpose( See
Figure 3). The Clinical Performance Record
would promote growth and development within
the student, without the associated tension
that permanent records induce. This
recommendation was supported by faculty
and administration. The Summary Records
(by student and by teacher) would be handed
in to the office of the campus head, and Clinical
Performance Records would be filed in the
Learning Resource Centre for three years.
Our committee agreed with experts who
claim beginning students have difficulty
evaluating their own behavior and writing
self-evaluations. Therefore, we recommended
the use of a daily Clinical Diary to facilitate their
interactions with the teacher about "my day"
on the unit, his/her feelings about it, and
his/her thoughts. By Semester 3, however, we
felt students should be capable of writing a
self-evaluation associated with clinical
performance.
t
Feedback
Once our plan was formulated, we asked
to speak at a faculty meeting of the department
of nursing We gave everyone a copy of the
plan, an instruction sheet, and a
questionnnaire and described our progress
from the time we had started. We encouraged
feedback through questions (and there were
many) The rating scale we had set up to
correspond with the specific behaviors was
unanimously vetoed. About half the faculty
were concerned about the time factor involved
in keeping the performance record up-to-date.
(The committee estimated that this would take
a teacher about three hours per week if she
had ten students).
Faculty were asked to review the tool
carefully and to complete the questionnaire
within a week. Approximately 75 percent
responded, some verbally, but most through
the questionnaire. We received many good
ideas. In general, two of the four campuses
were quite positive about using the Clinical
Performance Record and the Summary
Records; the other two were not. We adopted
any ideas that could be adapted to our tool,
and sent it to press. Semester 1 evaluation
forms were completed and so was the school
year.
In September, our committee visited the
four campuses and reintroduced the clinical
evaluation tool and its method of utilization.
There were still some teachers who felt the
time involved outweighed the value of the
Clinical Performance Record; however, they
were willing to cooperate. Teachers were
encouraged to discuss behaviors with
students as soon as they occurred and to use
the problem-solving approach,
Faculty and our committee decided
togetherthatthe form would be introduced in a
positive way to the students by their own
clinical teacher at the beginning of Semester 1.
Students and teachers were told that they
would be asked to evaluate the clinical
evaluation tool at the end of the first, third, and
sixth semesters, and that appropriate
revisions would be made. Feedback received
from the first evaluation, we felt, was
significant in that 85 percent of the students
and 82 percent of the faculty members
responded to our questionnaire.
Since the main emphasis in education is
on "helping the learner to learn," we were most
gratified by the student responses. Of the
students who responded, most felt that the
form was worthwhile. Teacher remarks, on the
other hand. emphasized the amount of time
spent in completing this record. The
committee's original estimate of three hours
weekly proved correct.
Suggestions made by faculty to improve
the Clinical Performance Record included the
following:
. Increase the space for comments.
. Combine the Clinical Performance
Records for Semesters 1 and 2, as it was
impossible for all students to complete all
clinical objectives in the first semester.
. Make objectives relate to specific skills
. Generalize the objectives a little more.
. Have a workshop to review the use of the
evaluation forms and to find a faster way of
completing the forms.
. Change the wording of some objectives in
order to make them more meaningful.
As a result of this feedback. several
events occurred:
- the committee discussed and assessed the j
suggestions and comments of faculty and I
students;
- survey results were presented to the faculty
at a general meeting; I
- action was taken on all student and faculty
suggestions, except the request for more I
specific objectives, as this would have meant
increasing the length of the Performance I
Record and the. time i
volved in co
pleting it. I
However, we did clanfy vague objectives.
Performance Records for Semesters 3.4,
and 5 were combined forthe same reasons as I
were 1 and 2. Since students rotate through I
Obstetrics, Pediatrics, Psychiatry, Medicine, I
and Surgery during these semesters, a more
generalized evaluation form was required. The
ten major areas or subsystems to be evaluated I
remained the same as in Semesters 1 and 2.
The specific behaviors were those included in
the course outline for Semesters 3, 4, and 5. I
When the third semester rotation was
completed, we had the Clinical Performance
Record evaluated by students and teachers. I
For ease in tabulating results, Likert-type
scales were used (See Figure 4).
Like our other Performance Records, the
form for Semester 6 is based on course I
objectives. Since students probably will be
evaluated by head nurses and team leaders ,
during the latter half of this rotation, as well as I
by their teachers, consideration was given to I
the limited amount of time these persons have
to participate in the evaluation process.
Therefore, the Semester 6 form, although still I
containing all the major areas of behavior that i
the student had been evaluated on for two '
years, will now have the specific behaviors
followed by Likert-type scales (See Figure 5),
The head nurse will be encouraged to I
discuss heropinions with the students, and the I
student will be asked to complete a Summary
Record (as done in past semesters) that will be I
attached to the head nurse's evaluation.
These will be forwarded to the permanent file.
In addition, each head nurse will receive a
letter from this committee describing the
purpose of the evaluation form and her
responsibility associated with it. Her opinions
regarding the Clinical Performance Record will
be sought in writing.
Conclusion
Both our short-term and long-term goals
have now been achieved. More than 400
students have begun their clinical experience
in Semester V at Mohawk College. Because of
the faculty's commitment to the clinical
evaluation tool, we feel these students
possess (and will continue to demonstrate)
increased:
. self-confidence on the clinical unit;
The Canadian Nurse June 1976
39
Figure 1.1
Mohawk College of Applied Arts and Technology
Health Sciences Division, Department of Nursing
Clinical Performance Record (Semesters I, \1)
Areas of Performance
1_ Attitude toward learning
a. Completes the pre-clinical
assignment given by her
teacher.
b Seeks guidance appropriately
from a reliable source.
c. Accepts and learns from
gUIdance received.
d. Makes significant contribution
to pre- and post-conference
e. Is developing skills in
group dynamics,
f. Independently seeks new
learning experiences.
2. Observing, data gathering.
assessing
a. Checks nursing care plans and
charts regularly.
b. Notes patients' usual pre-
hospital routines
Date
Item
Effective
Behavior
Date
Item
Behavior
Needing Date
Improvement
Item
Corrected
Behavior
Figure 1.2
Clinical Performance Record (Semesters III, IV & V)
Areas of Performance
Date
Item
Effective
BehavIor
Date
Item
Behavior
NeedIng Date
Improvement
Item
Corrected
Behavior
1. Attitude toward learning
a. Completes the pre-clinical
assignment in depth and
detail.
b. Independently seeks new
learning expenence s.
c. Recognizes the needs for
guidance and seeks it
appropriately.
d. Accepts and learns from
guidance received
e. Help s others apply theory.
Shows leadership ability in
gr oup discussion.
g. Makes significant contnbutions
to pre- and post-conferences
2. Observing. data gathering.
assessing
- --
a Checks nurSing care plans and
charts regula rly.
b. Checks that medications, treatments
and nursing care are consistent with
patient safety.
1
40
The Canadian Nurse June 1976
Figure 2
Clinical Experience Record (Semesters III, IV, V)
1. Attitude toward learning d. Demonstrates manual dexterity.
a. Completes pre-clinical assignment in depth e. Ensures the comfort and safety of the patient
and detail. when giving care.
b. Independently seeks new learning f. Provides a safe, orderly and comfortable
experiences. environment.
c. Recognizes the need for gUidance and seeks it g. Demonstrates organizational ability.
appropriately. h. Completes assignment in a reasonable length
d. Accepts and learns from guidance received. of time.
e. Helps others apply theory. i. Teaches patients and visitors pnnciples of
f Shows leadership ability in group discussion. asepsis.
g. Makes significant contributions to pre- and j. Utilizes health teaching to prepare individuals
post-conferences. for return to family and community.
2. Observing, data gathering. assessinQ B. Emotional
a. Checks nursing care plans and charts a. Nurse-patient and nurse-family interactions
regularly. are purposeful and therapeutic.
b. Checks that medications, treatments and b. Demonstrates the ability to reflect feeling tones
nursing care are consistent with patient safety. inherent in patient communication.
c. Observes and interprets physical c. Responds to patient comments in
manifestations of her patient. non-judgmental manner.
d. Observes and interprets psychological d. Offers appropriate support in periods of
manifestations of her patient. apparent stress.
e. Uses the assessment tools to gather e. Establishes, continues and concludes a
information. supportive relationship with a patient who has
an emotional problem.
3. Communicating 7. Evaluating and revising the nursing care
a. Utilizes interviewing techniques with patients plan
and families. Identifies changes in patient needs and nursing
b. Communicates effectively with teachers, a.
peers, patients, and health workers. problems as they occur and modifies or revises
c. Interacts constructively with group members. the plan.
\ d. Provides health teaching and explanation of b. Determines the effectiveness of nursing care in
procedures at the patient's level of terms of the nursing care plan and the total
understanding. treatment plan.
e. Communicates effectively in writing c. Validates her findings with her patient, her
\ (anecdotes, process recordings, nursing care clinical instructor, team leader and/or
plans). physician.
f. Records and reports physical and d. Supplements knowledge and develops skills
psychological manifestations in her patients. as needed.
g. Records and reports pertinent data regarding e. Evaluates the teaching process and revises it if
treatment and/or nursing care given. necessary.
4, IdentifYing patient's needs 8. Accepting of nursing responsibilities
a. When questioned, demonstrates knowledge of a. Assumes responsibility for own actions.
scientific principles and nursing theory. b. Maintains ethical standards and proficiency
b. Identifies the physical, psychosocial and according to nursing principles.
spiritual needs which the patient cannot meet. c. Aware of own limitations and refers situation to
c. Identifies appropriate nursing care for patient appropriate personnel.
1 needs. d. Follows established policy or procedure.
e Voluntarily assumes extra duties within limits of
5, Developing a plan of care responsibility.
a. Utilizes knowledge of nursing theory. f. Conserves hospital supplies.
b. Considers individuality and maturational level g. Demonstrates knowledge of proper care and
of patient. use of equipment.
c. Establishes patient and assignment priorities h. Uniforms are worn as required.
in previously experienced situations. i. Is punctual.
d. Establishes long- and short-term goals for j. Understands and carries out legal
nursing action in previously experienced responsibilities associaled with nursing.
situations. Is able to state the rationale of k. Cooperates with other health team members in
these. giving patient care.
e. Develops a plan of care for her assigned 9. Adapting to new and stressful situations
patient. a. Requires minimum guidance in adjusting to
f. Plans for appropriate health teaching. new situations.
6. Implementing a plan of care b. Performs new skills satisfactorily and
A. Physical efficiently.
Applies theoretical knowledge. c. Performs skills learned in previous semesters,
a. calmly and efficiently, under stress.
b. Maintains a high level of proficiency in d. Recognizes manifestations of anxiety in her
previously achieved skills. own behavior and seeks appropnate ways to
c. Applies principles of asepsis. reduce them.
e. Reacts appropriately to situations which
require immediate attention.
10. Integrity and self-appraisal
a. Recognizes own assets, potentials, limitations I
as well as utilization of coping mechanisms.
b. Realistically and honestly evaluates her own
performance and seeks appropriate
assistance.
c. Evaluates her interpersonal relationships.
d. Evaluates her ability to problem-solve.
e. Identifies and reports her own errors even if
unnoticed by others (e.g. isolation, surgical
asepsis, drugs etc.) and attempts to correct
them.
f. Identifies and reports incidents and accidents
that endanger the patient.
g Demonstrates respect for dignity and worth of
patients and co-workers.
h. Is discriminate with confidential information
i. Demonstrates an awareness of her own health
needs.
-
Figure 3
Summary Record of Clinical
Performance for Semester
Name
Clinical area
For p enod be g innin g To
Hours offered Hours absent
Grade -
Areas of strength and weakness: -
Student/Teacher comment
Signature of teacher:
Signature of student
Date:
Date:
The CanadIan Nurse June 1976
41
Figure 5
Clinical Performance Record (Semester VI)
Areas of Performance
1, Attitude toward learning
a. Completes pre-clinical assignment
In depth and detail.
---- --
- - - -
b Independently seeks new learning
experiences .
c. Recognizes the need for guidance
and seeks it appropriately.
d. Accepts and learns from guidance
received
e. Shows leadership ability in
grou p discussion
Helps others apply theory.
- --- - -
g. Makes sigmficant contribution
to team meetings.
Check Approprrate Column
Strongly
Agree
Agree
Undecided
Disagree
Strongly
Disagree
Figure 4
1. a. The concepts underlying the Clinical Evalua-
tion of student nurses at Mohawk College re-
flect the philosophy of the school.
b The main focus of the Clinical Performance
Record and of the Summary Sheet appears to
be on
- student learning
- stud ent growth
Q uestion # Agree Undecided Disagree
1 (a)
1 (b)
1 (c)
c The specific reason for creating the Clinical
Performance Record was to assist teachers
and students Identify
- behaviors that would indicate the learner
had achieved the clinical objectives out-
lined for Semester III
patterns of strengths and/or weaknesses
demonstrated by the student during
Semester III.
. observational skills on the clinical unit;
. motivation for learning
. growth In the development of nursing
skills, including problem-solving,
. willingness to cooperate with others;
. feelings of self-respect and respect for
others;
. acceptance of evaluation in general and
clinical evaluation in particular.
When this article was written, all four teachers
were in the Nursing Department of Mohawk
College, Hamilton, Ont.: June Morton,
Brantford Campus: Ann Stinson, Civic
Campus: Jan Wagstaffe, Chedoke Campus,
and Marie Yakimoff, Sf. Joseph's Campus.
The authors wish to thank Dorothy
Lambeth, Chairperson of the Nursing
Division ,Mohawk College, for the freedom to
be a little creative, her trust in their
capabilities, and her support.
. Additional information is available upon
request from the authors.
References
1 Tadlock, E. Jane. Student participation in
evaluating clinical skills. J. Nurs. Educ. 3:4:5-7,
20-21, Nov. 1964.
2 Palmer, Mary Ellen. Self-evaluatIon ofnursing
performance based on clinical practice objectives.
Boston, Boston University Press, 1962. p. 173.
3 Rhines, Alice. Evaluating student progress m
learning the practice of nursmg. Toronto, Lippincott.
1963
4 Tate, Barbara L. Evaluating the nurse's clinical
performance. Nurs. Outlook 10:1 :35-37, Jan. 1962.
5 Slater, Doris. The Slater nursing
competencies rating scale: tested and refined by
students and faculty of the College of Nursing under
guidance of Mabel A. Wandelt. Detroit, Mich.,
Wayne State University, College of Nursing, 1967-
6 Wood, Vivian Evaluation of student nurse
clinical performance: a problem that won't go away
Int. Nurs Rev. 19:4:336-343, 1972.
7 Ruesch, Jurgen. A general system's theory
based on human communication. In Gray, William.
General systems theory and psychiatry edited by...
et aL Toronto, Little Brown, 1969. p. 141-157.
8 Fivars, Grace. Nursing evaluation: the
problem and the process The critical incident
technique, by...and Doris Gosnell. New York,
Macmillan, c1966.
9 Flanagan, John C. The clinical experience
record for nursing students: instructor's manual,
by...et al. Pittsburgh, Psychometric Techniques
Assoc., c1960."
42
The Canadian Nurse June 1976
TORY -A Teaching
OARDIN
Tool
Whether you are a staff nurse in need of some specific teaching materials, an in-service director needing to
visualize some new technique, a public health nurse or nursing educator with a "message" to deliver - visual
materials can be a useful means of organizing your thoughts and of presenting your information.
Storyboarding, as the authors describe it, is a technique that offers many possibilities and can be used by
virtually anyone.
Gloria Dubin, Alison Dunsmore, Darlene Pedersen, Julia Quiring, Robert F. Rubeck
\
,
I
The social sciences suggest that
generally communication tends to be most
successful when more than one sense is
involved. In the example presented here -
"storyboarding" - both sight and hearing are
used to reinforce the basic message.
Borrowed from the "story hour" of children,
where pictures were often shown to illustrate
stories being read, storyboarding is a
technique that can be very useful in the early
planning and development stages of any
nursing education presentation.
The essence of a storyboard is that it
consists of a sequence of cards, each one
containing a visual message, a verbal message,
and any other details that may be necessary in
the final production. Thus, the "story" is planned.
suitable pictures, graphics or illustrations
are chosen, and each one is mounted on a
card with appropriate verbal commentary (see
figures 1 to 8). The "boarding" part of story-
boarding comes from the board or wall on
which the cards are displayed in the proper
sequence (see iIIus.). Using the storyboard,
the nurse can test the visual and aural impact
of different arrangements of the cards in
combination with the dialogue. He or she can
then decid...e on the sequence that offers the
audience the greatest impact.
One of the advantages of this technique is
that it is a relatively simple method of
organizing ideas, yet it can serve as the
preliminary step in producing anything from a
straightforward lecture that makes use of
illustrations, to a very complicated audiovisual
presentation. Television and film producers
and directors use storyboarding extensively to
plan and visualize each step in their
production. On a less sophisticated level, the
nurse-educator can also use this technique in
a number of ways.
The technique of developing a storyboard
is always, essentially, the same. However. the
length of the storyboard, the details on each
card, the format and the "professional" look
will vary greatly depending on the use it will be
put to. An educator may want to use a
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The CanadIan Nurse June 1976
43
oryboard to visualize a
,cture-demonstration. In this case, the
laterial on each card may be very roughly
resented. Yet the educator, and others
>aching the same subject, can use the
toryboard again and again to plan their
'ssons. The storyboard for a slide show will
robably be a little more detailed, and one for a
1m or audiovisual presentation will be still
lore complicated, particularly if it has to
rov;de all the material necessary for
I ameramen and audiovisual experts who may
now nothing about the subject, to shoot the
Jim.
The storyboard format described in this
,lrticle is not as complicated a
that. used for TV
>r film productions and reqUires little
IJrofessional expertise. Its advantage is that it
,;an be adapted for many different uses without
1ecessarily reqUiring any complicated
'iudiovisual hardware or talent.
Developing the storyboard
To develop a storyboard, usually a
lumber of cards (3" x 5", 4'" )( 6", etc.) are
essential. Commercial cards can be
purchased, but plain ones will serve as well,
,While "flip charts" or paper can serve the
same purpose, these are not likely to be as
I easy to use, as readily shifted around, or to last
as long as the card-type of background.
Each card should have a space
designated for picture, script, and, if needed,
, for technical and set directions. The latter, of
course, are much more complicated for
audiovisual presentations. Generally, you
should use professional graphs, photographs
or audiovisual help whenever you can.
Such help will be especially useful if you are
preparing a slide presentation or a film
package.
The format we suggest is this:
AQRAMOF POISS*.E
CAAD'
--
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1-
I
In the "picture" space, you need to
indicate as nearly as possible the exact detail
you want to stress, or reproduce with
illustrations, slides, pictures, or videotape
scene in your lecture. Since few of us are
artists, crudely-drawn stick figures are usually
quite sufficient to depict the scene of the
picture. Sometimes combinations of magazine
pictures might be cut and pasted together to
give a more realistic idea of the scene. The
"script" should be written exactly as you want it
to be delivered. whether in your lecture or in
the final production, even uSing the same
tense and person.
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The Canadian Nurse June 1976
I
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In more complicated audiovisual (A V)
presentations the "set" section should give
directions to the actors and crew and might
include notes on particular props and types of
action required. Similarly, "technical
directions" should give specific information to
the technician - whether the technician is
you, a friend, or a skilled professional
photographer or audiovisual expert. You need
to decide and to indicate the angle from which
the picture is to be taken, the amount of scene
to be included in the picture, and important
details such as written notations, or small parts
which must be included. The "number" section
assists in putting the cards in order quickly.
A separate card should be prepared for
each different picture in your presentation or
scene in an audiovisual production. If you have
a long or complex visual series you may have
50 or more cards. A shorter or simpler
segment, such as that pictured here, may
require five or six cards. As you prepare them,
number them. When you have prepared your
cards, slip each in sequence into your
storyboard or attach them to a wall using weak
tape or rubber cement.
In the card-producing stage it is easy to
make single card or sequence changes. For
instance, your last two cards might contain
material which, when you review the series,
you decide should be introduced at the
beginning. It is easy to change the sequence at -
that point - just erase the old number and
move the cards over. Or, you might decide
some pictures did not have sufficient detail to
illustrate a particular point. All you have to do is
add in the correct detail on a new card or cards.
If filming or taping is being carried out to
reach larger audiences or to preserve a
communication-education package, each
corresponding change requires considerably
more effort, and professional audiovisual help
may be required.
Conclusion
The process of storyboarding parallels, in
many ways, the planning and assessment
stages of the nursing process. Using the
storyboard approach you can plan illustrations
or pictures that complement your text and
include sufficent detail to reinforce each major
point. The storyboard technique IS simple,
direct, and effective. The minutes it takes to
make storyboard cards are a small investment
with great yield in the outcome of the finished
production. Whether you need to visualize a
lecture, a nursing procedure, or develop a
detailed slide-tape series or film of a complex
process, the use of this technique will enhance
the development of a high-quality product.
1
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The authors were members of a
faculty-student team at the University of
British Columbia that was involved in a
summer project to develop instructional
modules for different aspects of teaching.
Gloria Dubin (B. S.. University of Maryland) is
a graduate student at the UBC school of
nursing.
Alison Dunsmore (B.Sc.N., University of
British Columbia) is responsible for
coordinating instructional materials for
second year at the UBC school of nursing.
Darlene Pedersen (B.S., University of
Connecticut) is a graduate student at the UBC
school of nursing
Julia Quiring (R.N., Emanuel Hospital,
Portland, Oregon; Ph. D., University of
Washington) is Associate Professor at the
UBC school of nursmg.
Robert Rubeck (Ph. D., Ohio State University)
is a professor with the Faculty of Education at
UBC, and provides instructional design
consultation to the school of nursing..,
.
-
. .
..
-" ..........
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.
One of the instructional
modules developed by the
authors during a "Careers 75"
summer project at the University
of British Columbia's school of
nursing, was a teaching unit on
surgical asepsis. The
student/faculty team involved in
the project selected certain
aspects of the procedure and then
demonstrated by storyboarding,
how these could be taught.
The storyboard card above
depicts the planning aspect.
Rough "sketches" are used on
each card to indicate the finished
protograph, (on the right) or series
of "shots". Note thatthe camera in
these cases normally is at the
angle of the person doing the
procedure. This differs from the
usual type of picture taken
standing in front of a given subject
or object.
The CanadIan Nurse June 1976
45
It has been the policy of The Canadian Nurse to give preference to
writers who express themselves In prose rather than poetry but, when
this particular poem was submitted to us, the editors agreed that the
time had come to make an exception to our own rules. In the letter that
accompanied her submission the author wrote;
"For some time I have been concerned about and resentful of the
pitying and superior attitude of nurses and other staff because I work in
an extended care setting. Some of them are really quite critical; they
accuse me of wasting my talents and skills when I could be "putting
them to good use" in an acute care area
In this poem I have tried to show that there is much more to
extended care than wet beds and feeds. I realize that you would prefer
a scientific article but there are so many articles on this subject that I
would find it very hard to sit down and write anything new, whereas the
poem just wrote itself - bubbling up with my mounting indignation. '.
Extended Care
J reach out - my feet. my hands, my head,
To fill the role of those whose strength has fled.
My voice through voids of silence flies - to ring a bell
Within the minds of them so far away, and yet still here
Perchance my smile can generate sufficient warmth and cheer.
To light the spark of hope, encouragement and will
To DO again - when all seems finished, worn, and ill,
I reach out - far, far, beyond this place,
Into the boundless realms of mental space,
Where dwell the fantasies and spirits of confusion.
Dark demons of despair lurk there. along with fright, and fight, and flight.
I meet them, greet them, beat them, with my little light,
My Master's Gift - the torch that I must bear
Unto eterr.ih' - His Love and Tender Care.
Pat Nendick,
Shaughnessy Hospital. Vancouver, B.G.
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46
The Canadian Nurse June 1976
connC!ction
{.
*
.
.
Home Ec, Anyone?
Doreen Scott
\
I
Rehabilitation of the psychiatric patient is a
continui ng process. It begins at the door of the
institution when he is admitted and follows him
into the community when he is discharged.
Along the way, a variety of professional
helpers - nurses, psychologists,
occupational therapists, social workers, and
physicians - try to provide the assistance he
needs. For the past two years, patients at
Alberta Hospital in Ponoka have benefited
from the specialized education and
experience of a category of professional not
often involved in direct patient care - the
home economist. At this hospital, two home
economists are part of our rehabilitation team,
helping to pave the way for the work of
community nurses who will visit patients in
their homes after their release and generally
help the patient adjust to reintegration in the
community.
The role of these home economists is to
provide the patient, while he is still in hospital,
with the practical living skills he needs to make
his return to the community less traumatic.
Their job is to develop or restore in the patient
the ability to function on a day-to-day level and
to cope with problems that arise in ordinary
living. The work has been slow and, at times,
arduous for persons who have been in a
psychiatric facility for a number of years tend to
lose these skills because so much is done for
them. We are finding, however, that this
aspect of our rehabilitation education program
does pay dividends by making community
immersion less difficult and helping patients
maintain the level of well-being they had
achieved before discharge.
About two years ago, when we hired two
well-qualified home economists, we had only a
foggy idea what their role would be and so, I
am sure, did they! The first step was to give
them a brief orientation to the hospital and to
explain that. within the guidelines of the
hospital philosophy and objectives, they were
free to use their expertise within the seven
rehabilitation units and among the 200
residents. On our organizational chart they
were made responsible to the Department of
Nursing.
Home economics is a study of laws,
conditions, principles and ideals that are
concerned with man's immediate physical
environment and his nature as a social being.
It deals especially with the relation between
the two, with the purpose of improving the
'1
quality of people's daily lives. As home
economists, therefore, the two new members
of the rehabilitation team sought to provide
planned and purposeful activities that would
help patients improve or relearn skills for
readjustment into the community. In order to
do this, they have painstakingly built up a good
supply of resource materials, posters, visual
aids, sewing machines, and cooking
equipment.
Grace Nishi, the first member of the team,
began her program on a twenty-two bed
integrated unit designed especially for
independent living skills. The nursing
coordinator, head nurse, physician, social
worker, and psychologist, all meet two or three
times weekly with the residents to talk about
problems and concerns, and Grace was
included in these sessions. One of her most
successful experiments has resulted from
sharing her skills in menu-planning and
budgeting. Under her direction, small groups
of residents and staff sallied forth Into our local
town of Ponoka to compare prices of basic
foods such as coffee, sugar, bread, cereals,
etc. in all the stores. Armed with comparative
lists, the unit then approached Administration
and asked if they could be truly independent
and, not only cook forthemselves, but a!.so buy
the food! After considerable discussion, a
procedural agreement was reached, and they
began with a budget of $1.87 per day! The
program has been a great success in helping
residents learn to cook nutritious meals that
are within their incomes upon discharge. Even
with today's prices they have managed to keep
to the original budget.
Grace and Gwen Johnson, the second
home economist on the team, run a
collaborative effort; their office is together,
they share ideas, and plan programs with one
another. Gwen's work schedule is similar, but
different because she is responsible for six
units. Trying to spread herself amongst the
units was like putting butter on every sixth slice
of toast. The sixth slice got lots, the other five
none at all. Now she concentrates on two
wards, and acts as a consultant to the others.
The programs she has enriched are now run
by nursing staff who work very closely with
Gwen. Her positive reinforcement of good
personal hygiene has helped their work, too.
Her programs emphasize a variety of
aspects of daily living; the first was teeth. On a
ward of forty men suffering brain-damage
produced by trauma or alcoholism, and a large
group of long-stay residents with psychoses of
all the need for good personal hygiene is
acute. Two small pouches, one with
toothbrush and toothpaste, and another for
brush and comb, were made available for each
man to keep in his bedside locker. The men
attended her program weekly, and she
reinforced teachings by use of films, posters,
and praise. Now, they each have their own kit
and brush their teeth daily.
Gwen's weekly cooking programs are
well attended. Four to six residents, together
with their nursing staff and Gwen, use a
special kitchen to completely prepare their
dinner. At these sessions, she stresses good
personal hygiene, washing hands after using
the washroom and before meal preparatior
Table manners are also improved since thE
nursing staff and Gwen emphasize
family-style dinners, sharing with one anoth!
and learning again to make social
conversations. One young man who is
dominant and yet explosive in conversatior
thus discouraging others from speaking up
was effectively controlled by the use of token:
Each person was given five plastic tokens, or I
for each conversation at the meal. When It
five were used up, they were to be silent. Th
method worked with this man, and helped I
bring others into the conversation. I
Occasionally, persons coming to the
group sessions are not well enough to attenc
When this happens, the person is asked te'
return to the unit. More often, the person i
1
able to modify his behavior for the group I
session and act accordingly. He may be ups
on returning to the ward, but in the program hi
behavior is appropriate for the occasion.
We have asked Gwen and Grace not
wear uniforms and feel that this has helpe(
them to establish a rapport with group
members. Somehow, a sparkling crisp whll
uniform together with cap and pin , althou
certainly nice when one is sick in bed, sets u
an invisible barrierthat says the patient is on
different level than the professional.
Gwen and Grace, when not actively
engaged in a program, are busy planning tt
next day or week, ordering films, and trying t
attend treatment conferences on the ward. I
Theirwritten observations of progress help tt
team to see the hospital residents in a slightl l
different way. They would like to do more, I
follow their group members into the
community upon discharge but, so far,
budgetary constraints have prevented this.
They are now planning a workshop on mone
management for staff as well as patients; thE
have given classes on consumer informati!
and demonstrations in metrication. They ha\
even been consulted by a resourceful hea(
nurse as to what type of furniture looks best
different-colored rooms, the best fabrics, tI-
maintenance involved, and the best color t.
repaint the walls on the Units.
It is important that they are in a staff
relationship to the units, so that in a psychiatr
facility like ours, their professional opinions a
seen as positive, consultative, and not
authoritative which might prove restrictive.
Gwen and Grace meet regularly with tI'
nursmg coordinators to discuss their concern
éu Id problems. These meetings have
developed a strong collegial relationship th
has assisted in evaluating as well as validatin
their programs in an objective manner.
Progress has not been startling but we feel th
their input has been valuable, and they are
truly membes of the team!
Gwen and Grace meet regularly with th
nursing coordinators to discuss their concern
and problems. These meetings have
developed a strong collegial relationship th
has assisted in evaluating as well as validatin
their programs in an objective manner.
Progress has not been startling but we feel th
their input has been valuable, and they are
truly members of the team!..
Designs in Dacron
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Clothes that take care of the people who take care of Canada.
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Dress: IH3. Mr. Barco: !)490. Shoe: 8013.
Write for vour complimentary Uniform and Shoe Brochure to: Barco. 350 West Rosecrans Avenue. CN-76. Gardena. California 90248
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JACQUELINE'S UNIFORMS, 134 W 16th St.. No. Vancouver. B.C
48
The CanadIan Nurse June 1976
XtlJ11eS
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Colonel Joan Fitzgerald has retired
as director of nursing services,
National Defence Headquarters. The
first woman in the Canadian Forces to
attain that rank In peacetime.
Fitzgerald joined the Royal Canadian
Army Medical Corps in June 1942, as
a lieutenant and served in Canada and
Northwest Europe as a nursing sister
until November, 1945.
Following studies at the
University of Ottawa, she joined the
Royal Canadian Air Force in 1948 at
Rockcliffe and later spent five months
as a flight nurse with the U.S. Air Force
during the Korean airlift operations.
On returning to Canada in 1951,
she held a variety of senior medical
positions in Ontario and Quebec. In
1966. she was transferred to the
surgeon-general's office, Canadian
Forces Headquarters.
In 1968, she was promoted to
wing commander and appointed
matron-In-chief of the Canadian
Forces. She was promoted to colonel
in 1972.
Fitzgerald was the first
servicewoman to attend the National
Defence College, Kingston, Ontano.
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.
\
,-
.
Lieutenant-Colonel J.E. (Jess)
Lawson of Campbellton, New
Brunswick, has been promoted to the
rank of colonel and appointed director
of nursing services, National Defence
Headquarters, to succeed Colonel
Joan Fitzgerald on her retirement.
Lawson joined the Royal
Canadian Air Force in 1951 and served
as a nursing sister at various air bases
in Canada and Germany. She was
promoted to major in 1965 and
appointed di rector of nursing, National
Defence Medical Centre. Ottawa, in
1969. In 1972 she was appointed
career manager, nurses, at National
Defence Headquarters, and promoted
to the rank of Lieutenant-Colonel in
1973.
Elizabeth Bietsch, Director of
Nursing of the Medicine Hat General
Hospital for the past twenty-two years
has retired. She had been the Director
of the Medicine Hat General Hospital
School of Nursing for eleven years
before it closed its doors In 1971
An active participant in the affairs
of professional nursing groups, Miss
Bietsch was a member of the Board of
Directors Canadian Nurses
Association from 1955-57 and
President of the Alberta Association of
Registered Nurses 1955-57. She was
recognized by the Alberta Association
of Registered Nurses in May, 1975,
with an honorary membership. She
became a member of the College of
Health Service Executives in 1973.
Bietsch. who is living in Medicine
Hat, is a board member of the
Lutheran Foundation of Medicine Hat,
which is planning a senior citizens
apartment building for the community
Ruby Sirons (R.N., Calgary General
Hospital school of nursing: B.N.,
McGill University) has been appointed
director of public health nursing of the
Wellington-Duff erin-Guelph Health
Unit. Formerly nurse-in-charge of the
North Waterloo, Ontario, branch of the
Victorian Order of Nurses, Sirons has
for the past three years been active in
establishing a family planning service
in Guelph, Ontario, and in making it
available throughout Wellington and
Dufferin Counties.
Gail Donner(R.N., Winnipeg General
Hospital: B.Sc.N., University of
Pennsylvania: M.A., New York
University) has been appointed
Chairperson of the Nursing
Department, Ryerson Poly technical
Institute, Toronto. Donner had been
Instructor for the post-diploma
psychiatric nursing course at Ryerson.
Monique Chagnon (R.N., HôtelDieu
school of nursing, Montreal: B.N.,
Institut Marguerite d'Youville; MA,
University of Montreal) was some
months ago appointed coordinator of
professional inspectIon with the Order
of Nurses of Quebec. Prior to her
association with the ONQ in 1974,
Chagnon worked at the Montreal
Children's Hospital, the Children's
Medical Center in Boston, and at
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Sainte-Justine's Hospital in Montreal.
As associate director at St. Justine's
she participated actively in the
development of a classification of
pediatric þatients. She has also made
a preliminary study for the ONQaimed
at developing a method of evaluating
the quality of nursing care In Quebec
Anne Wallace (R.N., St. Paul's
Hospital school of nursing, I
Vancouver) has been appointed
asslstanl nurse coordinator of the
British Columbia and Yukon Division
of the Canadian Cancer Society. Her
work Involves her in an industrial
education program and a mastectomy
rehabilitation program that is geared to
the health professions.
\
\ Jr
,.
Wallace has included in her
expenence general duty nursing at St.
Paul's Hospital; office nursing with
physicians of Vancouver; and
occupational health nursing with
Woodward Stores of Vancouver. She
is currently first vice-president of the
Associated Alumnae of the Sacred
Heart of Canada and the United
States.
Kathleen Florence Brady died
November 1975 after a long illness. A
graduate of St. Mary s Hospital School
of Nursing Montreal, she entered the
School of Nursing, McGill University
and graduated with a Bachelor of
Nursing degree in Public Health
Nursing in 1951. She also received a
Bachelor of Arts from Sir George
Williams University and a Master of
Arts from Teachers College. Columbia
University.
For eighteen years she was a
valued member of the administrative
staff of the Montreal Branch of the
Victorian Order of Nurses. Through
her leadership the VON hospital
liaison was established, the first such
liaison program in Canada. In 1963
Bradv ioined the teaching staff at the
School of NurSing, McGill University
on a part time basis while continuing at
the VON part time.
Here's skillful coverage of basic clinical skills-
GILLIES AND ALYN
Patient
Assessment
and
Management
by the
Nllrs e
Practitioner
CO
TE
TS: Techniques of Health Interviewing. The Content of
the Patient's Medical History . The Physical Examination:
Overview/Examination of the Head and NecklExamination of the
Thorax/Examination of the AbdomelllExamination of the Pelvisl
Examination of the Back/Examination of the Extremitiesl
Neurological Examination . Laboratory Tests and Special
Examinations . Psychosocial Assessment and Intervention .
Recording Data and Planning Care. Management of the Patient
with Hypertension. Management of the Patient with Diabetes
Mellitus. Management of the Patient with Chronic Arthritis.
Management of the Patient in Chronic Congestive Heart Failure
. Management of the Patient with Obesity. Management of the
Patient with Alcoholism. Index
!380!
N!I
C!!
!
Jzl!
Pnces subject 10 change
í-------------------C
I Please send me on 30-day approval I
I 0 (4133-4) PATIE
T ASSESS)IEXT & I
I MA...'\"AGE)IE:\ì' BY THE
l"RSE I
I PR.\.CTITIOXER (About $11.35.) I
I 0 Payment enclosed, ship postpaid. 0 Bill me. 0 Send C.O.D. I
I Full Name I
I I
I Home Address I
I City Provo Zone I
L_________-___________
PATIENT ASSESSMENT AND
MANAGEMENT BY THE
NURSE PRACTITIO
ER
This brand new text by Dee Ann Gillies and Irene B.
Alyn instructs you in five vital skills that the nurse
practitioner must master.
JIi' You learn how to conduct a physical examination.
The section dealing with physical examinations is
almost 100 pages long and well illustrated with
photographs clearly depicting techniques including
palpation and percussion.
JIi' There's precise advice on the fine points of
psychosocial assessment including guidance in
determining when intervention will be necessary.
JIi' The authors review the interpretation of data
received from laboratory tests and special exam-
inations, including electrolyte and enzyme tests.
JIi' Practical guidelines are suggested for interviewing
patients; techniques and objectives of health
interviewing are stressed; and the content and
significance of a patient's medical history are
discussed.
JIi' Six individual chapters describe the management of
the ambulatory patient with frequently encountered
problems, such as hypertension, alcoholism, arthritis,
or congestive heart failure.
In keeping with modern nursing trends, the authors
stress your vital role in planning successful home care
regimens. Their book's comprehensive approach to
patient mana
ment shows how behavioral objectives
serve as the basis for your plan of health care for the
ambulatory ill.
By Dee Ann Gillies, RN, EdD, Assistant Director of
the Department of Education, Health and Hospitals
Governing Commission of Cook County, Chicago,
Illinois; and Irene B. Alyn. RN, PhD, Associate
Professor of Medical Surgical Nursing, University of
Illinois College of Nursing, Chicago, Illinois.
236 pages. Illustrated. About $11.35. Just Ready.
Order #4133-4.
.........
,,
-
50
Information is supplied by the
manufacturer; publication of this
information does not constitute
endorsement.
\\T] 1 lIt .8 Ne\y
---.I
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.
Infusion Pump
The IV AC Model 530 Infusion
Pump is designed for use in critical
care areas reqUiring exact fluid
administration
Easy to operate the IV AC 530
offers:
a Simple "dial the drop rate" feature
with 2 percent accuracy. Alarms and
ceases operation should bottle empty,
thus preventing air infusion.
. Automatic, self-regulating
operation, drop rate constantly
maintained.
. AU fluids and critical drugs
administered Intravenously or
Intra-arterially. even with microbe
filter.
. Up to four hours of operation from
self-contained battery. allowing for
ambulatory operation.
a Automatic recharging while
instrument operates on house current.
. Range of 1 - 99 drops per minute
(1 - 200 ml per hour) with instant
response if midinfusion adjustment In
drop rate necessary.
. Accepts all standard IV
administration sets without breaking
sterility of closed system.
For mformation, write:
Stensystems Ltd., 47 Baywood
Road, Rexda/e, Ontario, M9V 3Y9.
Infusion Controller
The Ivac Model 230 Infusion
Controller has been added to
Sterisystems Ivac total system of
automatic, self-regulating IV infusion
devices. Using gravity pressure,
Model 230 detects and stops most
infiltrations before they can be
observed externally, and informs the
nurse both visibly and audibly. It
reduces restart CoslS and operates
with any standard IV set, without
breaking sterility of closed system.
Weighing 8 lb., Ihe IV controller
has its own auxiliary battery power for
up to four hours of battery operation in
case of power failure or for
transporting patients elsewhere in the
hospital. It is accurate to + 2 percent of
selected drop rate and Immediately
responds to midinfusion adjustment in
drop rate.
For information, write:
Sterisystems Ltd., 47 Baywood Road,
Rexdale, Ontario, M9V 3Y9
"""
...
--
-,
.
',-
,
-
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.....
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"-
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Portable Aspirator
Vernitron Medical Products
Model No. 7410 lightweight Sorenson
Portable Aspirator is designed for
tracheal suction and other low-volume
suction applications. It is suitable for
use in clinics, nursing homes, doctors
offices, emergency rooms, and "at
home."
Model No. 7410, designed for
maintenance-free performance,
needs no lubrication, is easy to keep
clean, and can run for extended
periods of time.
Information from: Vernitron
Medical Products, Inc., 5 Empire
Boulevard, Car/stadt, NJ 07072.
The Canadian Nurse June 1976
Urine Reagent Strip
The Ames Company has
introduced N-MUL TISTIX, a urine
chemistry reagent strip that adds a key
test to the widely used Multistix: Nitrite
- specifically for the detection of
urinary tract infection. The Ames nitrite
test brings to 8 the number of tests
available on N-MUL TISTIX, the others
being: pH, Protein, Blood, Glucose.
Ketones, Bilirubin and
Urobilinogen.
The Ames Company Division
of Miles Laboratories Limited
is at 77 Belfield, Rexdale, Ontario,
M9W lG6.
Clear Equipment Covers
Tower ProductS, Inc. have
developed new Equipment Covers for
respiratory therapy departments,
designed to fit all the ventilators used
by respiratory therapists. They come
in three sizes to protect the equipment
from dust and dirt when not in use.
Tower Equipment Covers are
clear plastic, are disposable and bulk
packed for economy. Color coded
lettering identifies these covers as
Respiratory Therapy covers, The
three sizes are 16" x 14" x 38", 16" x
14" x 56" and 28" x 22" x 60".
For information, write: Tower
Products, Inc., 1919 S. Butterfield
Road, Mundelein, IL 60060 U.S.A
Mono-Pad for Chest Surgery
Monitrode, Inc. has introduced a
new Mono-Pad for use during open
heart and chest surgery and other
special monitoring requirements when
traditional electrodes cannot be used,
Consisting of four electrodes mounted
on a foam pad, Mono-Pad is applied to
the patient's back to provide accurate
monitoring of patient's heart during
surgery.
Mono-Pad IS pregelled and IS
quickly applied after peeling off the
protective liner. Its connecting wire is
an integral part of the unit. It has either
a male or female adapter cable but it is
also available with a built-in cable.
Mono-Pad is packed in an FDA
approved moistureproof high vac bag
with freshness guaranteed for one
year.
For mformatlOn, wnte: Monitrode,
Inc., 782 Burr Oak Drive, Westmont, IL
60559, U.S.A
"
to
-
:1 > h.
.
Emergency Air Splint
An Emergency Air Splint, to fit all
extremities, has been developed by
theJ.T. Posey Company of Pasadena.
It is designed for emergency first aid
treatment of common sprains,
fractures, dislocated or crushed
extremities.
Made of inflated clear plasllc for
visual observation and x-ray, Posey
Air Splints use Velcro closures to splint
extremities in straight or bent
positions, permitting minimum
movement while immobilizing,
cushioning and protecting patient for
safe transportation. Controlled air
pressure restricts blood flow and helps
reduce swelling.
Hot or cold pressure may be
applied with the Posey Insert Adaptor
For information, write: Enns and
Gilmore, 2276 Dixie Road,
Mississauga, Ontano, L4Y 1Z5.
X-ray Generator
Organomatic is an X-ray
generator that is easy to operate. For
rapid routine operations, it has the
advantage of being able to store the
organ-related, constantly recurring
identical combinations and of
selecting them at any time by means of
an organ-referred push button. The
technique IS simple and error-free,
saves time and is realized without an
automatic exposure device. Voltage,
current and focus with the automatic
exposure device kV, focus and
screen) are stored, organ-related, so
that aU that remains to do is to select
the organ to be x-rayed.
For information write Siemens
Canada Limited, P. O. Box 7300.
Pointe-C/aire, P. Q. H9R 4R6.
Uniforms technical. medical and
general purpose hospital coats. designed
fo" action comfort as you work Seam
)
arefmnlysewn FasteJ").er
stavon Fabnr
wa
h H dry dean for professlona we:n
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CAREER ClASSICS
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STYLE 814 STYLE 81.')
STYLE 814 PantSuit
Polyester Textured Warp Kmt
WhIte Blue Yellow Ice Mint
Sizes 6 to 18
To retail $2800
STYLE 810A
Polyester Corded Warp Kmt
White Sleeves
S,zes 6 to 20
To n tail $26 II
:;TYLE 81 OSS
Polyc')ter Córd('d Wa p
1"Jl.ltp Sh0rt SI c )
SIZt
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STYLE 888
\
STYLE 916 PantSUIt
Polyester Ribbed Double Knit
WhIte
Sizes 8 to 16
To retail $3800
STYLE 888
Polyester Textured Warp Kn t
Lace Trim White Pink Yello
S'ZF3 8 to 20
To retail ;22 ()O
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78
52
The CanadIan Nurse June 1976
l\ll(li ()y i Still I
Breast Self-examination
1 2
U u
H
3 4
\ L-
I
5
7
"It could save your life."
'---
6
8
Pamphlets on breast self-examination are available free of charge from your I
local office ofthe Canadian Cancer Society. Illustrations (reproduced at left) and
captions give step-by-step instructions for monthly BSE. 1) In front of mirror, with I
arms relaxed at sides, examine breasts carefully for changes In Size, shape, skin
texture and discharge or change in nipples. 2) Raise arms over head and look for I
the same things. 3) Lie on bed wrth left hand under head. With fingers of right ;
hand held together flat, press gently but firmly with small circular motions to feel
the inner, upper quarter of left breast for lump or thickening, starting at
breastbone and going outward toward nipple line. Also feel area around mpple.
4) With same pressure, feel lower, inner part of breast. 5) With left arm down at
side, feel under armpit. 6) Feel upper, outer quarter of breast from mpple line to
where arm is resting. 7) Feel lower, outer section of breast, going from outer part
to nipple. 8) Repeat entire procedure on right breast.
Films
The following films are available
on loan, free of charge, from your local
office of the Canadian Cancer Society
A catalogue is also published listing
these and other films available from
the Canadian Cancer Society.
All films are 16mm. and in color.
Breast Self-Examination and
Time and Two Women
This 21-minute film demonstrates
the lechnique of breast self-
examination and explains the
importance of the Pap smear in
cervical cancer detection.
Assignment
A 20-minute film concerning a
cured cancer patient and her
daughter. It is a fast-paced
educational film with a humanistic
touch.
The Elusive Enemy
A 15-minute general film
stressing prevention, detection and
treatment of the major sites of cancer.
To Take A Hand
An 18-minute film emphasIzing a
positive, helpful approach to cancer
nursing and discussing the need for
the nurse to understand her own
emotions about cancer before she can
relate to the patient.
Recovery After Mastectomy
This 16-minute film presents,
from a pallent s viewpOint, the
emotional strain experienced after
mastectomy surgery and the help
given by a mastectomy visitor.
We Can Help
An 11-minute film presenting the
services, both personal and practical, I
available 10 cancer patients in Ontario. I
After Mastectomy I
This 20-minute film gives a
medically-oriented picture of the I
physical and emotional needs of the I
patient after mastectomy surgery.
Early Diagnosis and
Management of
Breast Cancer
This 34-mlnute film depicts the
signs of breast cancer and the
essentials of thorough examination,
and emphasizes detection in the early
stages. Indications for
mammography, hormone therapy,
and chemotherapy are covered. A
positive approach to prothesis,
rehabilitation and follow-up is
presented.
Books
A Cancer Source Book
for Nurses
This is a valuable source of
current information regarding most
areas of cancer - its pathogenesis,
diagnosis and treatment. It discusses
the unique role of nurses in caring for
the cancer patient. An excellent
bibliography of current cancer
literature is also included. Published
by the American Cancer Society,
1975, and available free of charge
from your local office of the Canadian
Cancer Society.
Instead of holding
moisture, Pampers
hydrophobic top sheet
allows it to pass
through and get
"trapped>> in the
absorbent wadding
underneath. The inner
sheet stays drier, and
baby's bottom stays
drier than it would in
cloth diapers.
'-
...
Sa\'es
you tiIlle
Pampers construction
helps prevent moisture
from soaking through
and soiling linens. As a
result of this superior
containment, shirts,
sheets, blankets and
bed pads don't have to
be changed as often
as they would with
conventional cloth
diapers. And when less
trrne is spent changing
linens, those who take
care of babies have
more time to spend on
other tasks.
Kee(Js
him drier
.
i ...
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.
. Þers
,...
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54
The Canadian Nurse June 1976
Iloolts
Nursing Care of the Alcoholic
and Drug Abuser by Pamela K.
Burkhalter. 297 pages New York,
McGraw-Hili, 1975.
Reviewed by Joan Anderson,
Assistant Professor, School of
Nursing, University of British
Columbia, Vancouver, B.C.
\
1
This book is divided into three
parts: Part I discusses alcoholism, and
the nursing care of persons who abuse
alcohol: Part II is concerned with the
nursing care of persons who abuse
drugs; and Part III focuses on the
rehabilitation of persons with these
problems. Ideas about future nursing
education, research and practice are
also included. The material is
systematically organized and clearly
presented.
The author favors the disease
concept of alcohol and drug abuse
She comments on some of the
sociocultural aspects and briefly
outlines major theones of causation.
However, these tend to be summary
statements rather than thorough
sociocultural analyses.
The book lacks well developed
theories and interpretations. Some
major statements are not clearly
documented, e.g., on page 13 no
reference is given for the key
paragraph - "Dependency -
Independency," despite the sweeping
and vague nature of the hypothesis
about the alcoholic personality
suggested.
The book lacks theoretical
discussions but it still provides factual
information in a concise format.
Various treatment approaches are
reviewed, that could provide a useful
source of reference. The brief outline
of the effects of alcohol leaves the
reader with a good understanding of
the physiological consequences of its
abuse.
An overview of nursing care in a
variety of settings is presented.
Guidelines for assessment
components and nursing care plan
format with nursing approaches
necessary for achieving identified
goals are outlined. The nursing
assessment considers the physical,
psychological and social needs of the
client.
,
,I
Although the author
acknowledges the possible need for
referral services in relation to social
problems, the nursing care plans for
persons in the inpatient settings lack
developed guidelines for family
involvement. The focus is on the
identified patient.
Family Involvement is discussed
at the community level of intervention.
Granted, family interventions may not
be regarded as the primary focus in
the inpatient setting, but it could be
argued that this should be an integral
part of nursing intervention regardless
of the setting. It seems to merit more
consideration than that given by the
author, particularly in relation to the
psychiatric setting. Apart from this, the
material IS highly instructive.
Two of the more important
concepts that Burkhalter emphasizes
are nurses' attitudes toward the
person who abuses alcohol, and
education of nurses who care for
persons with alcohol and drug abuse
problems.
Research has shown that nurses'
attitudes are usually characterized by
ambivalence, but that extra
educational preparation results in
more posi1ive attitudes. Because the
nurse's attitude has a direct
relationship to the type of care that the
client receives, recognition and
change of negative attitudes, are
imperative in caring for persons with
such problems.
The author makes
recommendations for future trends in
nursing education that would enhance
the knowtedge and skills of
practitioners working with persons
who abuse alcohol and drugs. She
also discusses the interrelationship
among, and the interdependence of
nursing education, nursing research,
and nursing practice.
The book is practical, if somewhat
limited in theoretical depth. It could be
a useful source of reference to
students and practitioners in various
settings.
A Summary of Integrated
Nursing Theory by Sandra B.
Fielo. New York,
McGraw-Hill,1975. 186 pages.
Reviewed by Charlene
Deffenbacher, R.N., M.S.,
Curriculum Development
Instructor, School of Nursing,
Royal Jubilee Hospital, Victoria,
B.C.
The table of contents of this
book will excite any nurse who is
trying to pattern her approach to
nursing care on a nursing model. One
regards with great anticipation the
emphasis on basic needs, anxiety.
and growth and development in the
Mental Health section, and the use of
Stress and Adaptation as a
conceptual basis for dealing with
pathophysiology. Major Health
Problems are grouped under
socioenvironmental problems,
problems of hypoxia, neoplasm, cell
nutrition and elimination of wastes,
and deal with conditions that are
medically classified. The size of the
book makes it obvious that in.Qepth
content cannot be presented, but one
hopes the text will provide. as stated
in the Preface, a basis for
understanding "the interrelationship
of mind, body and environment" and
will "help eliminate the separateness
and fragmentation created by Ihe
artificial collection of contents into
specialty areas, e.g. pediatrics,
obstetrics, psychiatry."
Unfortunately, my expectations
of this book in regard to the
interrelationship of mind, body, and
environment were not realized.
Portions of the Stress and Adaptation
section discuss disease causation in
psychodynamic terms, but care of
these diseases is medical-model
oriented. Discussions that would tie
the diseases together under the
conceptual headings were
inadequate or omitted. Concepts of
disease prevention to increase the
individual s repertoire of coping
behaviors were not included. Models
for nursing individuals with
maladaptation disorders were not
present; pathophysiology is
discussed but this cannot be the sole
theoretical base for nursing care. In
summary, the book is not
well-developed in terms of concepts
for nursing, nor is it's theorellcal I
approach as ecologically-based as
one might expect.
The strength of the book is that It
does discuss disorders under
conceptual headings, with obstetric,
pediatric, medical, and surgical
conditions brought together. For
example, the section tilled "Problems
of Hypoxia" discusses hemorrhagic
conditions related to pregnancy,
congenital heart disease, sickle cell
anemia, myocardial infarction and
other disorders. This pattern of
intermixing the "specialty areas" IS
consistent throughout the book and
merits definite praise.
If using this as a textbook, the
nurse educator would need to
examine it thoughtfully in relation to
the student population. The
terminology is relatively sophisticated
in terms of reading levels and
knowledge of the biological sciences.
Good specific examples are included,
however, which could assist the
student to relate the terms to a
particular condition. The amount of
detail given about each disorder
might be overwhelming to the nursing
student, causing her to miss the
overall concept. The book might be of
value in post-basic nursing education,
since it could serve as a review of
disease conditions while laying
groundwork for discussions of the
concepts basic to all nursing care.
Canadian nurse educators would also
want to evaluate the book carefully
since it is totally American in its
orientation, with no mention of other
countries and their health problems.
Care of Patients with
Emotional Problems by Delores
F. Saxton and Phyllis W. Hanng.
St. Louis, The C. V. Mosby
Company, 1975. 104 pages.
Reviewed by Ken Green,
Teacher, Algonquin College
School of Nursing, Ottawa.
The authors of this text have
treated the material in a very
easy-to-understand style. They have
divided the text into four parts - The
Emotional Development of Man, The
Relationship Between Physical
Illness and Emotional Problems,
Patients with Emotional Disorders,
and Patients with Functional
The Canadian Nurse June 1976
55
Isychotic Disorders - and have
IJcceeded in making each part
Ievant to the here-and-now of
latient care Although each chapter is
1 >lativel Y short and touches only the
urface of a particular Issue, it is
'ompleted with "study questions" that
elp the student to review the concept
I r approach presented.
The organization of the first part
I f the book helps the student
,nderstand that all behavior,
lcluding one.s own, has meaning.
fJd that when the meaning is
J lnderstood, a more therapeutic
Ipproach to patient care can be
Ilanned.
Parts" and'" explain the
'elationshlp between physical illness
,md emotional problems, and present
';pecific approaches for dealing with
;ome of these problems. These parts
Jlso remind the student that many
)alients who may be suffenng from
hese problems will be found on the
Nards of general hospitals.
The final part of the text deals
,3pecifically with some of the major
l1ental disorders and provides
pproaches that can be utilized in the
psychiatric setting,
Although the text was written
rimarily for a specific group -
ractical nurses - I believe that other
students will find selected
chapters,e.g,Tools Utilized in
Psychiatric Nursing helpful for
discussion.
Biological Aspects of Human
Sexuality by Herant
Katchadourian and Donald
Lunde. New York, Holt, Rinehart
and Winston, 1975. 174 pages.
Reviewed by Barbara Reilly,
R.N., B.A. Instructor, Royal
Jubilee Hospital School of
Nursing, Victoria. B.G.
Biological Aspects of Human
Sexuality by Doctors Katchadourian
and Lunde is an extraction of SIX
chapters from their broader lext,
Fundamentals of Human Sexuality
(2ed, c1975).
Biological Aspects of Human
I Sexuality essentially pOints out
I that "Biology is the bedrock upon
which sex is based;" however, "there
is more to human sexuality than
biology." Katchadourian and Lunde In
their six chapters, manage to cover
the significant aspects of the anatomy
and physiology of sexual function as
well as pregnancy, contraception and
sexual disorders (disease-oriented). It
was refreshing to see discussed the
sexual responses or reactions of the
elderly as well as those of the
younger age groups.
In general, the book presents
well-organized information and
research without bias and it would be
meaningful reading for those less
sophisticated in their knowledge of
human sexuality.
Another attractive feature is that,
throughout the book there are
illustrations and brief discussions of
the cultural variations that exist in the
area of human sexuality.
In summary, Biological Aspects
of Human Sexuality would seem of
interest to any practicing nurse in the
hospital or community. Certainly, it
should find a place in any nursing
school library and would give the
student nurse a good core of
knowledge upon which to build. This
book would also seem of special
interest to those involved in planning
or offering a course in human
sexuality in their nursing curriculum.
The only drawback of this book is
that where budgeting has 10 be
seriously considered, the broader text
Fundamentals of Human Sexuality
would be a wiser investment
A Pediatric Play Program by Pat
Azarnoff and Sharon Flegal. 102
pages. Springfield, 111., Charles C.
Thomas, 1975.
Reviewed by Jane Grinnell, Child
Life Worker, Children's Hospital
of Eastern Ontario, Ottawa,
OntArio
A Pediatric Play Program is a
clearly wrillen guideline for setting up
a therapeutic play program for the
hospitalized child. The book considers
new and old hospital facilities,
available materials. sample programs,
staff qualifications, departmental
guidelines, and negative and positive
reactions to a therapeutic play
program
More pertinent, however, the
book stresses the overall importance
of such a program, in calming the
separation anxieties of the child, in
helping the child adjust to a particular
problem, and in ensuring the
continuing intellectual and emotional
growth of the hospitalized child.
It lists types of activities which can
be adapted to the hospital setting:
large and small group games, crafts,
special events projects, etc. A useful
addition to this section of the book
would have been a list of multiple
activities, suited to the various age
groups or medical problems in the
hospital, with explanations as to why
these activities are so appropriate.
The book clearly states that
children's needs cannot be met by a
program or facilities alone. To be
successful. such a program must have
input, acceptance, and participation
from all areas of the hospital
personnel. It suggests that it IS people
with positive attitudes who, through a
well-designed program, can provide
the warm emotional environment in
which children can relax and grow,
A Pediatric Play Program IS well
worth reading by all those involved in a
pediatric ward or hospital, as it
provides guidelines, sparks new
ideas, and reinforces the
committments to the emotional
well-being of the hospitalized child.
Meet summer head-on
with
.1
CHLOR-TRIPOLON*
't' (ChIOrPhenlramine maleate U S P.)
, '" ' antihistamine
Tablets/REPETABS* /Syrup/lnjectable
\ ' Full prescribing Information available
) on request from.
Sche
ing Corporation limited
Polnte Cla"e. Quebec. H9R 1 B4
, . '.t 'Reg.TM
\ .
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8
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56
The Canadian Nurse June 1976
I,J 1)1..ll.1J I T I )(I.l t(l
Publications recently received in the
Canadian Nurses' Association Library
are available on loan - with the
exception of items marked R - to
CNA members, schools of nursing,
and other institutions. Items marked R
include reference and archive material
that does not go out on loan. Theses,
also R, are on Reserve and go out on
Interlibrary Loan only.
Requests for loans, maximum 3
at a time, should be made on a
standard Interlibrary Loan form or by
letter giving author, title and item
number in this list.
If you wish to purchase a book,
contact your local bookstore or the
publisher.
\
!
Book and documents
1. American Nurses' Association.
Facts about nursing 74-75. New York,
1976. 237p.
2. Barstow, Ruth Elizabeth. Coping
with emphysema. San Francisco, Ca.,
(".11(11)(1.1 I.
June 21-23, 1976
Canadian Nurses' Association annual
meeting and convenlion to be held at
Hotel Nova Scotian, Halifax, Nova
Scotia. Theme: The Quality of Life.
June 20 - 25, 1976
InformACTION 1976, annual
conference of the Canadian
Foundation on Alcohol and Drug
Dependencies to be held in Toronto
Information from: Conference
Manager, Informaction, 33 Russell
Street, Toronto, Ontario M5S 2S 1.
July 19 - 24, 1976
Congress of the International
Federation for Home Economics to be
held at Skyline Hotel, Ottawa.
Theme: "Life, not just Survival."
Information from: Linda M. Stepenotf,
IFHE Congress Chairman, Suite 216,
56 Sparks Slreet, Ottawa, Ontano
K1P 5A9.
University of California, c1973. 143p.
(Thesis - California)
3. Bergesen, Betty S. Pharmacology
in nursing, by. . . and Andres Goth.
13ed. St. Louis, Mosby, 1976. 752p.
4. Birch, Alexander A. ed.Anesthesia
for the uninterested, edited by . . . and
John D. Tolmie. Baltimore, University
Park Press, c1976. 187p.
5 Bloom, Benjamin S. Taxonomie
des objectifs pédagogiques. Tome 1:
domaine cognitif, par. . et al. Traduit
de I'americain par Marcel Lavallée.
Montréal, Éducation Nouvelle, c1969.
Les Presses de rUniversité du
Québec,c1975.232p.
6. Bristow, Opal. Discharge planning
for continuity of care, by . . . et al. New
York, National League for Nursing,
c1976. 144p. (League exchange no.
112)
7. Brown, Joan C. How much
choice? Retirement policies in
Canada Ottawa, Canadian Council
on Social Development, 1975. 285p.
July 2 - 3, 1976
Saskatoon City Hospital Class of 66
Nurses' Reunion. Information from:
Dianne Minto, 413 - 112th Street,
Saskatoon, Sask. S7N 1 V7.
July 21 - 24, 1976
Conference on Behavior Modification
in the Community to be held at the
Winnipeg Inn, Winnipeg. Sponsored
by the Manitoba Behavior Modification
Association and the Behavior
Modification Association of Sao Paulo,
Brazil, with the assistance of the
Continuing Education Division.
Information from: Continuing
Education Division, University of
Manitoba. Winnipeg. Manitoba.
August 9 - 12, 1976
International Symposium on Sex
Education and Therapy to be held in
English in Stockholm, Sweden. For
information, write: Head, Swedish
Institute for Sexual Research,
Kungsgalen 15, S-111 43 Stockholm,
Sweden.
8. Bureau d'informatique dans Ie
domaine de la santé. L'ordinateur au
service de la santé canadienne;
catalogue et descriptions, v. 2, no 2.
Ottawa, 1975. 226p.
9. Burke, Shirley R. The composition
and function of body fluids. 2ed. St.
LOUIS, Mosby, 1976. 114p.
10. Campbell, Alastair V. Moral
dilemmas in medicine; a course book
in ethics for doctors and nurses. 2ed.
Edinburgh, Churchill Livingstone,
1975. 212p.
11. Chater, Shirley. Introduction à la
recherche infirmièfe. Genève,
Organisation mondiale de la Santé,
1975. 36p. (OMS Pub. Offset no 14)
12. Current literature on venereal
disease 1975, no. 2. Atlanta, Ga., U.S.
Center for Disease Control, Venereal
Disease Branch, 1975. 140p.
13. Mosby's current practice and
perspectives in nursing series.
Pamphlets. St. Louis, 1976. Current
perspectives in nursing education,
v. 1. 188p.
August 28. September 3, 1977
World Congress of Psychiatry to be
held in Honolulu, Hawaii. For
information, write: Congress
Coordinator, VI World Congress of
Psychiatry, c/o American Psychiatric
Association, 1700-18th StreetN. w.,
Washington, D. C. 20009, U. S.A
Housing and travel arrangements
available through: Travel Consultants,
Inc., 1025 Connecticut Ave. N.S.,
Washington, D.C. 20036. U.S.A
September 2 - 22, 1976
International congress on child abuse
and neglect to be held in Geneva.
Information from: Prof. P.E. Ferrier,
University of Geneva, Department of
Pediatrics, 1211 Genève,
Switzerland.
September 19 - 20, 1976
American Academy of Medical
Administrators 19th annual
convocation and annual meeting at
the Sheraton Hotel, Dallas, Texas. For
information, write: Noel Barber,
AAMA, 6 Beacon Street, Boston,
Mass. 02108.
14. -. Current perspectives in
psychiatric nursing, v. ,. 228p.
15. - Current practice in obstetric
and gynecologic nursing, v. ,. 254p.
16. -. Current practice in oncologic
nursing, v. ,. 230p.
17. -. Current practice in pedIatric
nursing, v. ,. 241p.
18. DeCastro, Fernando J. The
pediarric nurse pracritioner;
guidelines for practice, by . . . et al.
2ed. St. Louis, Mosby, 1976. 211 p.
19. Delforges, Pierre. Surveillance
infirmière des mala des atteints
de . . . , par. . et Alain Harlay. Paris,
Éditions Lamarre Poinat, 1973. 207p. I
20. Dison, Norma Grenier. Simplified
drugs and solutions for nurses;
including arithmetic. 6ed. Saint Louis,
Mosby, 1976. 110p.
21. Equity in health servtces. Edited
by Ronald Andersen, Joanna Kravits
and Odin W. Anderson. Cambridge,
Ballinger, c1975. 295p.
(continued on p. 58)
September 30 - October 2, 1976
Third annual workshop, professional
health workers' section, Canadian
Diabetic Association, to be held at
Chateau Halifax, Halifax, N.S.
Information from: Bev Cain,
Compartment 15, R. R. 1, Redbank
Road, Lower Sackville, N.S.,
B4C 2S6.
October 18 - 22, 1976
Course in "Practical Rehabilitation
Techniques" 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, Alta. T2E OA 1.
October 26 - 29, 1976
Ontario Occupational Health Nurses
Association annual conference to be
held at the Park Hotel, Niagara Falls,
Ontario. Information from: Anna L.
O'Brien, Publicity Chairman, OCHNA,
320 Queenston Rd., St. Catharines,
Ontario.
The Canadian Nurse June 1976
.
Use your
nursing qualifications
to come to
AUSTRALIA
Fairfield Hospital, Melbourne, Australia has a lot to offer trained
nurses. Fairfield is internationally known for its work in the
investigation and control of communicable diseases, and it gives you
the opportunity to gain specialised experience and post-graduate
qualifications in this field. Assistance with fare will be available if
tenure of stay at Fairfield, Victoria, Australia, is twelve months
minimum.
The hospital is modern, magnificently equipped, and close to the
centre of the city. Rates of pay and conditions of service are
particularly attractive.
Whatever your interests, there's a nursing job for you at Fairfield. in
pediatrics. adu" medical nursing and intensive care nursing.
Take the first step to a challenging career - send for full details of
nursing at Fairfield Hospital to the following address:-
Miss Vivian BuJlwinkel,
Fairfield Hospital,
Yarra Bend Road. FAIRFIELD, 3078 AUSTRAUA
.
TwO careers in one.
Have you ever thought 01 combining two
careers in one? As a Canadian Forces nurse
you could, because you would also be an officer,
eligible lor regular promotion, enjoying a mmi-
mum 01 lour weeks vacation your very first year,
Iree transportation privileges to many parts of
the world, early retirement including a generous
lilelime 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
01 the many military medical installations in
Canada or overseas. You might qualily lor flight
nurse's traming or even for a complete doctorate
study course
II you're a graduate (female or male) of a
school of nursing accredited by a provincial
nursing association and a registered mem
er
01 a provincial registered nurses' associatIOn,
a Canadian citizen under 35 with two 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 _ ,
K1AOK2
. <
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No W'ØtrJIII9 -'>>uI ecør.n.A. No'*"'IOPfIJI.
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58
The Canadian Nurse June 1976
l
il)l.ttl.!J l TI)(ltt tt>>
22. European Conference on Public
Health Nursing, Helsinki, 6-19 August,
1958. Public health nursing. Reportof
a European Conference sponsored
by the Regional Office for Europe of
the World Health Organization in
collaboration with the Government of
Finland. Copenhagen, Regional
Office for Europe, World Health
Organization, 1959. 37p.
23. Ferrer, M. Irène. Précis
d'é/ectrocardiographie. Paris,
Maloine, 1975. 144p.
24. Fordyce, Wilbert Evans.
Behavioral methods for chronic pain
and illness. St. Louis, Mosby, 1976.
236p.
25. General Nursing Council for
England and Wales. Report 1974/75.
London, 1975. 66p.
26. Health Computer Information
Bureau. Health computer
applications in Canada: catalogue
and descriptions, v 2, no. 2. Ottawa,
1975. 226p.
27. Huckstep, R.L. Poliomyelitis: a
guide for developing countries
including appliances and
rehabilitation for the disabled.
Edinburgh, Churchill Livingstone,
1975. 279p. (Medicine in the tropics)
28. Illingworth, Ronald Stanley. The
development of the infant and the
young Child; normal and abnormal.
600. Edinburgh, Churchill Livingstone,
1975 325p.
29. Ingram, Ian Malcolm. Notes on
psychiatry, by. . et al. 4ed.
Edinburgh, Churchill Livingstone,
1976. 134p.
30. Inter University Nursing
Research Council. Proceedings of the
nursing research forum 1973-1975.
Fort Worth. Texas, 1975. 1v. (various
paglngs)
31. Johnston, Dorothy F. Total
patient care: foundations and
practice, by. . . and Gail H. Hood.
400. St. Louis, Mosby, 1976. 617p.
32. Kelman, G.R. Physiology; a
clmical approach. 2ed. Edinburgh,
Churchill Livingstone, 1975. 215p.
33. Lawson, Ian R. The language of
geriatric care: implications for
professional review, edited by . . . and
Stanley R. Ingman. North Haven,
Conn., Connecticul Health Services,
Research Series, 1975. 86p.
(Connecticut Health Services
Research senes no. 6)
34. LeMaître, George D. The patient
in surgery; a guide for nurses, by . .
and Janet A. Finnegan. 3ed. Toronto,
Saunders, 1975. 506p.
35. Lesterel, Alice. Journal d'une
infirmiére hospitalisée. Paris, Le
Centurion, c1975. 103p. (Infirmières
d'aujourd'hui no 9)
36. McNaught, Ann B. Nurses'
illustrated physiology, by . . . and Rovi
Robin Callander. 3ed. Edinburgh,
Churchill Livingstone, 1975. 155p.
37. National League for Nursing.
Converting threats into challenges -
adaptations in baccalaureate and
graduate education in nursmg.
Papers presented at the thirteenth
conference of the Council of
Baccalaureate and Higher Degree
Programs. Atlanta, Ga., Nov. 1974.
New York, 1975. 72p. (NLN Pub. no.
15-1571 )
38. Canada Institute for Scientific and
Technical Information. Union list of
scientific serials in Canadian libraries.
6ed. Ottawa, 1975. 2v.
39. National Seminar on Nutrition:
Issues and Priorities, Ottawa, May 7,
1975. Nutrition issues and priorities;
Proceedmgs. Edited by Andrew
Sherrington, Ottawa, Canadian Public
Heallh Association, 1975. 85p.
40. Organisation mondiale de la
Santé. Etudes européennes
concernant les soins infirmiers et
obstétricaux. Rapport d'un Groupe
de travail réuni par Ie Bureau régional
de /'Europe de /'Organisation
mondiale de la Sante. Copenhague,
Organisation mondiale de la Santé,
1975. 51p.
41. Osenat, P. Manuel de
/'aide-soignante et de Iïnfirmiere
auxilia/fe. 300. Paris, Masson, 1976.
511p.
42. Sarda, François. Le droit de vivre
et Ie droit de mourir. Pans, Éditions du
Seuil, c1975. 255p.
43. Saskatchewan Registered
Nurses' Association. Membership
report Jan. " 1975 to July 2, 1975.
Regina, 1975. 76p.
44. Saywell, John T. 1974 Canadian
annual review of politics and public
affairs. Toronto, Univ. of Toronto
Press, 1975. 440p.
45. Schroeder, John Speer.
Techniques in bedside hemodynamic
momtormg, by. . . and Elaine Kiess
Daily. St. Louis, Mosby, 1976. 212p.
46. Staffing 3; a reader consisting of
eight articles especially selected by
The Journal of Nursing Administration
editorial staff. 1ed. Wakefield, Mass.,
Contemporary Pub., 1976. 43p.
47. Tuberculosis Conference for
Public Health Nurse Faculty
Members, New York, October 9-14,
1955. Abilities, basic concepts,
content in tuberculosis for public
health nurses. New York, National
League for Nursing, c1956. 54p.
48. Wilenski, Peter. The delivery of
health services in the People's
Republic of China. Ottawa,
International Development Research
Centre, 1976. 59p.
49. World Health Organization. Early
detection of health impairment in
occupational exposure to health
hazards. Report of a WHO Study
Group. Geneva, 1975. 80p. (Its
Technical report no. 571)
50. Wright, Frederick James.
Tropical diseases, by. . and James
P. Baird. 5ed. Edinburgh, Churchill
Livingstone, 1975. 147p.
Pamphlets
51. Public Affairs Committee.
Pamphlets. New York, 1949-1975.
no. 154 Baruch, Dorothy. How to
discipline your child. 28p.
no. 163 Hymes, James L. Three to six:
your child starts to school. 28p.
no. 239 Ross, Helen. The shy child.
20p.
no. 254 Neisser, Edith G. Your child's
sense of responsibility 28p.
no. 290 Mace, David R. What makes
a marriage happy. 20p. no. 305
Stevenson, George S.
Tensions - and how to master them,
by . . . and Harry Milt. 28p.
no. 355 Milt, Harry. Young adults and
their parents. 28p.
no. 357 Archer, Jules. What should
parents expect from children, by
and Dixie Leppert Yahraes. 20p.
no. 369 Milt, Harry. What can you do
about quarreling. 20p.
no. 381 Sunley, Robert. How to keep
your child in school. 20p.
no. 397 Klemer, Richard H. Sexual
adjustment in marriage, by . . . and
Marg2ret G. Klemer. 28p.
no. 405 Bienvenu, Millard, Sr. Helpmg I
the slow learner. 28p.
no. 410 -. Talking it over at home; I
problems in family communication.
28p.
no. 412 Margolius, Sidney. Family I
money problems. 20p.
no. 424 Klemer, Richard H. The early
years of marriage by , . . and Margaret
G. Klemer. 20p.
no. 443 Berland, Theodore. How to
keep your teeth after 30. 24p.
no. 445 Bryant, John E. Helping your
child speak correctly. 20p.
no. 447 Carson, Ruth. Your
menopause. 20p.
no. 524 Dickman, Irving R. Making
products safer; what consumers can
dQ 28p. I
no. 527 Pilpel, Harriet F. Abortion:
public issue, private decision, by . . .
and Ruth Jane Zuckerman. . . and
Elizabeth Ogg. 28p.
no. 528 Ogg, Elizabeth. Divorce. 28p.
no. 529 Lindbeck, Vera. The woman
alcoholic. 28p.
no. 530 Burkhart, Kathryn W. The
child and the law; helping the status
offender. 28p.
no. 531 Dickman, Irving R. Sex
education for disabled persons. 28p.
Studies deposited in CNA
repository collection
52. Chagnon, Monique. PRN 74;
projet de recherche en nursing,
par. Lise Marie Audette, Louise
Lebrun et Charles TilqUin.
Classification des malades en
pédiatrie. Montréal, Hôpital
Ste-Justine, 1975. 227p. R
53. College of Nurses of Ontario.
Nursing education and registration
1974. Statistical report. Toronto, 1975
46p. R
54. Lavoie. Denise Samson. Etude
de vingt situations d'échange entre
Iïnfirmiére et la famille du patient
hospitalise en milieu psychiatrique.
Montréal, 1974. 60p. (Thèse (M.
Nurs.) - Montréal) R
Audio-visual aids
55. Institut canadien du filM,
Catalogue des films sur les sciences
medic ales disponible de la
cinémathéque nationale scientifique.
Ottawa, 1972. 144p.
56. Barstow, Ruth Elizabeth. Copmg ,
with emphysema. San Francisco, Ca.,
University of California, c1973. 1 reel.
(Thesis - California)
Advertising
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The Canadian Nurse June 1976
59
THE FIT KIT FOR FAT CATS
LA PHVSITROUSSE OU LA TROUSSE POUR TOUS
HOW FIT ARE YOU?
TES-VOUS EN FORME?
FIND OUT TODA Y AGISSEZ AUJOURD'HUI
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.
Name/Nom
Address correspondence to:
Address! Adresse
The Canadian Nurse
No of kltsl
No de'rousses
Engllsh/françals _ _ __ _
Canada $4 50
Other countnes autres pays S500
Payment enclosed/CI-JOlnt S
50 The Driveway
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K2P 1 E2
Order the Fit Kit from C.P.H.A.
Commandez la physitrousse de fA.C.H.P.
J
-1mUS8e
'.:zo." '. '.
. ,
:h'.
* "'''":;
.
." ':;:
"-:"
'
>
III_
-
Postal Code
PREPAID ORDERS ONLY l ARGENT DOlT HRE ENVOV
AVEC lE BON DE COMMANDE
.
Send rhe form.o Canadian P..,bhc Health Assoc..hon
SS P.rkdllie Avenue.
Ollawa. Ontano. Canada
K1Y 1E5
Envoyez la commanc1e a "AssociatIon Canadlenne dHro.ene PubhQue.
SS avenue Parkdale.
Onawa. Ontano. Canada
KIY 1E5
Province of British Columbia
requires
Nurses
Mental Health Centres
Courtenay, Chilliwack and Other Locations
$1,395 - $1,608
The persons appointed to these challenging career positions
will be responsible to the Administrator of the Mental Health
Centre concerned for the Aftercare Program, involving
psychiatric patients from boarding homes and half-way
houses in the region concerned: to operate as a member of a
multi-disciplinary mental health team; to conduct individual
and group therapy sessions and provide individual, marital
and family counselling services. Applicants preferably should
have a recognized Master's degree in Nursing with emphasis
on the behavioural sciences, and have a license to practice
nursing in the Province of British Columbia; several years'
demonstrated clinical experience in a community health
practice,
Canadian citizens are given preference.
Obtain applications from the
Public Service Commission
Valleyview Lodge
Essondale, British Columbia
VOM 1JO
and return immediately.
Competition No. 76:364A.
f(JJcome- k the-
OtD
S I 0) t F };{(/(Ic(
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7
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'ft 5E RDEC
fi%
'1
- - :;:/0-;:. 1Ja<ò'@1Ð
Apply to: . ff d .
Director of Nursing Ongoll1g sta e ucatton
Montreal Neurological Hospital
380\ University 51.
Montreal, P,O_ H3A 284
Individual orientation
60
The Izaak Walton Killam Hospital
for Children
Halifax, Nova Scotia
Offers a 13-week
Post Basic
Paediatric Nursing Program
for
Reg istered Nurses
Classes Admitted
January, May, September
For further information and detail
write:
Associate Director of Nursing
Education
The Izaak Walton Killam Hospital
for Children
Halifax, Nova Scotia
Assistant Director of
Nursing
f
Required for an accredited 234-bed
active treatment hospital.
Preference will be given to applicant with
practical experience at the senior
administration level combined with
baccalaureate degree and/or other
formal education in the field of
administration.
Salary commensurate with education and
experience.
Please reply to:
Personnel Director
St. Joseph's Hospital
Saint John, New Brunswick
Head Nurse
with preparation and/or
demonstrative competence in
Psychiatric Nursing and
Management functions, required for
Head Nurse appointment. To be
responsible for participation in the
organization, initiation, and the
management of a New Psychiatric
In-patient Unit.
Please apply, forwarding
complete resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6.
The CanadIan Nurse
('liI8Si fie(1
.L \(IY..-I-t iSPll1(>>lltS
Alberta
SUMMER VACATION: Have you COnsidered horseback riding and
camping In the Rodue Mountains near Banff, Alberta? EIght 6-day
S9
sO
r
o
r
o;;
t:
r
:
r
r
,
;
<>JI
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Box 6742, Station "D", Calgary, Alberta T2P 2E6.
British Columbia
Experienced Nurses (eligible for B.C. regIstration) required for
409-bed acute care, teacl1lng hosprtallocated in Fraser Valley, 20
minutes by freeway from Vancouver. and within easy access of vaned
recreational facilities. EJ(ce
enl Onentatlon and Continuing Education
programmes. Salary $1,049.00 to $1,239.00. ClInical areas include
Medicine. General and Specialized Surgery. Obstetncs. Pediatncs.
Coronary Care. HemodialysIs Rehabilitation. Operating Roo
. Inten-
sive Care, Emergency. Practical Nurses (ehglble for B C. License)
also required Apply 10. Administrative Assistant. Nursing Personnel.
Royal Columbian Hospital. New Westminster. British Columbia.
V3L 3W7.
Experienced R.N. (eligible for B.C. registration) reqUired for team
leader position In a Psychialnc Day.care Unrt, (10--15) as soon as
possible. Salary and personnel policies in accordance with RNABC.
Apply. Director of Nursing, St Vlnænt's Hospital, 749 West 33rd
Avenue, Vancouver, Brillsh Columbia, V6N 2W2.
General Duty Nurses for modern 41-bed hospital located on the
Alaska Highway. Salary and personnel poliCies in accordance with
RNABC. Accommodallon available In residence. Apply Director of
Nursing, Fort Nelson General Hospital, Fort NEIlson. Bnhsh Columbia. .
New Brunswick
Director of Patient Care required to administer all patient care ac-
tivities for a health centre/nursing home complex consisting of 55
active beds and 70 nursing home beds, including office facilities for
eight physICians. one dentist. two optometnsts. public health. and
clinics. Applicants must be eligible for registration in the Province of
New Brunswick and should hold a bachelor's degree with preference
being given to a business maJor. Inquiries should be sent to Adminis-
trator, Sussex Health Centre, Sussex, New Brunswick, EOE IPO,
Canada.
Ontario
Director of Nursing required for a 58-bed active treatmen
hospital In
Eastern Ontario. Experience In nursing administration desirable. Unit
Management course or H.O. M course an asset Please
ply in
wntlng encJosing curnculum Vitae to: J.F. Adams. Administrator,
Glengarry Memonal Hosprtal, Alexandria, Ontano, KOC 1 AD.
Registered Nurses for 34.bed General HospItal. Salary $945 00 to
$1,145.00 per month. plus experience allowance. Excellent personnel
policies. Apply to: Director of NursIng, Englehart & DISlrlcl t-iospllal
Inc Englehart, Onlario. POJ 1 HO.
Nurse. 5' 7' or over and strong, without dependents, to care for 160
pound handicapped executive with stroke. Live-in. 1 '2 yr. In Toronto
and 1/ 2 yr. in Miami. Preferably a non-smoker. Wage $180.00 -
$200.00 weekly net. depending on expenenæ plus Moami bonus.
Send resume to M.D.C., 3532 Egllnton Avenue West, Toronto, On-
tano, M6M 1 V6.
Quebec
RegIstered Nurse reqUired beginning of September 1976 In Co-ed
Boarding School In country. Applicant must live In and share duties
with another resident nurse. Apartment with maid service provided.
Excellent wor1<lng conditions. Llbaral Holidays. Applications stating
quallficallons and expenence to: Comptroller, Bishop's College
School, Lennoxvllle. Quebec, JI M 1 Z8.
June 1976
Saskatchewan
Coronach Union Hospital, Coronach, Saskatchewan requires 1 R.N.
from mid Apnl. For detaIls apply: Chief E.ecutive Officer, Coronach
Union Hospital, P.O. Box 150, Coronach, Saskatchewan. SOH OZO.
United States
Immediate openings for Experienced Operating Room Supervisor I
and O.R. Staff Nurses at 62-bed community hospital located In I
sceniC White Mts. region of New Hampshire. approximately 125 miles
from Montreal and Boston. Excellent salary and fringe benefits. Can.
tact: Personnel Dept, Littleton Hospital, 107 Cottage Street Littleton,
New Hampshire, 03561: Tel: 603-444-7731.
Texas wants you! If you are an RN. expenenced or a recent I
graduate, come to Corpus Chnsll. Sparldlng Dty by the Sea .. a CIty I
building for a better future, where your opportunities for recreallon and
studies are limitless Memorial Medical Center, 500-bed. general,
teaching hospital encourages career advancement and provides
inservlæ onentatlon. Salary from $802.53 to $1,069.46 per month,
commensurate with education and expenence Differential for
evening shifts. available Benefits Include holidays, sick leave,
vacations. paid hospltahzatlon. health. hfe Insurance, penSion
program Become a vital part of a rrodem, up-to-date hospital. write or
call. John W. Gover, Jr., DIrector of Personnel, Memonal Medical
Center. P.O. Box 5280. Corpus Chnst,- Texas, 78405.
The Montreal
Children's Hospital
Registered Nurses
Nursing Assistants
Our patient population consists of the
baby of less than an hour old to the
adolescent who has just turned
seventeen. We see them in Intensive
Care, in one of the Medical or Surgical
General Wards. or in some of the
Pediatric Specialty areas.
They abound in our clinics and their
numbers increase daily in our
Emergency.
If you do not like working with children and
with their families. you would not like it
here.
If you do like children and their families
we would like you on our staff.
Interested qualified applicants should
apply to the:
Director of Nursing
Montreal Children's Hospital
2300 Tupper Street
Montreal, Quebec. H3H 1P3.
The Canadian Nurse June 1978
GfNE
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Quebec's Health Services are progressive!
So
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nursing
at
The Montreal General Hospital
a feaching hospital of McGill University
Come and nurse in exciting Montreal
r-------------------------------.
laD\
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The Montreal General Hospital
1650 Cedar Avenue, Montreal, Quebec HJG IA4
Please tell me about hospital nursing under Quebec's new concept of Social and
Preventive Medicine
Name
Address
L_______________________________J
61
SOFRA-TUUE' Rou..eI
Fr.mycetln Sulph.te B.P. "ntlblotlc
Indlcatlona: Treatment ot onfected 0< polenl<a/ly "'ected
bums crush II1Junes lacerations Also varicose u
ers bed-
sores and ulcerated ,^,Ound
C:-tr.lndtcallona: '<nown ...ergy 10 lanolin or framyce-
1m Cross-senSitization may occur among the grOup 01
slrep1Omyces-óenved antobtotl
(neomycon paromomyc.,
kanamycin) of whICh 'ramycet,n IS. a member but tt1lS IS
not tlwaraable
Pr.c.utlone: most cases aþsorplton 01 the antibIOtiC IS
SO Sloghl !hal rt can be dIScount eo Where very large body
areas are Involved (e 9 30'110 0< more body Dum) the po5Sl-
bllrty ot olotoxlcl\)' be,ng evenlually prOduced Should be
considered Ptotonged use ot antibiotics may resun In the
overgrowth 01 nonsusceptJbIe organisms Including fungi
Appropnate measu,es shouldJ>e laken d 'hlS occurs
Doa8llr. A Single layer 10 be 3PPI..d d"ectly 10 the wound
and covered wIth an appropnate dressing It exudative
dressongs Should be changed at least da
y In case 01 leg
ulcefs cut dressing accurately to sIZe of ulcer and when
Infected stage has cleared reo I ace by non-mpregnated
dreSSing
Supplied: A "ghlWeoghl. para",n gauze dressong rnpreg.
nated wnh 1% Iramycelln sulphate B P Sofra-Tulle alSo
contains anhydrous lanolIn 9 95'110 Ava,IaDle In 2 Sizes 10
em by 10 cm ster
e Single un, IS cartons 0110 and 50_ 10
em by 30 em sterile single Units cartons Of 10 Siore al
controlled room temperature
Erratum: In the March 1976 ISSue 01 The Canadoan Nurse the
above prC'ducl Informat,on lor Roussel (Canada) Limited
Sofra-tuHe appeared ,n French by mistake The CanadJan
Nurse apologizes to Roussel and our readers for thIS errOr
The Grande Prairie Health Unit
(Population 47,000) requires a
Supervisor of Community
Health Nursing. Preference will be
given to those with a B-Sc.N. and
experience in nursing supervision. This is
a challenging position with ample
opportunity for program development and
innovative change.
Excellent salary and fringe benefits.
All inquiries and applications in strict
confidence to:
Dr. I. D. Mcintosh
Medical Officer of Health
Grande Prairie Health Unit
9640 - 105 Avenue
Grande Prairie, Alberta T8V 385
Phone: Area code 403-532-4441
Blood is meant
:4f
circulate
Bea
RED CROSS
Blood Donor
62
Sunnybrook Medical Centre
Assistant Executive Director
Patient Services
Sunnybrook Medical Centre is a large teaching general
hospital owned by the University of Toronto, The hospital
provides services in most of the clinical specialties and has, in
addition, a large extended care component. An extensive
building programme is underway.
The hospital is seeking an individual to fill one of three senior
management positions reporting to the Executive Director.
The duties include participation in the general management of
the hospital and responsibility for all Nursing and related
patient services. Accordingly, applications will be welcome
from individuals with a strong background in Nursing who also
have the academic qualification necessary to participate at a
senior level in the teaching programmes of the University of
Toronto Faculty of Nursing. There will be a cross appointment
to the Faculty.
The hospital offers an excellent compensation and fringe
benefit package. Applications should be directed to the
Executive Director as Chairman of the Selection Committee:
Sunnybrook Medical Centre
2075 Bayview Avenue
Toronto, Ontario
M4N 3M5
\
(
School of Nursing
The University of British Columbia
Requires 2 Full or Associate Professors,
preferably with Doctoral Degrees.
Master's Degrees will be considered.
Experience in clinical nursing and teaching essential.
Salaries in $30,000 range, excellent fringe benefits,
Assistant Professors and Instructors also required
Apply to:
Muriel Uprichard, Ph.D.
Professor and Director
School of Nursing
University of British Columbia
Vancouver, B.C. V6T 1W5
Phone: (604) 228-2595 or (604) 228-2429
The CanadIan Nurse June 1976
The University of British Columbia invites
applications for the position of
Director of Nursing Services, Extended
Care Hospital.
This will be ajoint appointment between the School of Nursing
and the Extended Care Hospital.
The appointment will be at the associate orfull professor level.
Salary will be commensurate with qualifications and
experience.
Master's Degree essential, Ph.D. preferred. Candidate must
be a specialist in long term care, Successful experience in
nursing administration required.
Apply to:
Muriel Uprichard, Ph.D.
Professor and Director
School of Nursing
2075 Wesbrook Place
Vancouver, B.C.
Canada V6T 1W5
Nursing Supervisor
Extended Care
Required for a modern 227 bed accredited
hospital providing general acute and
extended care services in a community of
30,000 population situated 30 miles south
of Vancouver, B.C.
Function
To organize and directly supervise patient
care services for the 119 extended care
patients,
Qualifications
This position requires a nurse with, or
eligible to obtain B.C. registration, who has
attained suitable professional qualification
including formal post graduate preparation
in supervision.
The applicant must have demonstrated
leadership and organizational ability with a
special interest in extended care nursing.
Apply in writing with a resumé
including names of three references to:
Director of Personnel Services
Peace Arch District Hospital
15521 Russell Avenue
White Rock, B.C.
V4B 2R4
--
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
I specialised acute hospital in the
country. It is also a teaching hospital
of Sydney University, which it adjoins.
Graduate nurses at RP A get wide
clinical experience in the most modern
and advanced medical environment
available in Australia. They also under-
g
continuous in-service education to
ensure that their theoretical knowl-
edge ,keeps pace with their clinical
experience.
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:
1\1s Margaret Nelson
Director of Nursing
Royal Prince Alfred
Hospital
Camperdown, NSW 2050
Tel: Sydney 51-0444.
Australia.
The Canadian Nurse June 1976
63
1+
Health
and Welfare
Canada
Sante et
B'en-etre socIal
Canada
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For detailed information
Medical Services. on available positions,
Northwest Territories ..,arP'^ interested applicants
Region. is seeking are invited to complete
qualified personnel to Clip and mail this coupon today the attached coupon
fill a number of public r - - - - - _ _ _ _ _ _I and mail to:.
health positions in IN I Personnel Administrator
locations throughout ame Medical Services,
the NW.T. IAddress I Northwest Territories
We have openings for ICity I
:nd
physicians, nurses in IProvince 1 14th Floor,
possession of a Public Baker Centre,
Health Nursing IPostal Code 110025 . 106 Street,
Certificate or Diploma, ITelephone I Edmonton, Alberta.
Environmental Health T5J 1 H2 or call
Officers, X -Ray and I I collect Area Code
Laboratory Technicians .- - - - _ _ _ _ _ _ _ _ 403-425.6787
"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
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of providing health
care for the
Indian people
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I Please send me more information on career
I opportunities in Indian Health Services. I
I Name: I
I Address: I
City: Prov: _
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Medical Services Branch
Department of National Health and Welfare
Ottawa, Ontario K 1 A OK9
The CanadIan Nurse June 1976
Index to
Advertisers
June 1976
Abbott Laboratories Cover 4
Barco of California 47
Burroughs Wellcome Limited 9, 25
The Canada Starch C ompany Limited 5
Canadian Public Health Association 59
The Clinic Shoemakers 2
Department of National Defence 57
Equity Medical Supply Compan y 57
Hospital Corporation of America 16
House of Appel Fur Company Limited 6
J.B. Lippincott Company of Canada Limited 32, 33
Nordic Pharmaceuticals Limited 1
Procter & Gamble 53
Reeves Company 7
Roussel (Canada) Limited Cover 3, 61
W.B. Saunders Company Canada Limited 49
Schering Corporation Limited 55
-- -
Ste risystems Limited 11
Uniforms Registered 51
White Sister Uniform Inc, 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.
GÐ:J
776
The Canadian Nurse
& C:.3 I.JUIl JI,J':) 1-10 127
, ' '- . . " .
.u .
I L 1 111. 'yo
t I r A .... , I .., 1 L..,
1<M 61\
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-
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The "
Abbott I.
container... ,
.
clearly superior ':.. .. \
.
(you can count on it!) \
:s ... \
,
0
.t1S \
TheAbbo-VaL 1\
ql1.llity Abbo- V ac f
Its excellent clarity allm
fluid contents.
SOUOO
3 .,000\
You can count on
"-
Rigid, accurate graduations (upright m.d inVf
are molded into the wall. No guesswor in . . .
the meniscus.
Reliable glass
,
\
Glass is a stable, impermeable material
backed by years of successful hospital
experience. It offers known
compatibility with LV. solutions -
and additives.
Glass is solid, easy to use ,
Glass is strong, self-supporting,
safe from accidental puncture.
It allows the added security of a 1
vacuum system.
Plenty of solid gripping surface on o'
the Abbo-Vac bottle when attaching
the LV. set. Firmly mounted bull's-
eye target doesn't" dodge" when the
piercing pin is inserted.
Glass adds up
The glass Abbo-Vac bottle is part
of a total Abbott system that
includes solutions and sets for
every need. Versatile! Glass
remains the I. V. container of
choice in the majority of . IT t!
Canadian hospitals. . . and IT A. ,ITED
rRE ..AIJ
among these, the Abbo-Vac ' ......<:Xc....
system is number one! fI G
,
76
Input
News
Names and Faces
Clinical WordsearCh #1
Calendar
What's New
library Update
The Canadian Nurse
The official journal of the Canadian
Nurses Association published
monthly in French and English
editions.
4
8
12
13
14
48
49
Volume 72, Number 7
Monitoring Central Venous
Pressure: Principles,
Procedures and Problems
Coping with the Agressive Patient:
An Alternative to Punishment
Understanding the Patient
in Emergency
VIP Treatment Proves That
This Hospital Really Cares
Coming Out:
A Confrontation with Reality
Sleeplessness: Can You Help?
Is There a Nurse in
the Neighborhood?
The Occupational Health Nurse
in the Wor1< Environment
Disseminated Intravascular
Coagulation:
A Patient Profile
G. Kay, P. Kearns
15
W. MathesOn, M MIéJf1, J. MacLeod
18
W. McKnight
20
D. Grant
24
J. Harper
Sr. L Gillis
30
32
S.N. Steidl
35
M.J. Hayman
J Granberg. R. Lowndes,
N. Robinson, M Busslinger,
D. Bunch. J. Palmer
Y. Weitzel, M. Johnston,
W. Bowes, M. Kenny,
J. Harvey. B. Burden
36
42
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There is a special challenge that faces
the nurse who is a member of the
occupational health team. Author
Miriam Hayman describes that role
this month in an article that begins on
page 36. On the cover, occupational
health nurse Nadine Franks bandages
the hand of a worker at the Toronto
brewery where she works. This photo
and the ones that accompany the
article are by Suzanne Emond of
Toronto.
The views expressed in the articles
are those of the authors and do not
necessarily represent the policies of
the Canadian Nurses' Association.
ISSN 0008-4581
-
Indexed in International Nursing
Index, Cumulative Index to Nursing
Literature, Abstracts of Hospital
Management Studies, Hospital
Literature Index, Hospital Abstracts,
Index Medicus. The Canadian Nurse
is available in microform 'rom 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.
l:'1 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!
territorial nurses association where
applicable NOI 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.
What the well-bandaged
patient should wear=
Bandafix is a seamless round-
woven elastic "net" bandage,
composed of spun latex
threads and twined cotton.
Bandafix does not change in
the presence of blood, pus,
serum, urine, water or any
liquid met in nursing.
Bandafix has a maximum of
elasticity (up to to-fold) and
therefore makes a perfect
fixation bandage that never
obstructs or causes local
pressure on the blood vessels.
Bandafix is not air-tight,
because it has large meshes; it
causes no skin irritation even
when used for the fixation of "'\
greasy dressings. The mate-
rial is completely non-reactive.
Bandafix stays securely in
place; there are eight sizes,
which if used correctly will
provide an excellent
fixation bandage for
every part of the
body.
-
Bandafix saves time when
applying, changing and
removing bandages; the same
bandage may be used several
times; it is washable and
may be sterilized in an
autoclave.
/
Bandafix is an up-to-date
easy-to-use bandage in line
with modern efficiency.
......,;'
Bandafix replaces hydrophilic
gauze and adhesive plaster,
is very quick to use and
has many possibilities of
application. It is very suit-
able for places that otherwise
are difficult to bandage.
.
\
\
lj(f'j
." /
',\ .
Bandafix is economical in use,
not only because of its rela-
tively low price but because
the same bandage may be
used repeatedly.
.
l
Bandaft:/." does not fray,
because every connection
between the latex and cotton
threads is knotted; openings
of any size may be made with
scissors or the fingers.
.........-
Bandafix*
Jh
t nblttl'll by
Now available
"Ready to Use
Bandafix
. Pre-measured
. Pre-cut
. 14 dlfferenl apphcations
. IndIvIdually Illustrated
peel-open packages
IONi[pj
1956 Bourdun Street. Momreal PO H4M IVI
./ÚUUJit.l,d tradf..nUlTk- of Continental Pharma
'-(>>I.SI)e<.t i,ee
The Canadian Nurse July 1976
3
The notion that associations exist to
further the interests of their members
has its roots in antiquity. Aristotle
wrote that "men journey together with
a view to particular advantage and by
way of providing some particular thing
needed for the purpose of life ... and
continue in existence for the sake of
the general advantage it brings." More
than 20 centuries later, we still
acknowledge that in the professions,
each practitioner is his brother's
keeper and believe that, as a group,
we can solve our problems better than
as individuals.
Most associations regard their
annual meeting as an important part of
this democratic process. This is
the chance for those who are
committed to the advancement of their
profession to get together to express
dissatisfaction with existing
standards, policies and practices. It is
also the time when individuals can put
their Ideas before a group of their
peers and debate the validity of their
viewpoint. Forthe elected executive, it
is the time when they have the right to
expect direction and guidance from
the people they will represent over the
next year or two years.
Ile.e(-j 11
Annual meetings are like a finger
held up in the air to testthe direction of
the wind. They are a relatively easy
and efficient way to keep in touch with
membership (and readers). That is
why this year I plan to take in four of
them, including our own national
convention.
Having once worked for an
association that in pre-austerity tImes
was noted (not to say notcxious) for the
intemperance of its members at their
annual get togethers, I have to say that
what impresses me most about the
meetings I have been to so far this
year, is the concern and dedication of
the nurses who attend them. There is
warmth and hospitality - the chance
to make new friends and meet old
ones again - but the prevailing
attitude is one of serious concern for
the issues of the day. The audience is
attentive when guest speakers
address them. The resolutions exhibit
a range of interests that speaks well
for the developing self-image of the
nurse. The study sessions are almost
always packed to capacity.
-"
.
Prenatal genetic diagnosis 01 serious
genetic disorders and chromosome
abnormalities in the unborn fetus has
created new dilemmas and
responsibilities for expectant parents
and the health team alike Medical
developments have given parents a
new and sometimes difficult choice.
Dr. Noreen Rudd, (M.D.), and Betty
Youson, (B.N., R.N.), of the
Department of Genetics, Hospital for
Sick Children, Toronto, discuss some
of the problems attending prenatal
testing in next month's issue of The
Canadian Nurse.
Central venous pressure
monitoring is one of the most
significant advances in the
management of patients suffering
from shock, chest injury or major
trauma. Nurses need to be aware of
this procedure and the specific
nursing responsibilities involved since
CVP is used with greater frequency in
all acute care settings. In this issue,
Gloria Kay and Patricia Kearns
describe the "how to's" of CVP
monitoring in a feature article that
begins on page 15.
In short, a great deal is
accomplished in a relatively short
space of time BUT, and it is abigbut,l
am often left with the uneasy feeling
that much of what is accomplished is
done without the full knowledge and
understanding of all the members.
It's not that anyone is trying to
hide anything. Usually, in fact, it's just
the opposite. Most associations spend
a big chunk of their budgets on trying
to improve communications with their
members They phone, write letters,
send telegrams. publish newsletters,
bulletins and journals. They hold
meetings and workshops and ask the
nurses who attend to carry word back
to the people they wor1< with. And yet,
in spite of all this effort, many
individual members arrive at an
annual meeting unprepared to give
the guidance that the profession really
needs.
Think about it before you agree to
represent your chapter at next year's
annual meeting. Begin now to find out
what the issues are. Talk to your
friends. Attend meetings. Read your
provincial newsletter and your
national journal. Study the problems.
Do your homework and show up next
year prepared to speak up
knowledgeably on the issues that
concern you. Become an informed
member; you and your profession will
both benefit!
-MAH.
Editor
M. Anne Hanna
As sistant Editors
Lynda Ford
Sandra LeFort
Carol Thiessen
Production AssIstant
Mary Lou Downes
Circulation Manager
Beryl Darling
- ---
Advertismg Manager
- -
Georgina Clar1<e
CNA Executive Director
Helen K. Mussallem
r
4
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.
111))111
The CanadIan Nurse Julv 1976
,
Time to take a stand
I am angry and frustrated! I am
angry over recent events that have
affected my profession, (nursing) and I
am frustrated by my seeming
powerlessness to change or even
have a say in these events.
I never cease to be amazed at the
nature of nurses. We are indeed a
classic example of conditioning. We
are docile, well-mannered, respectful
of authority, dedicated and above all,
we OBEY! I have been waiting in vain
to hear or read some protest from
Alberta nurses re the budget cutbacks
for hospitals. None have been
forthcoming. Therefore I wish to go on
record as one nurse crying in the
wilderness "I protest."
The cutbacks have seen
reduction of staff If it required X
number of R.N. 's and ancillary staff to
give adequate supervision and
professional care to X number of
patients 6 months ago, how can it now
be said to reqUire less? When the
restraints were announced I don't
think we nurses truly realized the full
import of it. The Government had
spoken! "Cut the budget" and we like
the well-conditioned sheep we are
scurried around to do just that, voicing
no objection. We went right along with
the directive and in the process of
cutting the budget we have cut our
own throats.
How do you suppose we will react
as the full realization sinks In? I think
the reaction of our spokesmen in our
Provincial Association is a good
indication of our reaction in general.
Not one mild protest or objection has
been heard on the part of individual or
organized nurses. Perhaps there is no
feedback to our organization. If this is
so - what is wrong with us? We are at
fault.
We nurses are indeed a bunch of
sheep. Perhaps we are not even as
smart as sheep, they at least have a
leader and follow HER to the death'
Of course we can handle it' We .ve
done it before, we diploma nurses, for
years and years! The expanded role of
the nurse is nothing new. Nurses have
always expanded to fill the gaps
without protest So we know we can do
it, but let us ask - "Why must we? '
Do we blindly follow government
directives without protest? Must we
,
stand by and watch the Government
wipe out in a few months what took
nurses years to achieve?
It is a fact that an ounce of
prevention is worth a pound of cure.
The time for Alberta nurses to act is
now to prevent further deterioration of
professional nursing care. We must
make our protests heard before the
Government takes our silence and
compliance for agreement Let us, for
once. present a united front, nurses
and realize what affects one affects
all, be we diploma or degree.
I for one am writing my Provincial
Organization, Federal Organization,
my M.LA., our Premier, my Hospital
District and anyone else remotely
connected with this issue - what are
you going to do?
- Maxine Enderton, Rotating
SupefVIsor, Sarcee AuxIliary
Hospital, Calgary, Alberta.
Creativity in the profession
I wish to congratulate the new
editors for the many positive changes
that have marked The Canadian
Nurse in recent months. The zippy
new format, the fine editorial
comments under the "Perspective'.
heading and the increasing number of
cogent articles - particularly those
dealing with various dimensions of
nursing practice - are indeed
welcome.
Equally important has been the
encouragement of members to submit
ideas and manuscripts for publicallon.
In doing so, the editors are not only
reinforcing the CNA's objective of
promoting unity through its offical
organ: they are also reminding us as
readers that the success of such a
journal depends on the contributions
of its readers as well.
Thus to my nursing colleagues
who are doing many exciting things we
don't often hear about I would like to
say: the editors have shown us their
flying new colors. Now let us as
readers put our creativity where our
complaints have been and encourage
one another to CONTRIBUTE!
-Judith K Hindle, R.N., Willowdale,
Ont
Florence unfrocked
I have read and reread Pat Barr's
letter, .'Nightingale debunked"
(March, 1976). Having taken R.N.
training in England and immigrating to
Canada some 17 years ago, I feel that
I must answer simply because I agree
with most of what Pat wrote.
The very fi rst day oftraining we all
stood up so nicely and took what in
England is called the "Florence
Nightingale Pledge." I wish I could
remember it all but one thing stands
out in my mind: that is, you do what the
doctors and your superiors tell
you. Don't ask qúestions - do as you
are told - and all will go well. Young
people were not really any different
then than now - they didn't like the
idea too much - and in all the history
of English nursing it seems there had
never been a more audacious crew of
new recruits. But they couldn't dismiss
a whole school and for three years we
put up with them, or maybe they put up
with us.
It seems looking back that we not
only disagreed with the system but
tned to outwit "Old Flo." Ladies we
certainly were not. Rules were very
rigid but fOr young people this is a
challenge. We had a lot of jokes about
"Old Flo. " Many years have gone past
and I have learned a lot. But the same
old rules are still there and there are
still some nurses who try hard to break
them - when they believe that what
they say or do is right. What happens
to them? Barr is wrong in saying that
there are no iconoclasts, intellectuals,
rebels and mavericks in the nursing
profession. They are there but to keep
working they keep their mouths shut,
agree with everything and go home
after shift and cannot sleep because
they know they should have spoken
up or complained to the Association
they belong to.
If they do, things get rough. The
doctors you have delivered babies for
and stitched up lacerations for
because they are too tired to get out of
bed, and even the Director of Nursing,
turns on you and finds some way to get
you out of there fast. They are afraid
you might speak out, particularly when
something goes wrong and you refuse
to do these things anymore. Nurses
are not fired -they are justtold to quit
and nothing will be said.
But I for one won't give up all the
years I have practiced. So, Pat, you
want a rebel, an iconoclast and a
maverick? Count me number one
According to Webster's Dictionary ,
maverick is a nonconformist or an
unbranded steer - in cattle-raisinc
areas a maverick is a calf that has lõ
his mother. They go to another COY
and hope to be taken in - funny thir
is. they usually survive.
I am angry that things don't
change and that the new kind of nurSI
still goes along with "Old Flo." But,
somebody tell me, "Where does thl
branded nurse find employment?"
- Valerie A Wilson, New Denver,
B.C.
Geriatric interest group
The Gerontological Nurses
Association originated In April 1974 I
The initial group consisted of fourtee
nurses gathered together to discus
the health care of the elderly person
united by a common concern for tht
elderly in our society.
The main purpose of the
Association is to draw people togethe
who have an interest and a concern i
this field. Our hope is to improve th,
standard of care of the elderly by
sharing our ideas and experiences
with others; by gaining further
knowledge, awareness, and
understanding of the elderly and the
needs and in turn imparting this
knowledge to the public and the
elderly. Our aim is to improve the
image of those professionally involvec
in the field of Geriatrics and
Gerontology.
As we are a Nursing Association
full membership is limited to
Registered Nurses and Registered
Nursing Assistants. However, as thE
multidisciplinary approach is so
integral to the health care of the
elderly, associate membership is
encouraged. Our associate member
include among others: occupational
therapists, physiotherapists, doctors
pharmacists and patients. We woul(
like to hear from any other groups, 0
individuals, who share similar
interests and can be reached at the
following address:
Gerontological Nursing Association,
P.O. Box 368, Postal Station K.
Toronto, Ontario, M4P 2G7.
- Barbara Jensen, R.N. (president)
Marjorie R. Wilcox, R. N. (education
counselor).
5
Add TO YOUR NURSiNG EXpERTisE
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You'll find the most recent clinical information on about
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generic names The drugs are grouped under 16
categories. such as Antiseptics and Disinfectives, Antihis-
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Chemotherapy of Neoplastic Diseases
By Mary W. FalconeT. RN. MA; H. Robert Patterson. PharmO;
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This brand new text is ideal for developing your skills in
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By Dee Ann Gillies. RN. EdO: and Irene B, A1yn. RN. PhO 236
pp Dlustd $9.80. ApnJ 1976. Order #4133-4.
Kron: The Management of Patient Care:
Putting leadership Skills to Work. New 4th
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Here's a modem look at the challenges of nursmg leader-
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understanding. the administrative and managenal respon-
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leadership skills. Particular attention is paid to defining the
role of each member of the nursing team
By Thora Kron. RN. BS. 247 pp ntusld Soh cover $5 15. Apnl
1976. Order #5528-9.
The
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From chemical conversion of food-to modem diet plan-
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common misconceptions about food. and weight control;
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ified diets. (A Teacher's Guide is available.)
By PhyUis S, Howe. RD, BS, ME 454 pp lUustd Soft cover.
$750. Apnl1976 Order #4788-X.
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This practical workbook shows you how to establish a
therapeutic relationship with the mentally ill patient This
revised edition includes new guides on obseTValion of
anxiety. assessing the milieu, theoretical approach. crisis
interoention. descriptive data. assessment of the client's
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By Janet A, Simmons. RN. MS 248 pp. Soft cover $6.70. Apnl
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6
The CanadIan Nurse J..ly 1976
I II I) lit
Grass roots action!
With reference to the article in the
May issue, "The Handmaiden is NOT
Dead," we thought that you might be
interested in knowing Ihat the fight
continues at the grass roots level!!
Enclosed is a copy of an open
letter that we sent some time ago to
one of the pediatricians in an active
treatment hospital. This was in reply to
a note he had sent to the Unit
Supervisor on a busy week end in
which he had complained that no one
made rounds with him. This doctor is
now Chief of Pediatrics and his
relationship with the nurses is good.
He back slides occasionally but then
so do we. Luckily for us he also has a
sense of humor.
- Name withheld
Dear Dr. X:
In reply to your letter in which you
complained bitterly about the staff on
4 West, please be advised that we,
the nurses, are greatly disappointed
in you. We had assumed that you
were a young progressive medic with
up-to-date ideas. Now you convince
us that in your thinking you are back in
the dark ages, when the nurse really
was the doctor's handmaiden. Don't
you realize that the modern nurse is
vitally interested in patient care and
not at all in doctor care? That IS
exactly where the nurses were on
Saturday when you had to make
rounds alone. They were taking care
of your patients, as good Doctor's
helpmates should.
In this age of specialized
treatment and advanced technology
you (the doctors) have placed an ever
increasing workload on the nurses'
already bowed shoulders. Now when
it seems as if something must give,
you state categorically that it isn't
going to be you. Come now Dr. X.,
haven't you ever ordered a croupette
to pacify or impress a mother? And
who do you think does the chest
physio that you order O. I. D. ? It sure
isn't the physiotherapy department!!
Well, hang in there, before long there
may be a tape recorder at eve/}' bed
side and all you will have to do is push
a button, and a nurse will pop out with
all the information it seems to be too
difficult for you to acquire on your
own, even after we went to all the
trouble of simplifying it for you on one
single day care sheet.
We are disappointed In you!! It is
hIgh time you moved out of your
fathers' generation and into your own.
Feverishly yours,
4 West Staff..
An end to the benefits!
In "Frankly Speaking" some
months ago, author Glenna Rowsell
stated that readers' comments were
welcome, and I have a few. After
receiving some weeks benefits from
the UIC, I have now been disentitled
under what I feel is a very rigid
interpretation of Section 25. Although I
have an employment card and am on
the "Casuals" list of one hospital, I
cannot find permanent employment
due to my advancing pregnancy (28
weeks). In fact I have not even been
called for casual work. (My
Qualifications are apparently excellent
as earlier in my pregnancy, had I not
been pregnant, all three hospitals in
the area would have hired me). At any
rate, UIC has now disentitled me,
stating I can and should find
employment as a cieri<, cashier or
similar occupation. Is this truly fair? I
feel that as I have paid for my training
and have also paid UIC premiums
dunng my worl<ing experience, I
should not be channeled out of my
profession because for a short time I
am not employable in it. I intend to
return to nursing after my baby is born.
At present I am appealing the UIC
decision and also applying for
positions as clerk or whatever I can
find. I photocopied your article and
sent it to the commission with my letter
of appeal, as it expressed my
frustration much more adequately
than I could. I do not expect anything
to be done and I reallydonotexpectto
win my appeal but it does help to know
that the Canadian Nurses Association
is aware of problems between the UIC
and nurses.
- Patricia Bailey, RN, Saskatoon,
Sask.
Sex education in the
community
One of the responsibilities of the
community nurse is to plan a
comprehensive teaching program for
her community on methods and
responsibilities involved in the control
of conception and spacing of children
in the family.
My concern is that at such
classes there is never any mention of
the physical and emotional danger of
promiscuity. Teenage high school
students and others in this age group
are encouraged to go to the doctor and
learn the method best suited to their
particular needs. -One often hears
remarl<s like the following: "If you use
this or that particular device you can
go out and have fun."
A recent film strip on venereal
diseases, though very good in other
ways, was singularly lacking in any
direction in this matter. Viewers were
urged to go for treatment, name
contacts, get all available information,
but not once was the point made of the
part promiscuity plays in contracting
these diseases. Emotional damage,
guilt, and lasting effects on the
personality were ignored.
We are told by the, so-called
experts, that premarital sexually
active teenagers need
non-judgmental counseling and
directed to be realistic about teenage
sexuality but this supposedly modem
approach does not help young people
build stable healthy relationships. I am
not suggesting we adopt a critical
attitude. I have in mind the teaching,
which is for the highest good of the
learners and for best physical and
emotional well-being. Neither am I
suggesting that we withhold advice
and teaching on birth control. On the
contrary, I feel we must give sound
teaching and up-to-date information
on the subject. But let us also give
them a way to greater happiness and
fulfilment in sexual relations; a desire
for something that is not cheap and
easily obtained. Young people often
have high principles and ideals. To
teach responsibility in this area of life
should be a paramount objective in
our teaching of the subject.
- Margaret Wood, R.N., P.H.N.,
Uranium City, Sask.
Prepared childbirth?
I had a similar experience to thé
described in "Matthew My Son,"
(March, 1976).
I practised prepared childbirth
only to find, when I entered the
hospital, that I had practised it
incorrectly for four months. The
prenatal classes did not prepare mE
adequately for childbirth especially
when the "fetal monitor" was attache<
incorrectly. I was very frightened whe
I saw the baby's erratic heartbeat.
Even the case nurse thought for
awhile that the baby was in danger,
but finally was able to get the monitc
correctly connected.
The morning after delivery, I
heard the babies in the hallway for
morning feedings. I could not
understand why my baby was not
brought to me as it was ten hours sino
I had delivered; I did not even know
where the bell was to call the nurse
Finally, an hour and a half later, a
nurse came to my room. When I askec
why my baby had not been brought tc
me she replied that they were
short-staffed.
It also distressed me that the
nurses knew so little about
breast-feeding. Each had her own
ideas, or no ideas at all. Not until my
fifth day in hospital did a nurse take é
few minutes to get me nursing pads
and to brief me on care of the breast
On the eighth day my breasts were sc
engorged my baby could not grasp the
nipple. I asked the night nurse, for heir:
and her answer was, "What do you
expect me to do?" Thanks to the
nursing assistant, who helped me
express some milk so the baby could
grasp the nipple, I did get my baby fed.
Life on the obstetrics ward was
overwhelming and I was very happy
when the day came to take my baby
home. Now, six months later, I am stili
breast-feeding and find it a great joy;
worth going through all the misgivings
to finally feel secure in the "natural '
way of feeding my baby.
- Barbara J. Charles, B.A., B. Ed. ,
New Minas, N. S.
UI:.I'I:.I\UUi) "1:." ul\uur Uli),,"uuru;) on all
items shown, for group lJurct\ases. gradua'. , Kitts. faYOf'S. etc.
6-11 Same Items, Deduct 10%; 12-24 Same Items, Deduct 15%
25 or More Same Items, Deduct 20% J
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wrrsion with self..adheslW!
back to mooot m flat surtace. Choose
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T -300 (bead chain) or
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NURSES PERSONALIZED SPHYG.
Now in Fashion Colon! f -
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In w_ Germany Easy-tHItach Velcro" cull,
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l\Iarlllteed to :!:3mm. Semced by
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stamped m case fREt Choose BlACK
with chrome metal manometer or
BlUL GREEN or BEIGE WIt
plastic
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an enlor-coord,nated (specIfy m coupon1
No. 106 SphYl. . , . 39.95 ea.
Duty Free
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on Japan _..lIy for R..... Meets
all U.s. Gov. specs. :!:3mm accuracy.
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chrome ..........t.,. cal to 300mm
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No. 333 Tote . . . 2.95 ea.
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DRDER ND ITEM CDLOR QUANT. PRICE
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Cad,) . . No. CT-2 (Plain Cao.l. . . 2 95 pro
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Use eJ<tra sheet for additional items or ordets.
INITIALS as desired:
TO DRDER NAME PINS, fiU out aU ,nformatlon in box, top
left, clip out .no attach to thIs coupon
I PI.ase add 50<< handhnl/posta..
I enclose $ I on ordon totalling under $5 00
No COD's or bilhng to indIvIduals Mass. reSIdents add 3"'- S. T.r
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------.---.
B
The Canadian Nurse July 1976
Xe\ys
RNASC admits student members,
creates Labor Relations Division
Registered nurses in British Columbia
have moved to broaden the
membership base of their professional
organization and, at the same time, to
streamline the labor relations function
of the association's services to its
members.
Delegates to the 64th annual
meeting of the Registered Nurses'
Association of British Columbia in
Vancouver," May, approved changes
in the association's Constitution and
By-laws making it possible for
students attending an approved
school of nursing to become members
of their professional organization.
The decision is subject to
amendments to the province's
Registered Nurses Act and approval
by the lieutenantijovemor-in-council.
It makes B.C. the first province to
recognize students as members of
their professional association. As
"student members," they are eligible
to serve as voting delegates and to be
named to the Board of Directors.
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Delegates also approved, subject
to consent of the lieutenant-
governor-in-council, the
creation of an autonomous Labor
Relations Division that will act as the
collective bargaining agent for the
province's nurses. The Division will
operate within the frameworl<. of the
RNABC Constitution and By-laws. It
will be governed by a Labor Relations
Council composed of bargaining units
of the RNABC. The decision to alter
the framework of RNASC labor
relations activities came about as the
result of a resolution passed at the last
RNABC annual meeting and was
taken to comply with existing labor
legislation that prohibits
"company-influenced or dominated
organizations" (such as the RNABC)
from acting as certified bargaining
agents. The new Labor Relations
Division held its founding meeting on
the day following the close of the
RNABC annual meeting.
Delegates to the annual meeting
also approved a wide range of
resolutions affecting health care
services in the province and social and
economic welfare of members of the
nursing profession. One of the
resolutions endorsed a Bill of
Consumer Rights in Health Care. This
includes the right of people to be
informed about: preventive health
care, the structure of the health care
system, the individual's own diagnosis
and treatment program and specific
costs of procedures, services and
professional fees.
The Bill would protect the right of
an individual to maintain the
confidentiality of his health records, to
refuse experimentation, "undue
painful prolongation of life or
participation in teaching programs"
and the right of the adult to refuse
treatment, "to die with dignity."
Under the terms of the resolution,
nurses also endorsed the right of the
patient to participate in decisions
affecting his health, through consumer
representation at each level of
government and with health
professionals and personnel involved
in his direct health care.
Other resolutions approved by
the delegates urge the B.C.
government to enact legislation that
would require supervisors of
municipal playgrounds to possess a
recognized first aid certificate and
would also compel drivers involved in
motor vehicle accidents to have blood
alcohol samples taken if requested by
the police.
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Anthropologist, Dr. Elvi Whittaker, at
the mike.
Is nursing a professional ghetto? Are
nurses members of the 'professional
third world'? Are some parts of the
nursing world so alienated that
members regard themselves as an
'oppressed majority'? These were
some of the questions raised by Dr.
Elvi Whittaker, associate professor of
anthropology at the University of
British Columbia, when she spoke to
delegates at the most recent annual
meeting of the BC nurses' association.
Dr. Whittaker, who is co-author with
Virginia Oleson of "The Silent
Dialogue: A study in the social
psychology of professional
socialization" warned her audience
that, since she is not a nurse, she did
not intend to provide definitive
answers but would attempt to present
the facts in the light of her own
experience and let her audience judge
for themselves.
A series of dramatized real-life
situations. satirizing the
powerlessness of nurses under some
conditions, set the stage for an
examination of the issue In these
skits, association members acted out
typical behavior patterns of the
oppressed, including reluctance to
accept responsibility, sense of
dependence and lack of I
self-determination, as they might be
found in nursing.
In her talk, Dr. Whittaker also
looked at the self-concept of the
oppressed and the cultural and
structural themes in society that
support this arrangement. She
reminded her audience that "the
powerless themselves support the
perpetuation of the system by
accepting their helplessness and I
acting accordingly.-
Reaction to the ideas expressed
by the speaker came from two I
directions: each member of a panel or!
five nurses representing various area
I
of practice spoke briefly on her own I
personal feelings and, later, members I
of the audience took turns at the
microphones. Opinions on the central
Issue of whether nurses are in fact
members of an oppressed group in
society varied widely and included
agreement, surprise, resentment and I
denial. Panel members were:
Elizabeth Cahill, staff nurse, Burnaby I
General Hospital, Burnaby; Julie
Downey, student nurse, Cariboo
College, Kamloops; Gerry-Lou Miller,
staff nurse, Central Vancouver Island
Health Unit, Duncan: Gloria Parker,
supervisor, Glendale Lodge, Victoria;
and Criss Rogers, instructor, Faculty
of Nursing, U.B.O.. Vancouver.
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Criss Rogers fields a question from
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Photos by Attwood
The Canadian Nur.. .July 1976
9
)uality assurance program
o get underway in B.C.
.tarting this Fall, B.C. nurses will have
11e opportunity to find out for
I,emselves what "quality assurance"
an mean in their own practice setting.
hat's when the first of a series of
3gional workshops organized by the
INABC will get underway throughout
1e province.
The workshops are the first
:ingible steps in the "Quality
\ssurance Program" which promises
) be the focus of RNABC activities in
1e immediate future. Emphasis on
,uality assurance is a reflection of the
hift in priorities from nursing
tandards to a system intended to
'valuate nursing performance
"Jrocess), results of care (outcome),
md agency resources (structure)
,imultaneously. A quality assurance
,rogram not only permits evaluation of
are using written, ratified standards,
Jut it also initiates action to maintain or
prove desirable standards of care.
The RNABC points out that for
lurses in practice, administration,
ducation or research,
mplementation of the system offers
1umerous advantages, including:
. clarification of job descriptions;
direction of nursing practice;
feedback about the quality of
'are:
identification of learning needs;
a increased job satisfaction, and
a identification of the nurses' role
"IS a consumer advocate.
Implementation of the program
nvolves, along with the workshops,
dentification of "change agents" on a
egional basis These will represent
arious levels of nursing practice and
urses practicing in each area of the
ealth care system . They will be
vail able for consultation in each area.
RNABC nursing services staff
embers will also be available for
onsultation and will assist in setting
up workshops.
Standards of nursing care have
been one of the B.C. association's
chief concerns during the seventies.
Between 1970 and 1974, committees
Crafted standards in the five specialty
areas of nursing practice: emergency,
extended care, intensive and coronary
care, obstetrics and psychiatry.
In June, 1975, the Committee on
Adoption of Standards held its first
meeting. Members represented
RNABC standing committees on
Nursing Education and Practice, the
Nursing Administrators' Section, the
BC Continuing Nursing Education
Committee and staff nursing. The
name of the Committee was later
changed to the Committee on Quality
Assurance because members felt that
quality assurance necessitates more
than the statement and adoption of
standards.
NLN and ANA
approve plans for
U.S. screening agency
A project for development of
pre-immigration screening of nurses
trained in foreign countries has been
initiated by a joint board of trustees of
the National League for Nursing and
the American Nurses' Association,
Titled the Commission on
Graduates of Foreign Schools of
Nursing, the new organization will
function as an independent, nonprofit
body. The commission will develop
and conduct a pre-immigration
program to evaluate credentials and
assess nursing and English language
proficiency In order to provide
reasonable assurance that nurses
trained in foreign countries would be
eligible for admission to the state
licensing examination.
At a meeting in Chicago in May,
the board approved a proposed
schedule that could put the screening
program in operation by the end of
1977. The cost of developing and
maintaining the organization until it is
self-supporting was estimated at
approximately $100,000 - an
investment to be shared equally by
NLN, ANA and the Division of Nursing,
HEW.
The project was prompted by
government concern about increasing
numbers of nurses who enter the U.S.
in search of employment but fail to
qualify for state licensure.
First NWTRNA Meeting
Held in Yellowknife
The first biennial meeting of the
Northwest Territories Registered
Nurses Association was held in
Yellowknife in April of this year. Its
theme was "Emergency Nursing."
Dr. Masson, Director of the
Emergency Department of the
University of Alberta Hospi1al, gave
detailed lectures on emergency
treatment of burns, gunshot wounds,
head Injuries, stab wounds, and
shock. Mrs. Saad, Director of Nursing
of the same emergency department,
spoke generally on emergency
I'IIIrsing, stressing the initial
emergency care of patients based on
identification of their most immediate
needs. Dr. Covert and Mrs. Collins
from Hay River, spoke on emergency
cardiac treatment, while Dr. A.P.
Abbot dealt with acute psychiatric
situations.
The meeting brought members
from many areas of the million and a
half SQuare miles of the Territories;
from the Western Arctic and
Tuktoyaktuk, to the Eastern Arctic;
from Frobisher Bay, to the
southernmost settlement of Fort
Smith.
Huguette Labelle brought
greetings from the Canadian Nurses
Association and words of
encouragement from Health and
Welfare Canada. Dr. Helen Glass,
Director of the school of nursing of the
University of Manitoba talked about
Continuing Education in the nursing
profession.
The Convention was opened by
Assistant Commissioner Mullins of the
Government of the Northwest
Territories. President Leone Trotter,
President of the N. W. T. R. NA opened
the general meeting and elections
took place. Barbara Bromley of
Yellowknife was elected president of
the Association, and Sharon Collins of
Hay River, president-elect.
The NW.T.R.N.A. is the
youngest of eleven members of the
Canadian Nurses Association, its
membership in the CNA dating from
October of 1975.
Ontario offers courses
in long-term care
Long-term care, with special
emphasis on management of the
elderly, is the subject of two new
four-week programs being offered at
Ontario's George Brown College in
Toronto. The short courses are
intended for teachers of diploma or
continuing education programs on
long-term care and are being held
during June and July.
The courses came into being as a
result of a resolution passed by
members of the Registered Nurses'
Association of Ontario at their annual
meeting three years ago. Under the
terms of resolution, the RNAO
accepted as a priority "activities
relaled to promoting standards of care
and assistance to members engaged
in long-term care settings."
Other association activites
related to carrying out the terms of this
resolution have included: conferences
on care of the long-term patient;
government submissions; assistance
to individuals or groups of nurses and
meetings with government
representatives and appropriate
associations.
An RNAO coordinating
committee, composed of
representatives from government and
allied health organizations in
long-term care, developed a proposal
that the government initiate programs
for registered nurses in long-term
care. This proposal was presented to
Ontario Ministries of Health,
Community and Social Services and
Colleges and Universities, in July
1974. The program is open to
teachers who are registered nurses
wi1h university preparation and two
years of teaching experience or
equivalent, or registered nurses who
have related consultant and
management responsibilities.
Did you know
Men can have Pap tests, too! Dr. John
F. Seybolt, director of the
Papanicolaou Laboratory of New Yor!<
Hospital - Cornell Medical Center,
has pointed out that the Pap test can
be used to detect cancers of the
respiratory tract, lung, GI tract, GU
tract, CNS, breast and the eyes.
10
The Canadian Nurse July 1976
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Five nurses from France were in
Canada from May 13 to June 4 as part
of their studies at the "École de
cadres d' infirmiers et d' infirmiéres" in
the regIonal hospital of Nantes. One of
the objectives of the tour was to learn
about nursing education and care in
Canada. The tour took them to
Kapuskasing. Hearst, and Timmins in
northern Ontario where the five
nurses were guests of RNAO
members.
In Ottawa, the nurses visited
se
'eral health centers and CNA
house. The Canadian Nurses
Association, in its role as the national
representatIve of nurses' assocIations
in Canada, serves in a liaison
capacity for international visitors.
While at CNA house, the nurses
visited the Library where this picture
was taken. From left to right
are:Yvette Brillant. Marie-Louise
Hébant. Jacqueline Flick, Jeannine
Roussel, and Monique Daniau
AIB Issues Bulletins on
Compensation
Guidelines
Seven technical bulletins on
compensation to help bargaining
agents and employers interpret the
Anti-Inflation guidelines have been
made available by the Anti-Inflation
Board The bulletins deal with:
. the definition of an employee;
e a guide to employers in
determining the composition of
employee groups;
. compensation plans;
. methods to be followed in
determining base date for groups of
employees:
. the application of the regulations
to three types of employer
expenditures required by federal or
provincial legislation:
e retroactive compensation:
. amendment to the guidelines to
permit employer increases in
compensation of lower-paid
employees above the permissible
percentage increases for the group.
Copies are available at all district
taxation cfhces in Canada as well as
the Anti-Inflation Board's regional
offices at Halifax, Winnipeg, Toronto,
Quebec City, Montreal and
Vancouver.
U of A graduate
scholarship
A graduate scholarship, valued al
$1,000., in recognition of the 50th
anniversary of the schools of nursing
of the University of Alberta and
University of Alberta Hospital has
been announced by the U. of A.
Hospital Board. The scholarship
recipient must be a graduate of the
University of Alberta school of nursing
and have been accepted as a full-time
student in a recognized university for
advanced nursing=related education
at the Baccalaureate, Masters or
Doctoral level.
Applicants will be evaluated on
their potential for leadership in nursing
and for contribution to nursing and the
community, as well as their
educational experience and
references. Applications should be
submitted to the vice-president -
nursing, University of Alberta Hospital,
112 Street and 83 Avenue, Edmonton,
Alia., T6G 2B7.
NBARN celebrates
60th anniversary
In June, Simone Cormier was
re-elected president of the New
Brunswick Association of Registered
Nurses for a second year. Cormier is
the director of nursing at Hotel Dieu
Hospital in Campbellton, and a
graduate of L'Ecole d'lnfirmières Sl.
Joseph and L'Institut "Deux Alices,"
Brussels, Belgium.
Other newly elected officers for
the 1976-77 term are Judith Oulton,
Fredericton, first vice-president; Sister
Germain Preston, Moncton, second
vice-president; and Lucille Gaulton,
Saint John, honorary secretary.
The NBARN celebrated its 60th
anniversary as the professional
organization for the nurses of New
Brunswick in June. At the annual
meeting in Fredericton the
anniversary theme was 'Today's
Nurse - A Dynamic Professional.'
Swine flu attack
Canada has succeeded in obtaining
commitments for 7.5 million doses of
influenza vaccine, 6 million of
monovalent A/Swine vaccine and 1 5 1 '
million of bivalent AlSwine and
A/Victoria vaccine.
Acting on behalf of the provincial
governments which will be
undertaking immunization programs
against Swine influenza this fall.
Health and Welfare Canada and
Supply and Services Canada have
obtained firm commitments for
vaccine from two different
manufacturers and a commitment for
a large supply from the United
Kingdom. Discussions are in progress
with a number of other foreign
suppliers in order to obtain all the
vaccine necessary.
Swine influenza is thought to be
the same strain of flu blamed for 21
million deaths in the world pandemic
of 1918 - 1919. It was isolated last
February at Fort Dix, New Jersey,
following the death of one recruit from
influenza and pneumonia. The virus is
expected to hit Canada in the fall at the
beginning of "flu season" and,
already, plans are underway for a
massive innoculation program to
immunize 11.6 million Canadians at
an estimated cost of $70 million.
Vaccinations will be administered by
each province starting September 1.
At present, Canadian heallh officials
are carrying out a country-wide flu
surveillance program to predict the
course and intensity of the flu.
In its September issue, The
Canadian Nurse will publish an article
on the effects of Swine flu and the
nursing care involved. Look for it! You
may need to be prepared.
Did you know
The University of Alberta Hospital,
Edmonton, has recorded Alberta's
share of multiple births for the year.
Over a thirty day period, beginning
April 19, 1976, four sets of triplets
were delivered. That's as many as are
normally recorded at all hospitals in
the province in a year. The birth of
triplets usually occurs once in
approximately 8,000 births.
I
Tha Canadian Nurse July 1978
11
Unit-dose drug distribution
offers significant advantages
,,/\ national study has found that the
umt-dose system of drug distribution
can improve the level of
harmaceutical service in hospitals. II
cannot, however, be expected to solve
he problems of traditional systems
utomatically, and its introduction may
esult in cost increases.
Under the unit-dose system,
hospital pharmacists provide all drugs
in packaged, single doses ready to be
administered by nurses. In most
traditional systems, nurses obtain
requently used drugs from bulk floor
stocks and receive others in individual
patient prescriptions that normally
contain a large number of doses.
The study was launched by the
College of Pharmacy at the University
of Saskatchewan and the Canadian
'Society of Hospital Pharmacists and
'supported by a $250,000 national
I health grant. Dr. Bruce SChnell, of the
College of Pharmacy. directed the
f investigation, which was carried out
over the last three years at four
hospitals in different parts of Canada
tie was guided by a research
commit1ee chaired by Professor Jack
Summers, of the College of
'Pharmacy, and representing the
Canadian Society of Hospital
Pharmacists, the Canadian Nurses
Association, the Canadian Medical
Association, and the Canadian
Hospital Association.
Dr. Schnell reported the results at
the annual meeting of the Canadian
Society of Hospital Pharmacists in
Saskatoon recently. He and his
colleagues found a significant change
in work pat1erns when the hospitals
introduced the unit-dose system.
Pharmacists spent more time
dispensing drugs for inpatients and
providing Information related to
medications. Registered nurses, on
the other hand, spent significantly less
time on activities related to
medications and some of the time
saved appears to have been
channeled into direct patient care.
Important errors such as
administration of a wrong drug, an
unordered drug, or a drug that has
deteriorated were fewer under the
unit-dose system. However, the study
team found that pharmacies failed to
pay enough at1ention to the accuracy
and appropriateness of the volumes of
liquids packaged in unit-dose to
ensure the delivery of the dose
ordered.
Both pharmacy and nursing
personnel generally favor a unit-dose
system "when asked to compare it
selectively to a traditional system,"
and patients favor it because the
single, packaged doses are "labeled
and are more sanitary."
The study team identified
personnel expenses as the greatest
single factor in determining whether
total costs go up or down under a
unit-dose system. "Any increase in
pharmacy staff would have a large
effect on total cost unless a
corresponding reduction in nursing
time occurred."
The report includes a series of
recommendations on how to improve
traditional drug distribution systems
and how to implement the unit-dose
system. It also recommends both
professional and government
encouragement for the adoption of the
unit-dose system and urges follow-up
studies to obtain more information on
costs, on medication errors, and on
longer-term experience with the
unit-dose system; and to develop a
model to aid in designing and
budgeting unit-dose systems and in
determining optimum staffing
requirements.
New direction plotted
for world health
Dr. Halfdan Mahler, Director-General
of the World Health Organization, has
called for a "drastic and fundamental
rethinking of the relationships
between communities and their health
services." In his most recent annual
report, The Work of WHO, 1975, he
concluded that the most urgent health
problems in developing countries are
related to poverty. infection,
malnutrition, environmental hazards
and lack of accessible potable water.
Because these health problems are so
basic they are not likely to be solved by
separate programs designed to
control specific diseases or
centralized services based on
advanced health technology.
In the future WHO will be
commit1ed to a concept of health
which includes economic and social
development as well as medical care,
and will set priorities according to the
underlying causes of health problems.
Mahler also pointed out that many
of the health care solutions of the
industrial world are too costly and
inefficient to be practical for
developing countries. For this reason,
WHO will continue to place strong
emphasis on provision of primary
health care as an integral part of
national health services.
Notes on going metric
In a report to the federal Metric
Commission, the Canadian Hospital
Association has indicated that
approximately 69 percent of the
hospitals in this country converted to
the metric system during 1975.
Results of a sample survey
conducted by the CHA research and
statistics department showed that
another 12 percent of Canadian
hospitals reported partial conversion
to the metric system.
The CHA reports that since June
1975 not one Fahrenheit thermometer
has been imported Into Canada. The
SI Metric Conversion Kit for Hospitals
is available from the CHA at a cost of
$5.00.
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 manufacttrer at
lower costs.
BUDGET if you wish at no
extra charge.
LEATHER COAT DEPARTMENT
Famous brand of genuine leather
coats in latest styles æd
colours - plain - fur tnmned -
zip-in lining.
1IoUSB D
APPIL
}>' U ReO. L T D.
Manufacturers of
FINE FURS
119 Spadina Avenue
Toronto,Ont.
M5V 2L 1
Tel.: 363-7209
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............
E.A. Electa MacLennan was honored
by the presentation of a LL.D., Doctor
of Laws, Honoris Causa degree by the
Faculty of Health Professions,
Dalhousie University at their spring
convocation on May 13, 1976.
MacLennan, past president of the
CNA from 1962 - 64, has had a full
and varied nursing career. A graduate
of the Royal Victoria Hospital School
of Nursing in Montreal, she received
her diploma in Teaching in Schools of
Nursing from McGill University, and
her M.A. in Public Health Supervision
from Columbia University. She was
National Office Supervisor for the
Victorian Order of Nurses for the
Maritimes and assistant director of the
McGill School for Graduate Nurses
before becoming the first director of
the School of Nursing at Dalhousie.
Her active involvemen1 in nursing
spans to cover community health
nursing, the realization of in-service
education in Nova Scotia hospitals at
a time when the need for such
education was scarcely recognized,
and the organization of the annual
Nursing Institutes which serve to keep
nurses informed of trends in health
care.
She has represented Canadian
nurses internationally at ICN
conventions in Australia and in
Geneva. She was a Board Member of
the ICN from 1962 - 69 and in 1967,
Canada awarded her a Centennial
medal for her achievements.
Among her varied interests are a
love of music, stamps and gourmet
cooking. She is now retired from active
nursing and lives in Brookfield, Nova
Scotia.
Mildred Tuttle of Marshall,
Michigan, a leader in the field of
nursing died on April 2, 1976 at the
age of 73.
T ut1le was affiliated with the W K
Kellogg Foundation of Battle Creek,
Michigan, for 36 years until her
retirement in 1968. Over the years, the
Foundation has been identified as a
major private funding source for
programs to improve nursing
education and service. She was
responsible for the Foundation's grant
activities in this field. Shewas a leader
in movements to prepare clinical
nursing specialists and associate
degree nurses in the United States, for
the improvement of nursing
leadership in Canada and for
strengthening nursing education and
the training of nursing auxiliaries in
Latin America.
Her own nursing education was
extensive including a B.N. in 1926
from Case Western Reserve
University, M.A from Vanderbilt
University, M.S. in public health
nursing, an honorary Doctor of
Science degree from Wayne State
University in 1955 and a citation for
outstanding leadership in nursing by
the National League for Nursing.
She served as a community
nurse for four years and taught
nursing, public health nursing and
health education before joining the
Kellogg Foundation.
Carol Beazley (B.Sc.N., Mount St.
Vincent University) has been
appointed nursing and planning officer
with the Nova Scotia Emergency
Health Services
She has worked with the Victonan
Order of Nurses, Hawker-Sidley at the
Halifax shipyards, and has done
medical nursing at the Halifax
Infirmary. She has also had
experience as a ship's nurse with the
Canadian Coast Guard ship, Louis St.
Laurent. and the Bedford Institute of
Oceanography ship, Hudson.
Caroline A. Manley (R.N., St.
Joseph's School of Nursing, Cornwall)
of Berwick has been appointed
director of nursing at the Winchester
Memorial Hospital, Winchester, Ont.
She succeeds the late
Bernadette Legris,
Jean Armstrong (R.N., Regina
General Hospital School of Nursing,
P.H.N_ Dip!., University of British
Columbia) has retired as regional
nursing supervisor of the Moose Jaw
- Assiniboia - Gravelbourg Health
Region, following nearly 30 years of
public health nursing service in
Saskatchewan. She served as a
nursing sister in the RCAMC during
World War II
Mary Pack, who made better
treatment for arthritic patients a
personal lifetime crtJsade, has
become the first woman to receive the
$50,000 Royal Bank Award. She was
named 1976 recipient in recognition of
her contribution to human welfare and
the common good.
Pack is recognized as the moving
force behind the founding of the
Canadian Arthritis and Rheumatism
Society (CARS), established in 1947
and represented today in every
province. She founded and from 1948
to 1969 was executive di rector of the
British Columbia division of CARS, the
first provincial organization.
In announcing the award, the
Hon. J.V. Clyne, chairman of the
award selection commit1ee, said: "The
success of her efforts has benefited
hundreds of thousands of arthritis
sufferers and made Canada a world
leader in research and treatment of
the disease. As a result of her work,
sufferers who 30 years ago could have
been confined to bed from childhood
are today receiving treatment that
allows them to lead normal everyday
lives."
\ -}
...... .
-
'--
Mary Pack is the 11th recipient of
the Royal Bank Award and will be
presented with the specially struck
gold medal and a $50,000 cheque at a
dinner in Vancouver on July 12. Her
latest honor will be added to numerous
accolades at home and abroad. She is
a member of The Order of Canada an
a recipient of the Queen Elizabeth
Medal, a coronation commemorative
award for outstanding contribution to
the welfare of people of the British
Commonwealth.
'1
-\
Lily M. Turnbull, chief nursing officer
of the World Health Organization,
retired after 23 years of service to that
organization. Her first WHO post was
as senior nurse educator Iteam leader
with a nursing education project in
Malaysia. She then was regional
nursing adviser, Western Pacific
Region until her appointment as chief
nursing officer in 1969. A graduate of
the Regina General Hospital school of
nursing, she obtained her Bachelor of
Nursing degree from McGill
University, Montreal, and her Master
of Public Health degree from The
Johns Hopkins University school of
hygiene and public health, Baltimore,
Md.
Mary G. Smith (R.N., Ontario Hospital
Hamilton and Brantford General
Hospital; Nursing Unit Admin.,
Canadian Hospital Association) has
been appointed assistant director of
nursing at Weiland County General
Hospital, Weiland, Ontario. She has
been on staff in the emergency
department of the St. Catharines
General Hospital, and has for several
years been associated with the
Weiland County General Hospital In
an administrative capacity.
11_ "GIIGUIGII nUI;aoa' ,",UIJ' .;;r,g
Clinical Wordsearch #1
H I K E C S C U l T E T U S U l A
AYECLVLRAOPNCGNEY
PSPlOAIGPRRRINAVM
PSAEEHP I ASEPT I CAO
EUISRCSSRCONASONT
NENKSATEOAP I ESLOC
o L L lUG L R T NUS REO I E
IIANTIBIOTICCRSTT
CCPGULOEMLLANDTNS
IIALRESSYEYRAROEY
TTREEUlCERNTPCMTC
I YOVSMCATHETERYSE
S L SIC I S E G LAN A S B I L
EACNO I SUFSNART I DO
RROEOANAESTHET I CH
UAPTTUBEYMOTCELOC
MPYSYMOTCERETSYHN
Solve the clues. The bracketed number
indicates the number of letters in the word or
words in the answer. Then find the words in the
accompanying puzzfe The words are in all
directions - vertically, horizontally, diagonally,
and backwards. Circle the letters of each word
found The fetters are often used more than once
so do not obfiterate them. Look for the longest
words first. When you find alf the words, the
fetters remaining unscramble to form a hidden
answer. (Answers page 41)
1 Usually a mid-line abdominal incision (10)
2 Removal of the gall bladder (15)
3 Postoperative complication characterized by
absence of bowel sounds (9, 5)
4 Temporary or permanent opening of large
bowel on the surface of the abdomen (9)
5 A nasogastric tube (6)
6 Help in maintaining aCId base balance (12)
7 A stitch in time might have saved nine of
these (7)
8 Protective covering for a wound (8)
9 Free 01 infection (7)
10 Removal of the uterus (12)
11 A rubber or silastic tube used to drain the
bladder (8)
12 A drug that relieves pain (9)
13 A drug used for preventing and treating
infection (10)
14 The replacement of blood (11)
15 An abdominal binder used postoperatively to
provIde support (9)
16 May be caused by an accumulation of gas in
the gut (10)
17 Pertaining to that gland situated below the
stomach (10)
18 May be a barium swallow or barium enema
(8)
19 A method of providing nourishment
parenterally (17)
20 Inflammation of the vermiform appendix (12)
21 That portion of plasma less fibrinogen (5)
22 Usually used in addition to sutures to add
strength (5)
23 A drug which may have a local or general
effect in producing a lack of feeling or
sensation or rendering a person unconscious
(11)
24 Excision of the colon (9)
25 A mechanism for draining bile postop after
removal of gall bladder (5)
26 Medication gIven before surgery (5)
27 What one doesn't feel when inebriated (4)
28 A condition characterized by pallor, clammy
cool skin, rapid pulse, and decreasing blood
pressure (5)
29 It's usually well centred; not a military base
(5)
30 Pro re nata (3)
31 Motor vehicle accident (3)
32 Intravenous cholangiogram (3)
33 Nil per os. (3J
34 A technique of exploring the abdomen by
using a scope (11)
35 Operating room (2)
36 Test done by nuclear medicine (4)
37 The plastic surgeon's territory (4)
38 Bathroom privilege. (3)
39 A localized erosion of mucosa by
hydrochloric acid (5)
40 Between jejunum and ascending colon (5)
41 How you look with a haemoglobin of 7.4 gm.
(4)
42 Tres In die (3)
43 Shortness of breath (3)
44 Omne die (2)
45 What's left of last year's incision (4)
,...-
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14
(
a:llell(llll.
The Canedlan Nurse July 1976
July
"Life, not just Survival," Congress
of the International Federation for
Home Economics to be held at the
Skyline Hotel, Ottawa, July 19 - 24,
1976. Information from: Linda M
Stepenoff, IFHE Congress Chairman,
Suite 216, 56 Sparks St., Ottawa,
Ontaflo, K1 P 5A9.
Conference on Behavior
Modification in the Community, to
be held at the Winnipeg Inn, Winnipeg,
July 21 - 24, 1976. Information from:
Continuing Education Division,
University of Manitoba, Winnipeg,
Manitoba.
August
Ninth International Conference on
Health Education will be held at the
Skyline Hotel, Ottawa, Ontario, Aug.
29 - Sept. 3. Theme: "Health
Education and Health Policy in the
Dynamics of Development." For
information, write: Canada's
Organizing Committee, Ninth
International Conference on Health
Education. c/o CHESS P.O. Box
2305, Station D., Ottawa, Ontario,
K1P 5KO.
Critical Care Nursing: an eight-week
program offered five times a year, to
those registered or eligible for
registration in the Province of Nova
Scotia. The next program begins Dec
6, 1976 with an application deadline of
August 30, 1976. For further
information, contact: Group Leader,
Critical Care Program, Continuing
Education, Victoria General Hospital,
Halifax, Nova Scotia, B3H 2Y9.
Continuing Education Course,
"Fetal monitoring maternal -fetal
medicine," to be held at the Hyat1
Regency, Vancouver, B.C. on Aug. 26
- 28. Write: Department of
Continuing Education, ACOG, One
East Wacker Drive, Suite 2700,
Chicago, ILL 60601.
September
Respiratory Week - 1976
Educational Forum, at the Calgary
Inn Hotel, Calgary, Alberta, Sept.
1 - 3, 1976. Contact: Ms. E. Lord,
Registration Chairman, 6528 - 23
Ave. N.E., Calgary, Alberta, T1Y 1V4.
Ontario Psychogeriatric
Association: Third Annual Meeting,
to be held at the Talisman Motor Inn
Ottawa, Sept. 20 - 22, 1976. '
Information from: Dr. M. Farquhar,
P.O. Box 14, Station "C", Toronto,
Ontario, M6J 3M7.
RNAO - 20th Annual Conference
at Honey Harbour, Georgian Bay,
Ontario. Four unique programs: Sept.
20 - 24,1976, You as a Person; You
as a Team Leader; You as a Manager
of Change. Sept. 18 - 25, 1976,
Advanced Program in Group
Leadership. Contact Professional
Development Department, RNAO, 33
Price St. , Toronto, Ontario, M4W 1 Z2.
Canadian Society of Perfusionists
- Annual Dialysis Symposium, to
be held at the Chateau Halifax, Nova
Scotia, Sept. 25 - 26, 1976. For
Information, write: C.S.P., Dialysis
Unit, Victoria General Hospital,
Halifax, N.S. B3H 2Y9.
Association of Registered Nurses
of Newfoundland - 22nd Annual
Meeting to be held at the Holiday Inn,
St. John's, Sept. 27 - 29, 1976. For
further information, write: ARNN, 67
LeMarchant Road, Sf. John's,
Newfoundland.
The Nurses Association of the
American College of Obstetricians
and Gynecologists (NAACOG) -
3-Day Education Conference to
provide obstetrical, gynecological and
neonatal nurses with the latest
developments in their specialties. To
be held in Winnipeg, Manitoba, Sept.
30 - Oct. 2, 1976. Contact: Karen
Flatley, R.N., Administrator,
NAACOG, One East Wacker Drive,
Suite 2700, Chicago, Illinois. 60601.
October
Association of Canadian Medical
Colleges - Annual Meeting to be
held at the Bayshore Inn, Vancouver,
B.C., Oct. 3 - 5, 1976. The
Association of University Schools of
Nursing, and of Rehabilitation, are two
associations holding meetings in
conjunction with ACMC. Information:
Mr. C.A. Casterton, Executive
Secretary, Association of Canadian
Medical Colleges, 151 Slater Street,
Ottawa, Canada, K1P 5H3.
Symposium on Neurological and
Neurosurgical Nursing, Toronto,
Ontario Oct. 14 - 16, 1976. For
further information contact: Nursing
Department, The Toronto Western
Hospiæ
399Ba
u
tSf., Toront
Onærio. M5T 2S8.
Practical Rehabilitation
Techniques at the Calgary General
Hospital offered by the Department of
Physical Medicine and Rehabilitation
and the Department of Nursing
Service, Oct. 18 - 22, 1976.
Infonnation from: Director of Nursmg,
Physical Medicine and
Rehabilitation, Calgary General
Hospital, 841 Centre Avenue East,
Calgary, Alta., T2E OA ,.
Effective Diabetes Education - A
Workshop, to be held at Village
Green Inn, Vernon, B.C., October 22
- 23, 1976. For further information
contact:Mrs. Bernice Strachan, R.N.,
Diabetes Day Centre, Vernon Jubilee
Hospital, Vernon, B.C.
Annual Conference of Ontario
Occupational Health Nurses
Association to be held at the Park
Hotel, Niagara Falls, Ontario, Oct.
26 - 29,1976. Information from: Anna
L. O'Brien, Publicity Chairman,
OCHNA, 320 Queenston Rd.,
St. Catharines, Ontario.
Order of Nurses of Quebec -
Annual General Meeting, to be held
at the Queen Elizabeth Hotel,
Montreal, October 27 - 29, 1976. For
information, contact: ONQ, 4200
Dorchester Blvd., Montreal, Quebec,
H3A 1V2.
The Professional Team Approach
to Cancer Health Care, to be held il
San Francisco, California, for all
medical and professional personnel
involved in the care of cancer patients
October 30, 1976. For information
write: Department of Continuing
Education, Mount Zion Hospital anc
Medical Center, P.O. Box 7921, Sa,
FrancIsco, California 94120.
November
An Examination of the State of thE
Art of Palliative Care of Terminal
Patients and their Families, to be
held in Montreal, Nov. 3 - 5, 1976.
Guest speakers include: Dr. Cecily
Saunders and Dr. Elizabeth
Kübler-Ross. For further informatior
write: The Post-Graduate Board,
Royal Victoria Hospital, 687 Pine
Avenue West, Montreal, Quebec.
H3A lAl.
Ontario Public Health Associatior
27th Annual Meeting to be held at thl
Skyline Hotel, Toronto on Nov. 3 - 5
1976. Information from: Kae
Sutherland, OPHA, 7 Carlis Place,
Port Credit, Ontario, L5G 1 A8.
Second Northeast
Canadian/ American Health
Conference to be held at the
Sheraton-Boston Hotel, Boston,
Mass. on Nov. 3 - 6, 1976.
Information from: Dr. R. Robillard,
Fédération des médecins
spécialistes du Québec, Suite 601,
625 Avenue du Président Kennedy,
Montréa/, Québec H3A 1 K2.
Canadian Association on
Gerontology educational meeting II
be held at Hotel Vancouver,
Vancouver, B.C. on Nov. 11 - 13,
1976. Information from: CAG - 76,
2210 W. 12th Avenue, Vancouver,
B.C., V6K 2N6.
Although described as an indicator of right heart function. Central Venous Pressure
helps to determine the overall cardiovascular status of the patient. The nurse who
understands the underlying principles can adapt this procedure to the individual
needs of each patient.
V1onitoring @!]J
1frnillLb w!]J
([)rn
LPrn!]J
rnlli!]J
principles, procedures
and problems
J
I
Gloria Kay and Patricia Kearns
c!
31'
CENTRAL VENOUS PRESSURE (CVP) is the
hydrostatic pressure in the large veins close to the
heart, at the level of the right atrium that provides the
force necessary to fill the right side of the heart during
diastole. "Central veins" refer to the intrathoracic
portions of the superior and inferior vena cava. CVP
is measured as the number of centimeters of water
that can be raised by the pressure within the central
veins. The reference point for measurement is taken
to be the middle of the right atrium, located four to five
centimeters below the sternal angle (the relatively
prominent ridge where the second rib articulates with
the sternum).
Nurses are frequently required to monitor
central venous pressure when caring for acutely ill
patients. This pressure is an adjunctive vital sign,
providing information about the patient's clinical
status. Although CVP may be precisely descnbed as
an indicator of right heart function, it is generally
perceived as a useful mdicator of overall
cardiovascular status. Hence it is used as a guide for
intravenous (IV) fluid management of patients in
shock: with dehydration: postoperatively: and those
in whom cardiac decompensation might be
anticipated (i.e. patients with a history of cardiac
dysfunction who require IV fluids). The central
venous line may also be used for medication
administration, in hyperalimentation, and,
occasionally, for the insertion of a pacing electrode.
'Ie
J1
111
Physiological factors
The CVP level of each patient is influenced by a
number of interdependent physiological factors. For
clarity, these factors are discussed separately, but it
is important to remember that changes in anyone
factor may be concurrently or serially reflected
among the others (See figure 1). These factors
include:
- intravascular volume and flow,
- contractility of the heart chambers,
- neural regulation of the venous system, and
- intrathoracic pressure.
Intravascular volume and flow: The volume and
flow of blood being returned to the heart from
peripheral vessels varies with changes in
intravascular volume A decreased volume reduces
the pressure in the central veins: an increased
amount raises this pressure.
Reductions in intravascular volume may result
from absolute loss or from alterations in distribution.
Examples of absolute volume loss are blood loss due
to hemorrhage, plasma loss from burns, or fluid loss
in vomiting and diarrhea. Volume reduction due to
alterations in distribution occurs when increased
capillary permeability redistributes fluid from the
caillaries to the interstitial spaces, as happens during
intestinal obstruction, 1
Increases in intravascular volume may be
caused by fluid retention, as in hyperaldosteronism;
or by overloading the system, due to excessive fluid
replacement.
Contractility and distensibility of the heart: The
volume and pressure in the central veins depend on
the efficiency with which the right heart chambers
relax to receive, and contract to forward, the blood
being returned to them. Right ventricular failure may
have a primary cause, or be secondary to left
ventricular failure. A failing right ventricle will not
empty normally and blood will accumulate, causing
an increase in CVP.
Neural regulation of the venous system: Neural
regulation of the central veins is influenced by the
sympathetic nervous system. Sympathetic nerve
endings release the hormone norepinephrine, which
stimulates alpha and beta nerve receptors. Alpha
receptors are distributed throughout the arterial and
venous systems, whereas beta receptors are
predominantly arterial. Alpha receptor stimulation
results in vasoconstriction, while beta receptors
respond with vasodilatation. Therefore. events
causing sympathetic nervous system stimulation,
such as physical exercise or emotional stress, result
in vasoconstriction and increased venous tone,
potentiating increased venous return to the right
heart and an increased CVP.
Intrathoracic pressure: Pressure within the
central veins is influenced by changes in
intrathoracIc pressure. particularly fluctuations
occasioned by respiration. During inspiration,
intrathoracic pressure is lowered with a concomitant
lowering of CVP. On expiration, intrathoracic
pressure rises, leading to a rise in CVP. Sharply
increased pressure readings occur with coughing or
the Valsalva maneuver.'
t>
. Va/salva Maneuver. increase of intrapulmonic pressure
by forcible exhalation against the closed glottis.
16
The Canadian Nurse July 1976
Figu re 1
Physiological Factors Affecting Central Venous Pressure
Factors resulting in
decreased CVP
-
Blood or plasma loss
Diuretics
! volume
Heat
! venous tone
(vasodilatation)
c;Þ
Inspiration
! intrathoracic pressure Expiration
(more negative)
Î intrathoracic pressure
(less negative)
Factors resulting in
increased CVP
Increased IV fluids
Fluid retention
Î volume
Congestive heart failure ! cardiac efficiency
Exercise
Î venous tone
æ
c
-.::
o
c
o
::E
Preparation for monitoring
A small-bore, plastic, vascular catheter is
introduced into a peripheral vein percutaneously or
by direct intravenous cutdown. Frequent sites are
the external jugular, subclavian, femoral, cephalic,
and basilic veins.
It is preferable that the patient receive an
explanation of the procedure before the necessary
equipment is brought to the bedside.
The type of equipment and specific manner of
measurement vary somewhat among hospitals, but
nurses who understand the basic principles and
method can readily adapt or improvise.(See figure
2).
Assembling the equipment at the bedside
affords an opportunity to review again with the
patient what is happening and respond to further
questions. The IV infusion tubing and the CVP
apparatus are prepared by attaching one outlet of the
four-way stopcock to the tubing leading to the IV
solution bottle, attaching the second outlet to the
extension leading to the water manometer, and
joining the third outlet to the tubing leading to the
patient's vein. Figure three is a schematiç diagram of
the set-up, and indicates how the direction and flow
of the IV solution is altered by changing the stopcock.
The skin area surrounding the insertion site is
prepared by shaving, if necessary, applying a
tourniquet or blood pressure cuff, and surgically
cleansing the patient's skin. Wearing sterile gloves,
the doctor inserts the intracatheter, sutures it in
place, attaches it to the CVP line, and flushes the line
to ensure patency.
Antibiotic spray is applied to the skin around the
site of insertion, a sterile dressing is applied. and
taped to stabilize the catheter. The adhesive tape or
Elastoplast" is labeled with the time and date of
insertion. This date is important. since hospital policy
dictates the frequency of site and catheter changes.
A chest X ray is performed at this time to verify the
precise location of the intracatheter.
In preparation for monitoring CVp, a "zero level"
must be established. The zero indicator on the water
.. ElastopJast is a registered trademark of Smith and
Nephew Ltd., Lachine, Québec.
manometer should be level with the patient's right
atrium (see illustration). To establish the zero:
. Have the patient lie flat in bed, if the recumbent
position can be tolerated.
. Abduct the arm.
. Using the midclavicle as a guide. locate the
fourth intercostal space.
. Follow this space across the patient's chest to
the midaxillary line (approximately 5 centimeters
down from the top of the chest). This point
approximates the position of the right atrium.
. Marl< the patient's skin with an "X" and use this
point as zero for all future CVP readings.
. Using a carpenter's level, or comparable device.
measure a direct baseline from the midaxillary "X" to
zero on the manometer, stabilizing the manometer s
zero at this level.
. Using this procedure, normal CVP is 4 to 12
centimeters of water.
Monitoring
CVP readings are usually monitored and
recorded hourly. Serial pressure monitoring provides
more useful information than a single reading.
. Before every reading, establish the patient in the
identified position, confirm the zero point, and
determine catheter patency by increasing the IV
infusion briefly to permit a rapid flow rate.
. Turning the stopcock, allow the IV solution to run
into the water manometer to a level 10 to 20
centimeters above the expected pressure reading.
Avoid fluid overflow of the manometer, to decrease
sources of contamination and/or infection.
. Close off the flow from the IV solution.
. Turn the stopcock to allow fluid in the
manometer to flow into the catheter. The manometer
fluid falls rapidly and fluctuates slightly with the
patient's respirations.
. Observe the pulsation in the manometer as the
fluid drops . When the level is constant except for
respiratory fluctuations, record the CVP level using
the maximum reading.
. Return the stopcock to the IV infusion position
and re-establish the flow from the solution bottle into
the patient's vein. A microdrip is useful in regulating
IV flow.
The CanadIan Nurse July 1976
17
Figure 2
CVP Equipment Includes: 8. IV fluid, as ordered by physician.
1. Tray for skin preparation with razor and antiseptic solution. 9. Sterile dry dressing may be included on cutdown tray.
2. Tourniquet or blood pressure cuff. 10, Antibiotic spray.
3, IV cutdown tray. including sutures, 11. Adhesive tape (usually 3" Elastoplast).
4. Intracatheters (size depends on vein to be used), 12. Sterile gloves for doctor.
5. IV tubing and pole. 13. Armboard, if required
6. Water manometer. 14. Carpenter's level or other device for establishing the zero point
7. Four-way stopcock. 15. Heparin 500 - 1000 units/L. if ordered by doctor.
Figure 3*
Central Venous Pressure Via
Jugular Vein
IE: â ----
I I
- Mo"omete r arm ...........-..
---""'"- -
I ,,
t 6
--
!5 r-. In ext jugular
r. _
3 -
,
etn
..
-
2 . _
.-/
-_
<
pOSItIOn
Infra'Ve"Ou
fl\J.d
I
I I
.n J.. Manometer scale
!() I
.centlmeter
'
f9
,
I
Î'
-
-.
4 Way stoPCOCK
D
- cite
Precautions
An awareness of possible problems will assist
nurses to anticipate. prevent, or alleviate difficulties
inherent in caring for patients with CVP lines.
Problems to watch for:
Interference in transmission of pressure:
Obstructions to free flow within the system may be
caused by kinks or plugging in catheter or tubing.
Excessive tubing should be loosely coiled. The use
of an armboard can prevent kinking due to joint
flexion and other patient movements.
Clotting of blood within the catheter may be
prevented by periodic flushing of the line, and by the
addition of heparin to the IV solution. The small
quantity of heparin commonly used does not
adversely affect the body's clotting mechanism.
. Reprinted with permission from: Concepts and
Practices of mtensive care for nurse specialists.
Edited by LE. Meltzer, F.G. AbdeUah and J.R.
Kitchell, Bowie, Md.. Charles Press Inc. 1969. p. 294.
If flow becomes sluggish or blocked, do not
force fluid through the intracatheter by squeezing the
pump chamber. Notify the physician.
Infection: The observance of aseptic technique
during catheter insertion and during application of
dressings aids in preventing infection. The frequency
with which the dressing is changed vanes with the
hospital and doctor concerned. Although this
technique is not always delegated to the nurse
(certain doctors prefer to do itthemselves). her main
responsibility is in observing for complications.
Phlebitis is a hazard that may be eased with warm
compresses or may necessitate a change of catheter
site. If it becomes necessary to change the catheter
site, the tip of the catheter should be sent for culture
and sensitivity in a sterile container.
Catheter breakage: At the time of insertion. care
should be exercised to prevent catheter damage by
the needle point. If the catheter breaks while in the
vein, apply pressure over the vein and call the
physician immediately. Upon removal, the catheter
should be examined to ensure that it is intact.
Summary
When caring for patients with CVP lines. nursing
assessments are aided by knowledge of the
interdependence of physiological factors such as
cardiovascular volume and flow, cardiac efficiency
and central vein capacity. Comprehension of the
underlying principles facilitates adaptation of the
procedure to patient needs and to the available
resources,
References
1 Guyton, Arthur Clifton Basic human physiology
Normal function and mechanism of disease. Toronto.
Saunders, 1971. p. 240-1.
Gloria Kay R.N, B.Sc.N, B.A., M.Sc.N, is
coordinator of research (nursing) at the Sunnybrook
Medical Centre, Toronto. Patiricia Kearns, R.N..
B.N., M.Sc.N., is clinical nurse specialist In
cardiology at the same center. ...
18
The CanadIan Nurse July 1976
Coping with the aggressiv
Extremely aggressive patients in mental institutions constitute a threat to staff
and other patients that usually necessitates the use of physical restraints. With
chronically aggressive patients this cycle of behaviors is defeating for both the
staff and the patient. In this case history the authors describe how positive and
negative reinforcement and shaping were used to alter the previously
unmanageable aggression of a 36-year-old male psychiatric patient.
Wayne Matheson, Maqbul Mian, Joyce MacLeod
The most anxiety-provoking behaviors of
patients in mental institutions are those where
threat of assault is always present and actual
assault upon staff is a distinct possibility. The
usual result of such behavior is that the
offending patient is both physically restrained
and verbally rebuked. Another common
consequence is deprivation and the
withholding of privileges. Continuous assault
upon staff or other patients results in a cycle of
punishment whereby the patient becomés
isolated and out of contact with the daily social
environment of the institution.
Recently, behavioral approaches to
aggression have been used as an alternative
to the punitive use of isolation and deprivation
(the problems with side-effects of such
punishment are well-documented l ). This
involves the systematic use of positive and
negative reinforcement and shaping to change
behavior. 2 When the patient displays the
appropriate, non-aggressive behavior, he is
positively reinforced (rewarded); at the same
time, negative reinforcement (reinforcement of
attempts to avoid or escape from discomfort
resulting from aggressive behavior) is used to
encourage appropriate behavior instead of
aggression.
One of the difficulties with this method is
that the alternative behavior must first be
occasioned. Somehow a replacement behavior
must be made to appear. It is possible that a
replacement behavior does not exist and must
be taught. On the other hand, if the treatment
staff are satisfied that an alternative behavior
does exist, even at a low level of probability,
they can prompt for its appearance. With
assaultive behavior, the replacement behavior
need not be complicated or complex enough to
require teaching. Indeed it may be sufficient
that the individual do "nothing" rather than
assault. In other words, the patient need just
stop the old behavior rather than produce a
novpl response. In that case the staff could
!)o< 'Iy reinforce the behavior of "not
flghllng
In the following case history, the staff
decided to try the use of behavioral methods to
gain control over a patient who had not
responded to the punishment techniques of
isolation, deprivation and physical restraints.
t"
Case History
The patient chosen was a 36-year-old,
single, obese male who had been in the
hospital since 1955. Previous therapeutic
efforts had been inconclusive and, in fact,
there was no evidence of meaningful change
in the patient's behavior since early childhood.
A summary of the medical file indicated a
diagnosis of severe mental retardation and
severe behavior disorder. There were also
suggestions of brain trauma at birth. The
history was replete with accounts of assaultive I
and abusive behavior, uncontrolled and
spontaneous outbursts of violence, feelings of I
suspicion and persecution, and preferred
periods of seclusion and isolation.
Despite this discouraging profile, the
individual read the paper daily, watched the
news on TV with behavior that bordered on
addiction, and willingly discussed, at his own
initiation, issues relevant to the world around
his small prison-like room. These behaviors
cast doubt on the diagnosis of retardation, yet
this diagnosis had persisted across several
assessments by different professionals.
The patient was kept in a single-bed room
with a locked door and a wire mesh window.
The room was furnished with a bed, TV, radio,
and portable toilet. The portable toilet was
necessary since the patient would not use
ward toilet facilities because, he claimed, "the
other patients are after me." Access to the
room was limited to one or two preferred staff
with whom the patient had rapport. When the
patient was allowed to roam free, he assaulted
staff or other patients almost immediately. On
occasion, he even attacked staff in his own
room. The patient was allowed to leave his
room only to bathe, and this ritual resulted in a
constant physical struggle with accompanying
staff
The patient was extremely fond of his TV
privilege, his radio and his daily newspaper.
The Canadian Nurse July 1976
19
" .1111111111'llllllljllllllllll!III!I!lllllilll
illi
111:11111;::;:;':::::
Þatient:
an alternative
I)unishment
-hese had been provided without obligation
or a number of years despite his constant
iggression and threats. Indeed, control over
he assaultive behavior seemed to be in the
lands of the patient. The staff were
jetermined in the first stage to alter this control
md to do so without the previous struggling,
vrestling, and consequent use of punishment.
Treatment plan
The first step was to try to gain some
;ontrol over the patient's reinforcement
I;ystem. Since he was extremely fond of his
Irv, radio, and daily newspaper - and the staff
::auld control these sources of reinforcement
- it was decided to start the program around
hese variables. A fuse was connected just
)utside the patient's door which enabled staff
o control the power to the TV and radio, and to
mmunicate this to the patient.
The target behavior was the bathing
I .. .
5ltuatlon. The patient would not presently
equest a bath even when it was necessary to
<eep clean. When the staff did require him to
::lathe, he would fight and struggle with
:lccompanying staff on the way to the bath, in
the bath, and on the return trip. As a first step, it
was decided that the staff would request that
the patient have his bath. If he declined, as
expected, the staff would remove the new fuse
from the TV and radio, and tell the patientthat it
would be restored as soon as he requested a
bath. This is the principle of negative
reinforcement, Reinforcement is arranged if
the person avoids, or escapes. from his
deprivation or discomfort. Whenever the
patient requested assistance or indicated he
was ready to cooperate, he was to be assisted
immediately and the fuse was also replaced
immediately. This procedure was repeated
until a pattern was established and the patient
frequently requested his bath even though he
later fought.
In the second phase, if the patient
aggressed on the trip to the bath, he was taken
back to his room and the fuse was again
removed. He was told that it would be returned
if he asked for his bath and then went to the
bath without a struggle, In this way the staff
attempted to shape non-aggressive behavior.
During the trip to the bath any
non-aggressive behavior was praised,
encouraged and given appreciation, and
special visits to his room were arranged for
such cooperation. This was the application of
the principle of positive reinforcement.
Gradually, it became clear that the patient
was now asking for his bath, going to the bath
without a struggle, taking his bath and then
fighting and wrestling on the return trip. At this
point, the staff returned the patient to his room
after the bath and replaced the fuse, because
he had produced the target behaviors of
requesting a bath and going without a struggle.
The daily newspaper, however, was withheld
and the patient was reminded that he would
have his newspaper each day if he didn't
struggle on the way back from the bath.
Slowly, over a period of several weeks,
the use of positive reinforcement for
non-aggressive behavior, negative
reinforcement for cooperation and requests for
assistance, and shaping of an appropriate
chain of behavior enabled the staff to control
this patient's aggression. The target behaviors
have been met, and now he requests and
takes his bath without a struggle. In addition,
the staff have extended the behavioral
demands for cooperation to include his weekly
injection of medication. This, too, was a ritual
that necessitated a wrestling match. The same
positive reinforcement-negative
reinforcement paradigm was instituted with
the fuse system and the patient now assists
staff with his medication.
. . . . . . . . . . . . . .. .
...........................
.....-.. ...........................
................................
.................................
.................................
...................................
................................
.................................
................................
.................................
.................................
..................................
...............................
.................................
.................................
.................................
.................................
.................................
................................
................................
..............................
...............................
.................................
................................
................................
................................
... ......... ............................
. . ...... .............................
. ..............................
Conclusion
In the past, staff had considered this
patient an unrepentant and incorrigible
demon. Gradually, as cooperative behavior
appeared, they had second thoughts and
began to see some humanity peeking through.
For the first time in the memory of most of
them, this patient has been taking his baths
and medications without a struggle. He is also
less verbally abusive to staff,
The attitude towards this patient has
changed from extreme pessimism and
despair, to a more optimistic, positive
approach. There is hope that the program can
be extended to include toilet behavior and that
gradually the patient will be moved Into ward
socialization with others.
This example illustrates how effective the
use of reinforcement can be in patient
management. The application of a
non-punitive approach is being promoted
more and more in all areas of behavior
management. Hopefully, the helping persons
who are involved with individuals whose
behavior evokes anger and retaliation in
others, can control their own reactions
sufficiently to appreciate that change is more
likely through use of a reinforcement model
than a punishment model.
References
1 Skinner, B.F. SCIence and human
behavior. New York, Free Press; New York,
Macmillan, 1953.
2 Matheson, w.E. Functional help, by...
and J. Martin. Sydney, Cape Breton Hospital,
1976. Unpublished.
The authors are on the staff of Cape Breton
Hospital in Sydney River, Nova Scotia. Wayne
Matheson (Ph.D., University of Alberta) is
Chief Psychologist, Maqbul Mian (M.D..
University of Punjab) is Medical Director and
Joyce MacLeod (R.N.. Glace Bay Genera)
Hospital, Glace Bay, N.S.) IS Head Nurse in
the male psychiatric unit.
After several meettngs about the patient,
Matheson and Mian drew up the treatment
plan described above, and it was .
implemented by MacLeod and the nursmg
staff in the unit ..
20
The CIInacIIMI NIl,..
July 11178
Understanding the Patient in
Caring for a patient in an emergency department demands much more than
technical nursing skills. Quality care requires a nurse's understanding of many I
factors contributing to the emotional state and behavior of the patient and his
relatives in an emergency.
Wendy McKnight
The patient in emergency faces a situation of
sometimes overwhelming psychological
impact. His emotional state may be a reflection
of the event prompting his unexpected
admission to the emergency department, of
his physical condition, or of the strange
environment of the emergency department
itself. The reactions of the patient's relatives
and friends will also influence how he
responds to his suddenly altered
circumstances.
The Patient
An elective admission to the hospital
gives the patient time to prepare himself for an
absence from home and work. The emergency
patient has no time to prepare himself
practically or psychologically for his
admission, no time to develop coping
mechanisms, The event bringing him to
emergency may represent a sudden and
frightening change in his physical state. Other
concerns may be related to his job, his I
financial situation, his family, or his prognosis.
These concerns, suddenly magnified, will
affect his behavior.
The word 'emergency' has frightening
connotations. It suggests an urgent,
life-threatening situation. The emergency
environment; white, fast-paced, and efficient,
may also appear threatening to the patient.
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Tha Canadian Nursa July 1976
21
Ansequently, he may automatically react
ith anxiety and fear although his condition
ay not be considered urgent or acute by the
ttending staff.
A patient in emergency may accept care
'y hospital staff with quiet resignation, but this
J3ttitude should not be misunderstood by a
lurse, as it often stems from the patient's
feeling of loss of control. A feeling of
lelplessness in an emergency situation
::leg ins before the patient's admission to
'1ospital. A person has no control in the event
::If sudden illness or accident and may submit
ItO treatment with seeming complacency
because he feels very helpless, For example,
most patients rarely question what is being
done to them by ambulance or hospital
personnel; instead they quietly accept the care
and treatment administered.
The total situation of an emergency
ddmission imposes severe psychological
Istress on the patient and as a result he may not
I understand everything being explained to him.
'A nurse may help him to understand by simple
explanations of procedures and equipment,
and frequent repetition of such explanations.
Fear and anxiety are predominant
emotions in the emergency patient. Anxiety
'las been defined by Robinson as a persistent
uneasiness due to intemal stimuli. Fear is
elicited by extemal stimuli. An individual
usually knows what causes his fear but is often
unable to identify the sources of his anxiety.
Consequently. it is easier for health personnel
to attempt to reduce or alleviate fear than to
cope with anxiety. If the patient can be helped
to identify the cause of his anxiety, then
appropriate steps can be taken to alleviate it. If
the source of anxiety cannot be determined,
however, it is questionable whether the patient
will be successfully reassured, Nevertheless,
nursing support ought to be given in the form Of
explanations, touch and overt evidence of
caring.
Many patients in emergency experience
some degree of pain. Pain is an intensely
personal and all-encompassing phenomenon.
It is impossible for one person to enter into the
experience of another's pain. It intensifies fear
and anxiety, and these emotions may increase
pain. Unless analgesics are contraindicated
by the patient's condition, the most important
and considerate nursing measure in the
treatment of pain is the swift administration of
an analgesic as ordered by the doctor,
Emotional support of the patient is important to
reduce the level of fear and anxiety related to
pain.
Such support is especially important
when uncomfortable procedures are being
carried out. For example, the insertion of a
chest tube is often frightening to a patient. This
treatment should be fully explained before and
during the procedure. A nurse should take time
to listen to the patient's concerns, and to
remain close to the patient during the
treatment to give emotional and physical
support while assisting the doctor. Two-way
communication is reassuring to a patient and
may help to alleviate fear and discomfort.
The health team involved should be alert
to all behavioral cues which will help to identify
the concems and needs of the patient. All
behavior has meaning. Facial expression,
tone of voice and posture are some forms of
nonverbal communication. Such behaviors
are cues, which, when correctly interpreted,
can assist health personnel in deciding
whether or not the patient is comfortably
coping with the situation and responding to
treatment.
It is important for a nurse to verify with the
patient her perceptions of his behavior (the
meaning she gives to his action). Through
verification, a more accurate assessment of
the meaning behind the patient's behavior can
be made and the nurse can then take
appropriate action,
Individuals tend to interpret the behavior
of others according to their personal
orientation, including past experiences,
culture, age and sex. These interpretations
may be incorrect because our perceptions are
highly personalized and therefore sometimes
incongruous. The care resulting from our
personal interpretations of behavior may be
inappropriate.
For example, a patient is lying on a
stretcher in emergency; his condition is stable
and he is waiting to be transferred to a ward. A
nurse notices his hand grip tighten on the side
rail. Her interpretation of this behavior may be
that the patient is concerned about his
prognosis and his admission to hospital, The
nurse says "Don't worry. Everything will be all
right." She is reassuring the patient according
to her own preconceptions and personal
interpretation of his behavior, \f the nurse had
said "\ noticed your hand tighten. Is something
bothering you?" the patient may have
answered "I've just remembered that there
was $100.00 in the glove compartment of my
car." Here the action taken by the nurse to
relieve the source of his concern goes beyond
that of a stereotyped response.
It is often difficult to tell whether or not
effective psychological support has been
given to the patient. Minimal but significant
changes in the patient may be seen in such
behavioral cues as a more relaxed facial
expression or a decreased pulse rate.
"Everything will be all right," is an empty
phrase when it stands alone. It acts as a
panacea, preventing health personnel from
becoming involved with patients. It is used to
compensate for lack of time, or for hesitancy
due to feelings of discomfort or incompetence
when confronted by a patient's emotions and
anxieties. It may communicate an uncaring
attitude,
Similarly, it is impossible to alleviate
anxiety by saying "Don't worry." Such a
remark has no value. Unless a nurse knows
exactly what is worrying the patient, she
cannot know what will alleviate his specific
Concern. The patient may interpret such a
response as a rejection of any expression of a
problem or question and therefore the nurse
should attempt to find the source of the
anxiety.
Relatives and Friends
The emergency situation may also have a
strong impact on the relatives and friends of
the patient. Often they feel very helpless and
apprehensive. While the patient is receiving
treatment, relatives may wait anxiously in the
emergency waiting room. They require the
nurse's attention and may be supported by
simple, concise, and personal explanations of
the patient's condition and care. The quiet
relatives who wait patiently need as much
attention as those relatives who continually
demand reports.
Once the initial care has been given and
the patient's condition is stable, visitors may
be brought to the bedside. It is often
encouraging to the patient to have relatives
with him. Visitors may benefit from closeness
to the patient and from seeing for themselves
what is going on. Hysterical relatives will be of
questionable benefit to the patient Health
22
The Canedlen Nurse July 1976
personnel should assess each situation
individually according to the amount of support
relatives will be able to give the patient.
The patient's appearance (for example, if
he has sustained a facial injury in a car
accident), his general condition, and the
reason for unfamiliar equipment should be
explained to relatives before they visit. Health
personnel too often take for granted that
equipment familiar to them is also familiar to
the public. A simple intravenous may be very
alarming to uninitiated relatives. Relatives and
patients often hesitate to question the staff
because they appear busy. Health personnel
should take the initiative to encourage
questions.
The patient's condition may be both
unnerving and anxiety-provoking to his
relatives. They may feel very uncomfortable if
left alone with the patient, because of his
illness and the possibility of change in his
physical condition. If the patient's condition is
such that he can be left alone with his visitors,
they should be asked whether or not they
would like the nurse to stay.
An accurate interpretaton of the verbal
and nonverbal cues expressed by relatives is
no less important to the nurse than her
perception of the patient's behavioral cues.
Relatives should be included as an integral
part of the total care of the patient. If the
relatives are neglected, then an essential part
of the patient's care has been overlooked,
The Emergency Nurse
A nurse's behavior conveys meaning to
both patient and relatives. Facial expression,
clinical dexterity, and tone of voice are only a
few cues open to interpretation by others. A
nurse should be constantly aware of how her
own behavior is perceived by patients and
relatives. If patients or relatives never
approach or question a specific nurse,
perhaps it is because her behavior is
conveying to them that she is either too busy or
not sufficiently interested to talk to them.
The behavior of a nurse may be a
reflection of certain attitudes, and each nurse
ought to be aware of her attitudes and how
they affect her care of patients. The individual
prejudices of a nurse against alcohol abuse,
for example, may predispose her to neglect
the emotional support of many emergency
patients. A nurse working in a critical care area
must also be able to support dying patients
and their relatives. If she finds the subject of
death personally threatening, she may avoid a
very important aspect of patient care.
Continual self-evaluation of attitudes and
reflected behavior is necessary.
Summary
Psychological care should be integrated
with physical care even when one worl<s in a
busy 'acute care' environment, be it an
emergency department, an intensive care unit,
or at the roadside as a member of the
atnbulance team. The quality of care is
enhanced by awareness of psychological
needs. _
Initially a conscious effort is needed to
remember to have cues verified and to be
open to noting subtle changes in behavior. If a
continuous effort is made by each health team
member, this verification process will become
automatic without being time-consuming.
All members of the health team must be
aware that they are individuals with a
multiplicity of factors affecting their thinking,
feeling and behavior. They care for individuals
who are also unique. A form of support proving
successful with one patient may not be
effective with another. Each patient must be
assessed as an individual before appropriate
psyChological care can be effectively given. By
being open to cues given by the patient and his
relatives, and by having perceptions of these
cues verified, an important step is taken in
deciding on appropriate psychological care.
With an increased awareness of the total
psychological impact of the 'emergency'
situation on the patient, his relatives - in fact,
on the entire health team - individualized
patient care will be administered in a more
thorough and understanding way.
* Case Study
It was 10 p.m. one Sunday evening in
February. A chaotic day in the Emergency
Department of a large general hospital was
drawing to a close and the pace was
somewhat subdued.
I was tidying up the Emergency
Resuscitation Room. The last patient had
recently been transferred to a ward. My
attention was suddenly drawn to the door as
the orderly brought in a gentleman, slumped
over in a wheelchair. The patient was
obviously fatigued and in considerable
distress. I introduced myself to him. As he
raised his head I recognized him as Mr. J., a
47-year-old patient we had treated a year
before for a severe myocardial infarction.
The patient repeated my name once and
then let his head fall again. I noticed that hiS:
color was grayish, his skin cold, clammy and
diaphoretic. He appeared to be in cardiac
difficulty. Mr. J. was helped onto the stretcher, I
and dressed in a gown. While the orderly went
to get the doctor, the patient was given oxygen
by mask. Cardiac monitoring was established,
his vital signs were taken and an IV of 5
percent D/W was started.
Mr. J. complained of severe chest pain
radiating down both arms. His arms were
tender and he withdrew them immediately
when they were touched.
To relieve his chest pain, the doctor gave
IV morphine in small doses ranging from 2 - 5
mgms over a 1-hour period. A total of 20 mgms
was administered, before his pain was
somewhat eased.
Once treatment had been initiated, I went
to the waiting room to talk to his wife. who had
brought him to the hospital. She was sitting
alone, quietly, smoking a cigarette. No one
had yet spoken to her. I sat down beside her
and said that her husband was a very sick
man, but that his condition was stabilizing and
his chest pain was easing. I also told her what
was being done for him. I asked her if she
would like to visit him, as it seemed to me she
would not be likely to ask to see him. She
appeared most grateful.
Mr. and Mrs. J. said nothmg to each other,
as Mrs. J. entered the room. Mr. J. opened his
eyes momentarily to acknowledge his wife's
Th. Can.dl.n Nurs.
-
-
.
July 1976
23
esence but closed them again, his arms It was not until they thanked me that I realized
ostrate at his sides. When his wife tried to the importance of this support and dialogue to
Id his hand. Mr. J, asked her noUo touch him both of them.
cause of the pain. Mrs. J. remained silently Another individual in a similar
Jated at the bedside and I remained in the physiological state to that of Mr, J. might have
)Om with them. required a great deal of verbal support and
Approximately one hour after admission reassurance, Mr. J, had given me behavioral
I the Emergency Department, Mr. J.'s cues to guide my approach. He kept his eyes
I :>ndition was relatively stable. The cardiac closed, withdrew his arms from touch and did
10nitor indicated some new cardiac damage not verbally communicate to anyone,
, Id I watched it closely for further changes. suggesting that a silent approach would be
is VIS were stable at 136/96, pulse 86. most supportive. Apparently, it was.
Ixygen therapy was continued. An IV was Nurses in emergency rarely obtain the
mning to keep the vein open for possible kind of feedback that allows them to see how
dministration of medication. Soon, his wife successful their support is. Such feedback
turned to the waiting room to have a reinforces the theory that emotional support in
Igarette. I stayed with Mr. J.. who remained the appropriate form is truly an essential part of .
'.'.'.'.
ry still and gave no indication that he wanted our nursing care. ".: -:.:. .... . . . . .
) talk, move, or be spoken to. Periodically' .... . ......
liped his face with a damp cloth and checked Wendy McKnight (R.N., Ottawa Civic . 1 :::::: :::::: :::: . = . = . = .. :: . .: . :: . . . :. . .. . :. . .
lis vital signs. Hospital; B.N., McGill University) currently . .'. ............ ....
Two hours after he was brought to teaches nursing at Queen's University. After .-::::::: '::::::::::: :::: :.:.:.:-:.:.:-:.
I mergenc y Mr. J. was transferred to CCU. graduation, the author worked in the .-:-:-:-:-:'. :-:-:-:-:-:. '.:. . ..:.:.:.' '.: :.:
'hreeweeks later, he was ready to go home. I Emergency Department at the Ottawa Civic . .............. ........ .............. ... . ....
Ilet Mr. and Mrs. J. as he was being Hospital where she developed a strong . . ......::: ::::$:
::::::' ::: .
:.:..;
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. said that m y P resence with him in emer g enc yp atients.Sheintendstoreturnto" .............. . ...... .......................... .
I:mergency "had made the difference McGill this fall for graduate studies, clinically ',' :':':':':.:..:. '.:.::-:-: -:.:- :-:-:
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letween night and day." specializing in emergency nursing. . . . . . . . . . . . . :? . .
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Bibliography
1 FranCIS, Gloria M. Promoting psychologIcal
comfort. by... and Barbara Munjas. Dubuque, Iowa,
Brown. 1969.
2 Johnson, Margaret Anne, Developing the art
of understanding. New York, Springer, 1967.
3 Lewis, Garland K Nurse-patient
communication. 2 ed. Dubuque, Iowa, Brown, 1973.
4 McCaffery, Margo, Nursing management of
the patient with pain. Toronto, Lippincott, 1972.
5 Robi"lson, Lisa, Psychological aspects of the
care of hospitalIzed patients. 2ed. Philadelphia,
DavIs, 1972.
24
The Canadian Nurse Julv 1976
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For a small child, there's nothing quite so
traumatic as suddenly finding himself
hospitalized. Most hospitals do
everything possible to alleviate the
devastating experience of even a
temporary separation from home and
family. But health professionals will be
among the first to admit that it isn't easy to
convince a sick, lonely child he is among
people whose one concem is to get him
better as fast as they can!
Western King's Memorial is a small
rural hospital in Berwick County, Nova
Scotia but its limited size hasn't stopped it
from being highly progressive. One of its
most successful and innovative programs
is a tour especially designed for primary
school children. The results have been so
impressive that many medical people and
educators in Nova Scotia are anxious to
see it become an accepted part of the
province's early education program.
It all started about two years ago
when a registered nurse on W.K.M. 's staff
had an idea. It occurred to her that
children visit all kinds of places like
newspaper plants, bakeries and fire
stations on tours organized by their
schools. Hospitals, however, are seldom,
if ever, included in these trips. She knew
some children's hospitals encourage
visits prior to scheduled admissions but in
an emergency there is no lime for
orientation or education. So, she
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TlW Qlnadl8n Nurse .July 19711
25
'Suggested to Yvonne Nichols, the
Director of Nurses at Westem King's that
the hospital offer tours for children in the
area. The Director remembered a story
one of her nurses had told her. The
woman's little boy had just been
discharged from hospital and she'd given
him an affectionate hug. To her surprise,
he looked sadly into her eyes and said, "If
you really love me Mommy, why did you
ever put me in that place?"
The program got underway in 1974,
and, since then, nearly 400 children have
visited the hospital where kids get V.I.P.
treatment. The Director of Nurses or one
of her staff is waiting to greet the children
when they arrive and a lot of time is soent
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finding out what preconceived ideas they
have about hospitals. Many children have
very serious misconceptions. One little
boy's first question was, "Hey, nurse
where do you keep all the dead bodies?"
Once the children have run out of
questions, they visit the lab where they
are introduced to a white-coated
technician. The purpose of the room is
explained in very simple terms and
they're told about the blood tests doctors
order for their patients, Children are
asked to volunteer to have a finger
pricked and invariably, several little gir1s
are the firstto comply. (Boys soon follow).
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The understanding is that vo1unteers will
be the first to see their blood under a
microscope. Interestingly enough, not
one volunteer, male or female, has ever
shed a tear,
Next comes the x-ray department
and a simplified explanation of
procedures, Eact> of the children is invited
to climb up on the x-ray table to pretend
they're having a picture taken. The
importance of keeping perfectly still so
the technician gets a good x-ray the first
time is stressed.
X-ray films of skulls, hands and
chests are shown to the children who are
invariably impressed by this glimpse of
the workings of their bodies.
Hospital laundries, although
important, tend to be taken for granted.
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16
The canadian Nurse July 1976
This is not the case at Western King's
where the laundry staff look forward to
visits of the school children. The children
meet each staff member, and are shown
the huge machines that churn through
tons of dirty hospital linen.
Next comes what is often the
highlight of the entire tour. With a little
luck, there is a brand new baby in the
nursery. Standing on benches, in front of
the nursery's glass windows, they watch
as a nurse undresses the infant and
shows them the umbilical cord. Most
children can't wait to get home to tell their
parents about what a little baby's "belly
button" looks like!
In the pediatric ward, the group
meets other children who are hospital
patients. They talk to them, see
-
youngsters in croupettes and spend
some time in the playroom where
convalescing children watch television or
play games, Nurses in this department
make a point of taking the temperature,
pulse, respirations and blood pressure of
several children. And a nurse dressed in
operating room garb drops by to chat
about operations. She explains the
reasons why it's necessary to wear
masks and gowns and then invites the
children to have a short ride on a
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stretcher. The kids climb on board and
groups of six or more giggling boys and
girls have a happy ride down a hospital
corridor.
At the end of the tour, each child
receives a cartoon drawing of a nurse to
take home and color. Back at school, the
children are asked to illustrate their
impressions of the tour. Sometimes, the
laundry room is the favorite part of the
visit; often it's the new baby, but
invariably, the children draw happy,
smiling faces. Child psychologists who've
seen the drawings have also noted that
the children and the hospital personnel
are usually pictured as being about the
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same size or else in the same proportions
as in real life. This finding is surprising
and significant in the light of the fact that
children in hospitals tend to draw
themselves as very small figures while
doctors and nurses loom large and very
ominous. There are other benefits to the
hospital tour. Other children in the family
are exposed to the enthusiasm of their
brothers and sisters and absorb some of
the very positive reactions.
Some "graduates" of the tour have
since been admitted to Western King's.
Has their reaction differed from other
youngsters? One mother of a little boy
diagnosed as having leukemia told the
hospital staff she was amazed at her
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The Canadian Nurse July 1976
son's attitude! "I'm quite sure from the
way he talked about having to go to the
hospital that the tour had a great deal to
do with his lack of apprehension about
being a patient there." No hospital tour
can completely dispel a child's fears but
one of the worst things we can do is to
ignore their existence in the hope our
children never have to be admitted to one.
Western King's Memorial has taken
an important step towards convincing
children that hospitals really do care and
children are tremendously responsive to
this knowledge. Ask Yvonne Nichols and
shell tell you about the number of little
ones who come to her just before they
leave so they can give her a kiss. She and
her staff have become the children's
friends and the hospital represents an
extension of their warmth. It's a good way
to begin any relationship
(,' f1/
--
.
...
27
Dorothy Grant is a graduate of Halifax
Infirmary school of nursmg who has
worked as a Tree-lance writer and
broadcaster for the past nine years. She
is a frequent contributor to cac radio and
television, for both regional and national
networks. Since 1974, she has taken a
special interest in consumer-oriented
reporting and acts as Nova Scotia
representative for the cac program
"Marketplace. "
She points out that the children's tour
described in this article has inspired
plans to implement a similar program at
The Izaak Walton Killam Hospital for
Children in Halifax.
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CLINICAL PROTOCOLS: A Guide
for Nurses and Physicians
Designed for portability and quick reference in the
field, this manual of clinical guidelines fits conveniently
into the pocket of a lab coat. The protocols themselves are
divided between acute problems and chronic diseases, The
acute problems are based on the most common presenting
complaints seen in the ambulatory adult care setting; and
the chronic disease protocols include those conditions most
often followed by the nurse practitioner in a continuing
care clinic. The authors define an appropriate data base for
the common acute problems as well as the chronic illnesses
which nurse practitioners may be managing. Presented in a
problem-oriented framework, the protocal material outlines
both subjective and objective data and includes diagnostic,
therapeutic and patient education aspects of the plan. The
rationale for each piece of data is presented in the same
sequence as the worksheet items,
By Carolyn M. Hudak, R.N., M.s.; et 01.
Lippincott
461 Pages
1976
$8.75
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EMERGENCY-ROOM CARE,
3rd Edition.
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A new edition of a favorite textbook brings together
the expertise of 29 specialists in all aspects of emergency
care. Clear and concise text and accompanying illustrations
direct the clinician in the rapid setting of priorities and
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memory devices is discussed, as well as immediate and
thorough assessment of incoming cases and coordinated
emergency-care response that must often succeed in
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Edited by Charles Eckert, M.D. By 29 authors.
Little, Brown
Paper, $12.50
480 Pages
Illustrated 1976
Cloth, $17.50
.
rlmar
AMBULATORY CARE MANUAL
FOR NURSE PRACTITIONERS
Written expressly for the nurse practitioner, this
text covers the diagnosis and treatment of commonly seen
conditions in adults. The student is taught to interpret
signs and symptoms on the basis of history, physical exam,
and lab findings; formulate a diagnosis; and treat the
patient or (if indicated) refer him to a practitioner with
special expertise.
Individual' chapters, except for the introductory
material, cover conditions of all body systems that are
commonly seen in the ambulatory care setting. Discussion
of each condition includes history, physical exam findings,
lab data, treatment, complications, and follow-up. Each
chapter has an extensive section on the pharmacology
of medications commonly used in treatment. Throughout,
the authors present guidelines for determining boundaries
of treatment.
At the end of each chapter is a superb divice for
clinical problem-solving, a two-part section entitled Self-
Assessment. The first part consists of a series of cases in
which the stúdent is asked to analyze the data, and form-
mulate a diagnosis and a plan of management. The second
part consists of detailed discussions of each case to enable
the student to test her diagnostis skills.
Most chapters have diagnostic flow charts that
give direct assistance in decision-making. Much of the
material has been summarized in tabular form for quick
reference. The book has about 60 illustrations, half-tone
and line. Two-color format is used where helpful.
By Peter T. Capell, M.D., and David B. Case, M.D.
Lippincott
Abt. 400 Pages
1976
Abt. $12.50
DYNAMICS OF PROBLEM
ORIENTED APPROACHES
As problem-oriented approaches are applied to their
full potential, they offer the nurse an opportunity to:
identify patients' problems so that goals can be set, prior-
ities assigned, preventive measures taken, and care given;
examine patient problems in isolation or in combination;
maintain continuity of observations, judgments, and goals
throughout a sequence of time; rapidly retrieve significant
data which facilitates communication with other disci-
plines; and establish a base for research into patient and
nursing problems.
Presented in three sections, the book illustrates
the potential growth, development, and influence of the
problem-oriented process. Discussion of the concepts
and theories related to problem-oriented recording and the
problem-oriented approach in the first section is followed
and augmented by the section on implementation. Aspects
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care.
such as preparation, education, implementation, charting
and evaluation, are dealt with in each chapter in this
section. The third section is concerned with the effect of
the problem-oriented approach on future nursing practice.
By Judith Walter, R.N., M.N., Geraldine P. Pardee, R.N.,
M.S., and Doris M. Molbo, R.N" M.A.
Lippincott
225 Pages
1976
Abt. $ 7.50
HE PRACTICE OF EMERGENCY NURSING
Practical guidelines in this comprehensive new book
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Emphasized is the emergency nurse's need to acquire
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are stressed, as is the need for teamwork, based on a col-
league relationship between physician and nurse.
By James H. Cosgriff, Jr., M.D., F.A.C.S., and Diann Laden,
R.N., M.N.; with 31 contributors.
Lippincott
1975
$15.75
488 Pages
Illustrated
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HOW TO COLLECT
AND RECORD
A HE L TI-' . ECORD
This is a unique primary health care book that fits
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at any stage of the client's development. Use of this format
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retrievable, reduces the need for multiple, repetitive inter-
views, and affords greater consistency in data collection
and recording. This Health History promotes a comprehen-
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for establishing an environment conducive to effective
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Numerous examples demonstrating effective practitioner-
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how to help the client verbalize his concerns; how to use
directive and non-directive techniques; and how to record
the data using the client's words.
By Elizabeth Anne Mahoney, R.N.
Lippincott
$3.95
Approx. 150 Pages
1976
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30
The Canadian Nurae July 1976
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Nursing is a profession that attracts many idealists. In schools
of nursing these ideals are reinforced as students learn that good
patient care involves meeting the patient's emotional needs as
well as his physical needs. Yet, many students come out of
training to find that they must compromise their high ideals to stay
in line with the realities of hospital economics. In her book, Reality
Shock, Marlene Kramer describes this period as one of great
inner conflict and concludes that the tide of nurses leaving the
profession or job-hopping could be abated if students were
prepared in school to meet the reality of the working situation.
Here, one student describes her reaction to reality shock.
ù
o
At the time of writing. Jocelyn Harper was
a second year nursing student at
Algonquin College School of Nursing,
Vanier Campus, in Ottawa. She wrote this
paper after completing a clinical project
at an Ottawa hospital and says that
bringing her thoughts and conflicts out in
the open helped to stimulate discussion
with teachers and other students. The
paper was later used to provide food for
thought during a faculty-staff
development day. The author would like
to acknowledge the help and support of
her clinical instructor, Linda Stafford.
Jocelyn Harper
"Graduation from a nursing school and
induction into employment in a hospital
is... a period of great conflict. It is at this
time that the professional ideals stressed
in school confront the bureaucratic
principles that operate in the hospital... "I
Marlene Kramer points out that this
period of conflict, when the new graduate
tries to put her ideals into practice within
the structure of hospital administration, is
a universal phenomenon. I do not doubt
the universality of it. But, while the conflict
is universal and the results can be
categorized under such headings as
hostility, aggression, fatigue and illness,
the effects on the individual nurse are
intensely personal. Each of us must deal
with this inner struggle in our own way.
My way includes the writing of this
article and I have done so far a number of
reasons: partiy to vent frustrations; partiy
so that students who feel the same way I
do will be able to identify the problem; but
mostly in the hope that teachers will
realize that reality shock exists and is not
just an academic theory and, in light of
thIs realization, make the appropriate
curriculum changes to prepare nursing
students for reality now.
Theory vs. practice
We all know that what is said in
theory and what is really done are not
always the same, This happens in any
job. In sChool you learn how it's supposed
to be; on the job you learn the way you, or
your boss, find it works best. Usually,
slight changes are made to ensure that
things operate smoothly while still
following most of the important principles.
Such a discrepancy between the ideal
way of doing things and the expedient
way is fine when you are dealing with
numbers and letters, but there are
important differences between nursing
and other jobs. For example, when I
worked in a bank, on an extremely busy
day, most of us had to keep more than
$2,000 in our cash drawers even though
this was against the rules. The effect on
me - I worried occasionally. If I got
robbed I would be In trouble, but I didn't
feel very guilty about it. Now, take a
similar example from nursing. On a busy
day, a nurse might have six patients, four
of them bedndder At.
er tJ of the day
she thinks, "0'1 I < "e'l turned Mr.
S. four times, not once. _ d I now Mrs. K.
needed to talk to someone, and I
should have taught Mr H about
such-and-such r- -lea ling, not just
with money, but Witt, rE I people. They
are sick, they depend on her, and she
knows it. The feeling you get when you
have failed to meet the needs of a person
who depends on you is quite different
from the feeling you get knowing you
have failed to follow some rule
conceming money. At the same time, the
The Canadien Nurse July 1976
reality of what you can do on a busy ward,
and the ideal you learn in class (what you
feel you should do) are also quite
different.
How do we encounter the reality?
What forces in the hospital work towards
changing our ideals and habits? They
come in all forms. Physicians, other
nurses and nurses' aides are usually
more than willing to help the new nurse
orientate herself to the hospital routine.
But this orientation more often than not
involves cutting corners in the emotional
care of the patient, while stressing
technical care and getting through the
"work" in the time allotted. The attitudes
of head nurses support this; "temps and
treatments" are their main concerns.
Co-workers can also shape new habits:
by simply not responding to suggestions
which are too idealistic and
school-bookish; by assigning the new
nurse to areas where she works fast and
efficiently; and by limiting their questions
and comments to the basics. After you
leave nursing school, you rarely hear
about patient care plans anymore.
Suddenly, we find that no one has
given us any preparation for the reality of
our first job. No one has told us it is
physically impossible to do what we were
taught and feel is our responsibility to do,
and at the same time please our
supervisor and keep our job,
When we have to take seven or eight
patients each, we have about one hour
per patient. In the classroom, we are
generally taught as if we have one or two
patients and a hospital administration that
cares more about patients than about
time, organization, and money. Sounds
like an ideal situation, a fairy tale. If you
expect it to be reality, however, you're in
for a shock. Your reaction, if you are like
those who have gone before you, will be
intense inner conflict. This will probably
result in exhaustion until you have solved
it. Perhaps you will try to fight for awhile,
try to change the ward, attitudes, faulty
procedures. However, this is a totally new
situation for you, You have had no
training in how to deal with it, no
anticipatory guidance, and consequently
you will probably have no viable ideas
about how to deal with it.
Having failed to resolve the conflict
this way, you will probably rationalize and
join those nurses you couldn't understand
before. Or, you may try to keep your
ideals and job-hop from one place to
another searching for a more ideal
setting. As both surveys and common
sense will tell you, your job satisfaction
will be very low. You can always leave
your job, and many do, or you can go back
to school for a few years where your
ideals will be reinforced. In one study, out
of 218 nurses, 116 remained in hospital
nursing, 16 went to community health, 15
31
went to non-nursing jobs, 36 went back to
school, 21 quit working because of job
dissatisfaction, and 14 turned to raising
families,2
What can be done to improve the job
satisfaction of new nurses? We need
more real-life teaching in our schools. As
it is now, we are taught the one and only
correct way of doing a procedure rather
than several practical and correct ways of
doing the same procedure. We need to be
able to assess priorities and ways to
compromise in various situations.
The reality...
In everyday life, you see many
examples of instances where basic
principles of quality care are notfollowed,
where the needs of the patient are not
fully met by the health care providers
involved - whether the procedure is
asepsis or verbal communication, Think
about it. How often have you, as a nurse,
observed one or more of the following:
1. An ambulance attendant is not notified
by the doctor involved in the case that a
patient he has brought in to the hospital
has been diagnosed as having a
contagious disease. The doctor
comments in a facetious manner "could
be smallpox."
2. An elderly lady with psychiatric
problems is ignored when she complains
about having her possessions stolen. The
nurses do not attempt to point out her
wallet (or whatever) on the dresser but
speak rudely to her and tend to ignore her
bell.
3. A young patient in traction says he
doesn't need a backrub. Most of the
nurses on the floor accept his statement
at face value. One nurse takes the time to
talk to him about the necessity of
preventing bedsores and finds, on
commencing a backrub, a reddened area
near his coccyx.
4. A confused, elderly lady becomes the
subject of much hilarity as nurses "try to
get a milkshake down her." While she
moans and groans, nurses from all over
the floor take part in the fun through the
intercom system as if she isn't there; even
the orderlies join in,
By putting the "realities" of hospital
work into focus, I hope to make it harder
for all of us new graduates to appease our
consciences and rationalize any
questionable techniques we use, Next
time you see rules being broken or are
tempted to do it yourself, for whatever
reason, think back and know that you are
not alone, and that we are all having the
same conflicts."
References
1 Kramer, Marlene. Reality Shock. Saint
LOUIS, C.V. Mosby Co., 1974. p. 19,
2 Ibid., p. 29.
32
The Canedian Nurse JulV 1976
SLEEPLESSNESS-
GiN
YOU
ELPI
Sister Loretta Gillis
"If the matter is one that can be settled by observation, make
the observation yourself. Aristotle could have avoided the mistake
of thinking that women have fewer teeth than men, by the simple device
of asking Mrs, Aristotle to keep her mouth opened while he counted.
He did not do so because he thought he knew, Thinking you know when
in fact you don't is a fatal mistake to which we are all prone. "1
Automatic vs. deliberative
nu rsing activity
Too often, nurses make hurried and
stereotyped assessments about patient
behavior on the basis of "past
experience." Frequently, the present
situation is not fully explored and the
meaning of the behavior is, therefore, not
understood. Thus, the need expressed by
the behavior remains unmet. One patient
behavior that nurses deal with constantly
regardless of the specific illness category
- medical, surgical, psychiatric - is
difficulty In sleeping. This universal .
problem taxes the creativity and expertise
of all health workers.
How does the nurse respond to this
problem? Does it matter how the nurse
approaches the patient? Can it be shown
specifically that what the nurse does for
her patient significantly influences the
patient's ability to sleep? To help find
answers to these questions, a study was
conducted to observe the effects of
deliberative nursing activities on patients'
inability to sleep.
For the purposes of the study, a
distinction was made between
deliberative and automatic nursing
activity. Deliberative nursing activity was
defined as follows:
1 The nurse observes the patient's
appearance and behavior.
2 The nurse ascertains the specific
meaning of the patient's behavior by
exploring her observations with him.
3 The nurse determines whether or
not the patient is in distress.
4 If the patient is in distress, the nurse
finds out what activity is needed to relieve
it.
5 The nurse carries out this activity to
improve the patient's initial behavior and
relieve the distress.
6 The nurse evaluates the effect of
her activity by observing the patient's
verbal and nonverbal behavior,
7 If the patient is not relieved of his
distress, the nurse repeats the same
process again until the patient is relieved.
Any nursing activity which did not
fulfil the above conditions of the
deliberative process was defined as
automatic nursing activity.
The study was conducted on one
medical and two surgical units of a small
general hospital between the hours of
12:00 a,m. and 4:00 a.m. The sample
population included all patients who
summoned help by ringing the call light.
This activity was rega rded as an
indication of inability to sleep and a signal
for help from the nurse. The patients in the
sample population were randomly divided
into a control group and an experimental
group by alternating the response to the
call light. The staff nurse answered the
first call light, the investigator the second,
and this procedure was continued
throughout the hours of the study.
The patients in the control group, a
total of ten, were cared for by the staff
nurse. The nine alternate patients, made
up the experimental group and were
cared for by the investigator who used the
deliberative process in all cases. In order
to determine if there was any relationship
between the type of nursing activity and
rehef from sleeplessness, the following
data were examined:
1 observation of the patient when the
nurse entered the patient's room after the
call light sounded
2 the activity of the nurse in response
to the patient's complaints of
sleeplessness
3 the results of the activity on the
patient.
Records of nurse-patient interactions
were kept for both experimental and
control patients and the data were
analyzed to determine whether a
deliberative or automatic nursing process
was used. Patients involved in the study
were checked at half-hour intervals for
one hour following nursing intervention to
determine whether or not they were
sleeping. One example of an interaction
which took place between nurse and
patient is indicated in Table 1. This
incident illustrates the approach used with
patients in the expenmental group. Step
by step, the nurse observed and verified
the patient's needs and was able to
respond specifically to these so that the Þ
II
I
The Canadian Nurse July 1978
33
Table 1
Experimental Group
Name: Mrs. D.
DiagnosIS: Cholecystectomy
MedicallOn given - None
Observation of the patient when nurse entered room in response to call light being
sounded
Patient lying In bed with buzzer still in her hand, looking up at LV. bottle.
Nurse-Patient Interaction
Patient behavior (verbal and non-verbal)
Patient looking up at LV. bottle,
grimacing
"Yes," she said, "I am. You know I was
just to the operating room today and they
still have these tubes in. , got so
frightened when I awoke and saw them."
'Would you please? The last time I had
so much trouble because of the catheter.
I think it was an infection and I am so
worried that it will happen again."
'" was very worried but now I can relax
since you checked them."
"Could you nurse? I am so scared to move
with all these tubes that it's very
difficult to get comfortable."
"Oh no, I feel so good now I think
I will get right back to sleep. Will
you be around if I need something
later onT
"Thank you nurse. That's a big relief."
Need of Patient
Nurse said or did
"You look like you are worried over the LV.
Is that right?"
"Do you mean you are wondering if they are
all working alright? Would you like me to
check them?"
I checked the LV., Levine tube and
catheter. All were working perfectly.
I said. "The tubes are all running perfectly;
do you feel better about it now?"
"You do look mOre relaxed now but you still
look warm and uncomfortable. Do you think
it might help if I sponged you off and
rubbed your back?"
Sponged her off, rubbed her back and made
her comfortable in bed. "You look like
you are ready to sleep now, but I am
wondering if you would like your pain
medication before I leave you."
"Sure I will, and remember we will watch
the tubes while you sleep so you need not
worry."
To have someone check the tubes and tell her they were working alright.
To be positioned comfortably in bed.
Activity of the nurse:
Checked the tubes for proper functioning, told patient they were working properly.
Positioned patient comfortably in bed.
Results of activity immediate:
." feel so good now. I think I will get right back to sleep."
"That's a big relief."
'/2 hour - Asleep, eyes closed No response to name called.
1 hour - Still asleep.
.
. Example 01 Form Oeslgned by the Investigator lor the CollectIon of Oata
(Data Included on the form IS on Expenmenral and Control Group Patients)
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34
The Canadian Nurse July 1976
patient was able to sleep even without the
aid of medication. The investigator found
that when these specific needs were met
only two patients required medication for
sleep
A typical interaction between a staff
nurse and a patient in the control group is
shown in Table 2. Observation of what
transpired in the control group
demonstrated that patients' complaints
of inability to sleep were considered to be
indications for giving medication.
Results
When the meaning of the patient's
inability to sleep was not determined by
the nurse, the patient did not experience
relief from sleeplessness even when
medication was given. All ten patients in
the control group received medication,
Three of the ten patients were relieved
and slept but the other seven patients
were still unable to sleep.
In the experimental group where the
deliberative process was used to
determine the specific meaning of the
patient's inability to sleep, seven of the
nine patients did not need medication and
were able to sleep. The two patients who
were given medication did not appear to
be helped until other comfort measures
were also carried out. One of these two
patients, a 13cyear-old girl who had had a
tonsillectomy, was not relieved of a sore
throat by Tylenol, even though both
investigator and patient expected that this
drug would provide relief. The patient was
still restless and uncomfortable until she
was given a mouth rinse and helped into a
comfortable position. The other patient
was a 40-year-old mother of four children
who, three days previously had been
involved in an accident in which she
sustained a fractured hip. fractured
vertebrae, multiple bruises and
abrasions. She expressed severe pain
and was given Pantopon 20 mgm. Relief
by medication was not obtained until she
was given a sponge bath, made
comfortable in bed and given an
opportunity to verbalize her feelings about
the accident. (She expressed guilt
feelings about leaving four small children
without a mother for an indefinite period of
time).
Records of nurse-patient interaction
show that only three patients from the
control group and three patients from the
expenmental group asked directly for
medication to help them sleep, but, all ten
patients in the control group were given
medication. Only two patients in the
experimental group were given
medication.
Table 2
Control Group
Medication given - Demerol 50 mgs
Name: Mrs. F.
Diagnosis' Post-cholecystectomy
Observation when nurse entered room:
Patient lying in bed, asking for something to help her sleep.
Nurse-Patient Interaction
Patient Behavior (verbal and non-verbal) Nurse said or did
Lying in bed, eyes open, saying, "Can
I have something to help me sleep?"
"Yes, but I stili can't sleep and the
pain is killing me."
Need of patient
?
Activity of the nurse:
Gave medication
Nurse said. "You know you had your
sleeping pill already."
"Well, perhaps we can get you something
then." Nurse left her, checked chart and
got Demerol, 50 mgs ready. Came back
and gave it to her saying, "This will
help you," then left her.
Results of activity immediate:
Still lying on back - hands clenched as if in pain.
'12 hour - Awake - eyes open, responded when name was called
Conclusion
The results of this study indicate that
patients' complaints of inability to sleep
are indications of distress which are not
necessarily relieved by medication. The
complaint needs to be explored by the
nurse until sufficient information is
obtained to determine the specific
response needed to relieve
sleeplessness. In this study 01 19
patients, it would appear that nurses tend
to give medications to relieve patients'
inability to sleep even when they do not
ask directly for medication.
The study is not meant to question
the value of medication as a remedy for
sleeplessness, provided that the patient's
need for medication is validated, and the
medication does, in fact, relieve his
inability to sleep. When the nurse
automatically assumes that the patient
needs medication, or when she assumes
the patient needs only medication, she is
not responding to the specific cause of
sleeplessness and hence not offering the
patient an effective remedy.
References
1 Russell, Bertrand, Unpopular Essays.
New York, Simon and Schuster, 1966. p. 103.
Bibliography
Dumas, Rhetaugh Graves, Psychological
preparation for surgery. Amer. J. Nurs.
63:8:52-55, Aug. 1963.
Dye, Mary, Clarifying patients'
communications. Amer. J. Nurs. 63:8:56-59,
Aug. 1963.
Elder, Ruth G., What is the patient saYing?
Nurs. Forum 2:1 :24-37, Jan. 1963.
Frances, Gloria M., How do I feel about myself?
Amer. J. Nurs. 67:6:1244 - 1245, Jun. 1967.
Orlando, Ida Jean, The dynamic nurse-patient
relationships: function, process and
principles. New York, Putnam's, 1961.
This artIcle is based on a study done by
Sister Loretta Gillis (R.N., St. Joseph's
Hospital School of Nursing, Glace Bay,
N.S.: B.Sc.N., University of Western
Ontario, London; MSc., Boston
University) entitled The Effect of an
Automatic and Deliberative Process of
Nursing Activity on Patient's Inability to
Sleep. It was written in partial fulfilment of
the requirements for a degree in Master
of SCIence in Nursing. Gillis presently has
a joint appointment at St. Francis Xavier
University and the Mental Health
Centre,both in Antigonish,N.S...
The Canadian Nurse July 1976
35
connC!ction
"_S. '*
Is there a nurse in the neighborhood?
Susan N. Steidl
In my ten years as an RN, I have come to realize
that nurses, like doctors, have our own form of being
"on call" twenty-four hours a day for emergencies.
Our patients are usually friends and neighbors. Our
emergencies can be anything from a missed birth
control pill to a feverish toddler at two o'clock in the
morning. The problems we are asked to solve most
often are not life-threatening but for the individuals
involved they do represent a real crisis.
As professionals, with the special education and
expertise of nurses, we have a marvelous
opportunity to share our knowledge with others. In
our daily contacts with people, there are countless
chances to teach correct first aid and home care, to
give emotional support in crises, and to interpret
doctor's instructions to families, That doesn't mean
that our "off duty" hours need to be entirely devoted
to these things. Emergencies don't all happen in the
same day. Sometimes, though, they do lead to some
interesting experiences, like the ones I remember
from my "off duty' hours in the past few years.
Mary is a seventeen-year-old neighbor who
often babysits for us. Her mother called one Sunday
morning and asked me to come and see her. She
had been having abdominal pain for several hours,
but her parents were uncertain what to do about It.
When I arrived, I found Mary pale and apprehensive,
lying on the sofa. Automatically I checked her pulse
while I talked with her. It was strong, but slightly
rapid. Her pain was localized in the lower right
quadrant. As we talked, the pain became
increasingly severe. Trying not to alarm her parents,
I suggested that she should be examined by a
doctor. but time should not be wasted trying to locate
him by phone. The local life squad was there in a few
minutes and took her quickly to the hospital. several
miles away, where they diagnosed and treated her
problem. The final diagnosis was not, as I had
suspected, acute appendicitis but a kidney stone and
shock that sent Mary to the intensive care unit for two
days.
In my "spare time" I have been guilty not only of
calling ambulances, but of chasing them as well.
Another of my neighbor . George, slipped while
mowing a hill. The mower cut through his shoe and
severed three toes. I heard the life squad arrive and
raced for the scene of the accident. The attendants
placed my pale and diaphoretic friend in the
ambulance and took off quickly. Remembering my
emergency room training, I enlisted the help of my
husband (who has some first aid experience) and
found the amputated parts in some nearby brush. I
made a saline solution of salt, water, and ice, and, In
that. we rushed them to the hospital where the
doctors were able to use some of them for
reconstruction and grafting.
Health education is another important aspect of
my "off duty duties". Often, people have the wrong
impression of the right thing to do; even those who
know what to do are sometimes paralyzed by fear.
Once, a mother called me to see her little girl whose
fingers had been caught in a car door about an hour
before. The skin on two fingers had been broken and
the nails appeared to have taken the force of the
pressure. They were ecchymotic, with slight
bleeding from underneath, and some edema around
them. Sally, the child, had been crying from the pain.
Her fingers felt very warm and I asked her mother
what she had done for her since the accident She
had soaked the fingers in warm Epsom Salts. When
the nails discolored she had called a local doctor who
told her to release the pressure under the nails by
drilling a hole with a hot paper clip. She was afraid
and thought I might do this for her. I suggested that
first we elevate the hand on pillows and apply ice to
reduce the pain and swelling, In the meantime, the
mother was able to contact Sally's pediatrician who
sent her to the hospital for X-rays to rule out any
fractures. By the time we reached the hospital. the
edema and pain were much improved and there was
no need to pierce the nail.
In situations like these tact is crucial. I try to
tackle the immediate problem first and, later, talk
about what to do the next time. Judgment, scolding,
or ridicule only leads to guilt and embarassment. Not
all of my experiences end in tnps to the hospital.
Often I just answer questions that people feel
awkward asking their doctors - like what to feed a
child with the flu or could those funny red spots on
Johnny's back be Chicken Pox? If an injUry or illness
looks serious or requires more than basic first aid I
refer them to their physician,
One of my most challenging cases involved a
two-year-old male named Otto. About SIX inches tall
and two feet long, with short red hair, he IS a
Daschund belonging to the family next door. When
his tail got caught in a door, the tip was neatly
severed. My nearly hysterical neighbor called for
help. After speaking to the pup's veterinarian on the
phone, I administered a tranquilizer to my friend. a
little beer to the dog, and dressed what remair.ed of
the tail as you would a fingertip. The basic pri na pies
of first aid still applied, even in this case.
I enjoy my role as "neighborhood nurse"
perhaps because of my experience as an
emergency room nurse and first aId instructor. I am
always willing to help if a problem arises and the
people around me know this. The children have
learned that nurses don't always wear white
uniforms and carry a needle. The adults have
learned that members of the caring profession are
willing to share their expertise, even after five
o'clock. And me? I feel I reap the biggest benefits of
all, the satIsfaction that I have helped others. which is
why I became a nurse in the first place
Susan Nau Steidl lives in Lexmgton, OhIo and
is a graduate of the College of Nursing,
UniversIty of Florida , Gainesville, Florida. She
was co-author of an artIcle based on her
experience in pediatrics during her student
days and published in The Canadian Nurse
ten years ago. Now, she says '" am once
again turning my thoughts towards writmg for
publication after taking time out for marriage
and raising a family." ..
36
The Canadian Nursa July 1976
The Occupational Health NursE
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A survey of the existing qualified manpower pool reveals that
occupational health is still very much in its infancy in this country.
Right now, there are probably fewer than 2,000 nurses in the whole
of Canada who classify their job as that of occupational health nurse.
Nevertheless, for the nurse who does enter this field, there are, as
this author points out, many specific contributions she can make to
improve health and safety in the work environment.
The ea..dlan Nu..... July 1976
37
n the Work Environment
Miriam J. Hayman
When it has its full complement of members,
the occupational health team includes
representatives of four professions -a nurse,
doctor, industrial hygienist. and safety officer
In practice, the size of this team varies,
depending on the scope of the program being
conducted within a given industry, firm, Or
government agency and on the size of that
establishment. Most large national and
international companies have well developed
programs and employ qualified staff to
manage them. However, 85 - 90 percent of
Canadian industries employ fewer than 500
employees and it is not always financially
feasible for them to employ the entire team on
a full-time basis. Forthis reason, the role of the
nurse, as the professional most likely to be in
close and continuous contact with the workers
she IS employed to care for, is crucial to the
success of the occupational health program in
many industries. As one observer
commented: "Success in health programs
depends upon the ability of nurses not only to
work independently but also to bring in others
as needed to achieve continued good health
and safe working practices of employed
persons. "I
It is unfortunate, therefore, thaI at the
present time in Canada there is a definite
shortage of readily available nurses with
occupational health training and experience,
willing to accept this role in which treatment
assumes a back seat to prevention 2 and health
promotion activities. It is also unfortunate that
both health professionals and the general
public tend to view industrial health programs
as the nurse putting on Bandaids. and the
doctor doing medical examinations. Most of
the literature describes the basic occupational
health nurse's functions as: treatment,
counseling, health promotion and education
activities, screening programs, physical
assessments assessing illness absenteeism
and maintaining reports and records. Few
references can be found to the nurse's role in
relation to the work environment. Whether she
is working in a large industry with the full
occupational health team or a small company
with one nurse, how could any nurse expect to
function effectively without a good knowledge
and understanding of the conditions,
processes and problems affecting the
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On-the-Iob at the Richard L Hearn Generabng Plant
operated by Ontario Hydro, Maureen Townsend (opposIte
page) removes a splinter from the hand of one of the plant's
employees. Above, Nadine Franks (cover) learns more
about the eqUIpment at the plant where she works from the
project engineer.
31
The Canadien Nurse July 1976
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Protective devices and safety equipment are important
factors in reducing health hazards and both nurse
Townsend and her fellow worker above wear helmets,
safety glasses and hearing protectors.
.'
employee groups in the work locations?
What about the work environment? What
should the nurse be doing in this area and
why? To some extent her role depends on
what other members of the occupational
health team are available to work with her, but
regardless of this, the first thing she must do is
to make regular visits to all the work areas in
the plant. During these visits the nurse has an
opportunity to observe and learn many things
about what goes on in the work environment,
knowledge that will have a direct Impact on her
own effectiveness in dealing with health and
safety problems that the ill or injured employee
presents at the Occupational Health Unit.
There are many reasons for the nurse to visit
the work area. Eight of these reasons follow.
- 1 To become familiar with the body
mechanics required of each occupational
group - bending, lifting, kneeling, reaching,
standing, etc. This information is valuable in
appraising the cause of physical symptoms
but it is also necessary when assessing an
employee's fitness to return to work after an
illness or accident. Possibly the employee will
require a period of rehabilitation before
returning to his regular job.
2. To become familiar with the health
hazards that exist in the work area - solvents,
dusts, gases, noise, radiation, toxic
chemicals, etc. The nurse in this situation
must be aware of the body portals for the
various toxic substances as well as the
physical signs and symptoms of occupational
illness and disease. This essential information
facilitates earlier recognition of health
problems, enabling more prompt medical
treatment. It should generate a need for
inspection and evaluation of the problem at the
work site. Remedial action in the form of
improved control methods 3 should be the final
result.
3. To become aware of new processes as
they are developed and initiated. New
processes can mean new problems and an
alert nurse researches the possible toxic
agents in order to be prepared for potential
problems. Sometimes these problems can be
eliminated before the process becomes
operational.
4. To become familiar with the protective
devices and equipment used to prevent
Tha Canadian Nur.. July 11J78
39
illness or accidents. The nurse then can use
the pre-employment interview to encourage a
new employee to utilize all the protection
available, She can also reinforce the need to
use protection in her contacts with other
employees who sometimes tend to become
careless or over-confident.
S, To observe unsafe conditions and
unsafe practices. The nurse, as a member of
the safety committee, has a responsibility to
assist in reducing the frequency and severity
of industrial accidents. Problems should be
reported to supervisors and the safety
committee. As well, a tactful word on the spot
to a forgetful employee can result in immediate
use of available protection. .
6. To maintain regular contact with
foremen and supervisors. This assists in
building good rapport and enhances the
mutual understanding and cooperation
necessary for a team effort to improve health
and safety.
7. To enable accurate, appropriate
referrals, The six previous items constitute the
major reasons for visits in the work areas,
however, there is another important reason -
accurate appropriate referrals to doctors,
industrial hygienists and safety officers - the
other occupational health team members.
8. To observe basic hygiene and sanitary
conditions as well as inspect emergency
rooms and first aid supplies. These reasons
may seem elementary but unfortunately they
are still necessary in most companies.
Conclusion
There is ample evidence today to support
the theory that we are in the midst of an
"environmental revolution." Almost daily. the
media reports activltes of small groups acroSs
the nation who are endeavoring to gain public
support in their fight against environmental
pollution. Public concern overthe quality of the
air we breathe, our waterways and the
landscape around us, l1as brought about
government ìctlOr. or ,OIT'P. environmental
issues. Unfortunately '10 r Aresponding
degree of public conc"'rn has developed
regarding the work environment, even though
it is recognized that m':my health and safety
hazards do exist. Gov"rnments, industry and
the unions have neglected this area. Even
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A tour of the work area leads to greater understanding for
Nadine Franks of the hazards that eXIst for the worker
40
The Canadian Nurse July 1976
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treatment oriented health professionals have
paid little heed to the effects of the work
environment on the physical and emotional
health and well being of their patients.
None of the occupational health team
members work in isolation: each of them has a
role to play in relation to the work area. What
does seem clear, however, is that "the nurse
with a high index of curiosity can be the most
valuable co-worker that the occupational
health physician and industrial hygienist can
have. She is management's most sensitive
indicator of potential people or environmental
problems. "4
References
1 Brown, Mary Louise, The quality of the
_ work environment. Amer. J. Nurs.
75:10:1755-1760, Oct. 1975.
2 Schilling, R.S. Occupational health
practice. London, Butterworths, 1973. p. 54.
3 Olishifski, Julian B. Fundamentals of
industrial hygiene, ed. by... and Frank E.
McElroy. Chicago, Natl. Safety Council, 1971.
p. 439-440.
4 Brown, Mary Louise, Trends for the
future of occupational health nursing. Occup.
Health Nurs. 21: 8:7-11, Aug. 1973.
Miriam Hayman, who writes about the role of
the occupational health nurse in the work
environment, is presently employed as
Regional Nursing Officer, Atlantic Region.
Medical Services, Health and Welfare
Canada in Halifax, N.S, She is a graduate of
Payzant Memorial Hospital in Windsor, N.S..
received her P.H.N. and D.N.S.A. from
Dalhousie University in Halifax and holds a
Certificate of Occupational Health Nursing
from the American Board of Occupational
Health Nurses. The article formed the basis of
a paper she presented to delegates to
"Occupational Health: Issues and Priorities, "
sponsored by the Canadian Public Health
Association and held in Toronto last winter.
Editor's Note:
The term "occupational health" was first used
officially in 7950 by the World Health
Organization {International Labor
Organization expert committee on
Occupational Health. The committee stated
I ne \,AInilUllUI nut:ztu .IUIY I
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Clinical Wordsearch
Answers
-
1 Laparotomy
2 Cholescystectomy
3 Paralytic ileus
4 Colostomy
5 Levine
6 Electrolytes
7 Sutures
8 Dressing
9 Aseptic
10 Hysterectomy
11 Catheter
12 Analgesic
13 Antibiotic
14 Transfusion
15 Scultetus
16 Distention
17 Pancreatic
18 G I series
19 Hyperalimentation
20 Appendicitis
21 Serum
22 Clips
23 Anaesthetic
24 Colectomy
25 T-tube
26 Preop
27 Pain
28 Shock
29 Navel
30 Pm
31 M.V.A.
321.V.C,
33 N.P,O.
34 Laporoscopy
35 O.R.
36 Scan
37 Skin
38 BRP
39 Ulcer
40 Ileum
41 Pale
42 T.I.D.
43 S.O.B.
440.D.
45 Scar
that "Occupational Health should aim at the
promotion and maintenance of the health of
workers in all occupations. "
The first nursing organization to use the
name "Occupational Health Nursmg" was the
Royal College of Nursing in London, England,
which has offered a Certificate in
Occupational Health Nursing since 1954.
Short-term course records in the CNA
Library indicate that courses in Occupational
Health Nursing are available in this country at
Grant MacEwan Community College in
Edmonton, Alberta (two trimesters) and at the
Faculty of Nursing, University of Toronto
(5 days). ...
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Hidden Answer: Surgical Nursing
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fhe puzzle on page 13 is one of a series
submitted by Mary Elizabeth Bawden
(R.N., B,Sc.N.), who began constructing
puzzles originally for use in staff education.
Bawden is an active member of the
Registered Nurses' Association of Ontario,
and presently works as Team Leader in the
Rheumatic Disease Unit, University
Hospital, London, Ontario, When she sent
the puzzle in, Bawden wrote, "I think it
would be fun for the readers of The
Canadian Nurseto have a puzzle...... Hope
you enjoyed it!
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42
The CanadIan Nurse July 1976
Disseminated Intravascular Coagulation:
A patie.nt profile..
Joyce Granberg, R. Lowndes, N. Robinson,
M. Busslinger, D. Bunch, J. Palmer, Y. Weitzel,
M. Johnston, W. Bowes, M. Kenny, J. Harvey, B. Burden
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Figure 1 - Right forearm showing
eccymotic skin lesion.
The treatment of any critically ill patient
involves the utilization of all the resources a
hospital has to offer. The resources of
emergency, medical and nursing staff are
taxed to provide the best care possible,
hopefully both physiologically and
emotionally.
The patient described here arrived in
emergency in critical condition. A few years
ago, her symptoms might have been
misdiagnosed since disseminated
intravascular coagulation has only recently
been recognized as a clinical entity. Improved
understanding of the pathophysiology
underlying DIC has brought about more
frequent detection and, in this case. resulted in
appropriate diagnostic tests and treatment.
Careful nursing observation and intervention
were essential in preventing further
complications and in aiding her recovery.
The Patient
In emergency department... Mrs. Monty,
a 24-year-old woman, was admitted to
emergency at 0620 hours. She was
accompanied by her husband who had
awakened to find her cold, clammy and
mottled. At the time of admission, she was
conscious but confused, with poor color and
blotchy limbs. Her vital signs were: BP 58/40
mm Hg.. apex 100 beats permin., no palpable
peripheral pulses and an oral temperature of
36 0 C. Within one hour, her diastolic pressure
had dropped to 30 mm Hg. and her apex had
increased to 160 beats per min.
Immediate treatment included the
administration of oxygen at 6 liters per min. via
nasal cannula, insertion of an IV via cutdown,
through which Sodium Bicarbonate and
Solucortef were given, and the insertion of a
Foley catheter. Hourly urine output and vital
signs were recorded q 15 minutes. A throat
swab as well as specimens of blood, urine and
stool were sent for culture and sensitivity.
Venous and arterial blood was drawn for blood
gas analysis. By 0800 hours, Mrs. Monty's vital
signs were: temperature 39 0 C rectally, apex
112, respirations 28 per min.. BP 50/40 and
adequate hourly urine output. After the
attending physician had spoken with her
- family, she was transferred to ICU,
Mrs. Monty's past history showed that she
had been healthy until two years before, when
she had contracted a un nary tract infection
which was successfully treated with sulfa
drugs.
Four months prior to this hospitalization,
she developed a vaginal discharge which was
resistant to therapy. One week before
admission, she had symptoms of nausea,
vomiting, diarrhea and fever, and was treated
with Gantrisin. Further treatment with
Ampicillin and Gravol for a urinary tract
infection was commenced. The only other
medication she was presently taking were
birth control pills. She was described as being
a social drinker and smoked approximately
one package of cigarettes a day.
Diagnostic Tests: "OIC is not usually hard
to diagnose. Coagulation screening tests are
markedly prolonged in addition to severe
thrombocytopenia, hypofibrinogenemia,
marked deficiencies in prothrombin, factors
V, VIII. and elevated levels of fibrin degradation
products. "1
On admission, Mrs. Monty's hemoglobin
was 13.8, white blood count 16,000,
sedimentation rate 7. A coagulation screen
done later that day showed markedly elevated
fibrin split products, a prolonged PT and PTT
a fibrinogen titre of 67 mgm percent, and a
platelet count of 16,000. Her initial BUN was
56 and this eventually rose to 192. A CPK was
over 10.000 units and her SGOT was 1710
units. A urinalysIs showed bilirubin,
hemoglobin, and myohemoglobin in the urine.
Cultures of the throat, blood, cervix and
cerebrospinal fluid were negative. A lumbar
puncture showed no abnormality. On the basis
of her blood results, a diagnosis of OIC was
made(See Table 1).
The Can-.lian Nurse July 1976
43
Table 1
Results of Mrs. Monty's diagnostic tests
Hematology and Normal values at the
Biochemistry tests Admission Day 1 Day 2 Day 3 Day 4 Calgary General Hospital
Prothrombin Time 27.9 24,1 17.8 17.1 (11.5 - 14.5 sec.)
Partial Thromboplastin Time 143.2 5 min. 88 70 (35 - 45 sec,)
Platelets 16,000 26,000 16,000 11,000 (2oo,000-350,OOO/cu mm)
Fibrinogen Titre 67 66 66 67 50 (200-400 mgm percent)
Fibrin Degradation Products 40 40 (40 ug/ml)
Bleeding Time 6 (2 - 6 minutes)
Sodium 130 133 130 119 122 (135-145 mEqlliter)
Potassium 4.8 3.9 3.9 3.8 4.9 (3.8 - 5.0 mEq/liter)
Chloride 98 91 87 82 83 (136-148 mEqlliter)
BUN 56 67 95 148 100 (5-20 mgm)
Creatinine 5.4 5.4 6.5 7.7 9.4 (0.7 - 1.5 mgm)
Therapy
On arrival to ICU at 0800 hours, Mrs.
Monty was suffering from shock and fever. A
stat dose of IV Solucortef 500 mgm and IV
t<anamycin 1 gm were given. IV Solucortef
was then given q6h. Other IV antibiotics,
Clindamycin, Cloxacillin and Kanamycin. were
started immediately. Dextran, albumin and
plasma. which act as plasma expanders, were
also used as an adjunct in the treatment of
shock.
Because the u
e of anticoagulants in this
disease is very controversial. it was initially
decided to withhold large doses of Heparin in
the absence of clinical bleeding.
Twenty-four hours later, Solucortef was
reduced to 100 mgm q8h because of
increased capillary perfusion. A biopsy was
done of ecchymotic skin lesions on the right
forearm (See Fig. 1) which showed two gram
negative diplococci. This raised the question
as to whether meningococcus was the
causative organism. However, since Mrs.
Monty had been given Ampicillin prior to
admission, only one meningococci organism
was found in the blood culture,
A vaginal examination done at this time
showed a severely inflamed cervix containing
approximately 60 mls of pus. Prior to
admission, Mrs. Monty had had a yellow-white
discharge for several months which had been
resistant to treatment. The causative organism
of this persistent infection was not determined.
Forty-eight hours after arrival to ICU her
vital signs were returning to normal but her
urine output had dropped. reflecting insuffident
intake. She was edematous due to the
intravascular coagulation in the microvascular
bed which was reflected in profound hepatic,
renal and skin damage. The plan of treatment
was to increase fluid intake in view of her
decreased urine output. She was again
treated with Rheomacrodex (Dextran 40),
albumin and saline to try to increase the
amount of intravascular fluid. She was
continued on steroids and wide antibiotic
coverage. This resulted in a rise in her blood
pressure and urine output to normal levels.
By the third day, her PT and PTT were
returning to normal but her platelet count was
still only 16,000/cu mm. There were no sites of
active bleeding and the skin lesions were
resolving. However, she had developed an
acute renal failure complicated by hepatic
failure, both of which were secondary to the
effects of DIC. Her BUN was rising and
myoglobin and hemoglobin were found in her
urine, factors which were thought to be
contributing to the development of a lower
nephron nephrosIs.
On consultation with a urologist, it was
decided that the first priority was to correct her
electrolyte imbalance before proceeding with
dialysis. In view of her serum sodium level of
119 m Eq per liter, she was given 600 mls of 3
percent Sodium Chloride IV. However, by the
fourth day her serum creatinine was still rising
and had reached 9.4 mgm while the serum
sodium increased only to 122 mEq per liter.
She still showed a marked thrombocytopenia
with a platelet count of 11,OOOIcu mm and a
fibrinogen level too low to be recorded. There
was no evidence of any massive bleeding,
although she was bleeding from her gums. It
was thought that her platelet depression was
due to renal failure. She was continued on
steroids but the antibiotics were discontinued.
She was unable to regenerate prothrombin
due to her hepatitis, and was given a dose of
VItamin K. In view of the continuing
deterioration of her renal function, dialysis was
indicated and she was transferred to another
hospital.
Follow-up
One month after her transfer, Mrs. Monty
was readmitted to the Calgary General
Hospital for a prolonged program of
rehabilitation to correct mononeuritis multiplex
with flexion contractu res In her fingers, and
foot drop. These complications were probably
a result of the excessive swelling of her
extremities which had made passIve joint
exercises impossible. By this time, a series of
hemodialysis treatments had reversed her
renal and liver failure. After one month of
rehabilitation, she was discharged home but
continued with physiotherapy as an outpatient.
It is expected that she will regain full use of her
fingers and that the foot drop will be corrected.
[>
44
The Canadian Nurse July 1976
þ1eet summer head-on
with
t1t! CHLOR-TRIPOLON*
,t' "(chlorpheniramine maleate U.S.P.)
.,. "', ,
ntihistamine
Tablets/REPETABS* /Syrup/lnjectable
. ) ' Full prescribing information available
J on request from:
Schering Corporation Limited
Po,nte Cia".. Quebec. H9R 184
, . .
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* The Disease
The term "disseminated intravascular
coagulation" means diffuse or widespread
coagulation within arterioles and capillaries all
over the body. DIG, also called consumption
coagulation or defibrination syndrome, is a
complex and Important coagulation disorder
characterized by two apparently conflicting
sets of manifestations; clot formation and
hemorrhage (See Table 2).
DIG is not a primary illness but, rather,
occurs as a response to a wide variety of
diseases (See Table 3). The underlying
disease causes tissue injury which results in
the release of thrombin into the circulation.
Thrombin catalyses the formation of fibrin, and
fibnn deposits form throughout the small
vessels. This diffuse clotting results in clotting
factors being consumed more quickly than
they can be replenished by the liver. The
presence of fibrin activates the fibrinolytic
mechanism by which fibrin is broken down into
fibnn degradation products, thus interfering
with normal clotting. Therefore, the patient
develops bleeding tendencies despite his
hypercoagulated state (See Table 2).
Although the specific cause of DIG is
unknown, approximately 50 percent of
diagnosed cases are associated with mothers
with obstetrical complications while another 33
percent of cases are related to terminal
cancer. 2 Another common disorder
associated with DIG is gram negative
septicemia.
,
C)
.
.
.
.
)flA.
.
Most patients demonstrate signs of
impaired function of at least one organ system,
caused by the occlusion of small blood vessels
in the brain, kidneys, heart and other organs
leading to microinfarcts and tissue necrosis.
Signs and Symptoms
The onset of DIG is usually acute;
manifestations may be either mild or extremely
severe. Symptoms include the following:
. petechiae and ecchymoses on the skin,
mucous membranes, heart lining, lungs, etc.
. prolonged bleeding from a venipuncture
. severe, uncontrollable hemorrhage
during surgery or childbirth
. oliguria and acute renal failure
. convulsions and coma which may
terminate in death. 3
Treatment
The priorities in the clinical care of a
patient with DIG are directed towards:
. the treatment of the underlying disease or
problem e.g. shock, delivery of a fetus,
irradiation of cancer
. the reversal of clotting. ( The use of
Heparin is controversial. By slowing clot
formation which, in turn, slows the depletion of
clotting factors from the circulating blood,
Hepann indirectly decreases hemorrhaging)
and -
. the control of bleeding and shock. Blood
transfusions may be administered to replace
"'-
.
.
.
.
blood loss, and human fibrinogen is
sometimes used in cases of severe
fibrinolysis. Gare must be taken, since humar
fibrinogen may cause hepatitis.
Prognosis
Prognosis generally depends on the
severity of the bleeding and the amount of
organ damage sustained. Severe bleeding i
associated with an ominous prognosis if it
occurs in three or more sites. It has been
estimated that two-thirds of patients with DIC
die in the hospital. 4
References
1 Weiss, A. E., Diagnosis and treatment of
intravascular coagulation. by. and A.I.
Cederbaum. Amer. Fam. Phys. 8:5:110-119, Nov
1973.
2 Luckman, Joan, Medical-surgical nursing; s
psychologic approach, by... and Karen Creason
Sorenson. Toronto, Saunders, 1974. p. 798.
3 Ibid p. 799.
4 Colman, Robert W., Disseminated
intravascular coagulation: a problem in critical carl
medicine, by... et al. Heart & Lung 3:5:793, Sep.Oct
1974.
Bibliography
Anthony, Catherine Parker, Textbook of anatomy
and physiology. St Louis, Mosby, 1963.
Corrigan, James J. Management of disseminateo
intravascular coagulation: Heparin should be useo
cautiously and selectively. In Controversy in Interna
Medicine II, edited by Franz J. Ingelfinger et at
Philadelphia, Saunders, 1974, p.623-632.
Hudak, Carolyn M ed. Critical care nursing, edite<
by... et al. Toronto, Lippincott, 1973.
Rodriguez-Erdmann, F.. The syndrome of
intravascular coagulation. Postgrad. Med.
55:5:91-98, May 1974.
Weiss, A.E., Diagnosis and treatment of
intravascular coagulation, by... and A.I.
Cederbaum. Amer. Fam. Phys. 8:5: 11 0-119, Nov.
1973.
The Canadian Nurse July 1976
45
rable 2
ormal Coagulation
- contact of circulating blood with
a roughened surface due to
vessel injury
- platelets split releasing platelet
factor III
- platelet factor III, in the presence
of other blood proteins and
Ca + + forms active
tissue thromboplastin
- thromboplastin reacts with
prothrombin and Ca + + to
form thrombin
thrombin activates the formation
of fibrin from fibrinogen
to yield fibrin clot
"'ormal Fibrinolysis
presence of fibrin activales
enzyme fibrinolysin
fibrinolysin causes fibrin clot to
disintegrate
- fibrin degradation products are
released
DIC
- extensive tissue damage
!
- extensive coagulation
!
- depletion of clotting factors
!
Hemorrhage
- extensive coagulation results
in extensive fibrinolysis
!
- large amounts of fibrin degradation
products released
!
- some flbnn degradation products
interfere with normal coagulation
!
Hemorrhage
Carngan, J J. Jr 'Heparln Should be Used CautIously and SelectIvely Internal Med,cine 1974
pp623'632.
Team effort pays dividends: Some of the ICU nurses at Calgary
General Hospita( whose combined talents resulted in the pub(ication
of "Disseminated Intravascular Coagulation" got together recently to
have this picture taken. From left to right they are: Row one - M.
Kenny, D. Bunch, J. Granberg, J. Harvey, B. Burden. Row two - W.
Bowes, J. Palmer, N. Robinson. Not present when the picture was
taken were: M Johnston, Y. Weitzel, R. Lowndes and M Busslinger.
After working together in (CU caring for "Mrs. Monty" (a fictitious
name), they decided the case had some unique features that wou(d
make it worthwhife for other nurses to read about. We thank them for
sharing this learning expenence and invite other groups of nurses to
consider doing so too. Do you have an interesting case to share?
Nursln. Care Plan for Mr
Problem
1
a) Apprehension and
worry about her
sudden and serious
illness and about
her child's welfare.
L . nty
Goal
Relief from
apprehension
Table 3
Underlying diseases associated with DIC
Septicemia (due to)
gram negitive bacteria
virus
fungus
rickettsia
protozoa
snake venom
Surgical procedures
lung surgery
open heart surgery
renal homogragh rejection
Hemolytic disorders
thrombocytopenia purpura
purpura fulminans
polycythemia vera
hemolytic transfusion reaction
hemolytic uremic syndrome
Complications of Pregnancy
toxemia of pregnancy
abruptia placenta
fetal death in utero
amniotic fluid embolism
uterine rupture
Other problems
allergic reaction
burns
trauma
shock
pulmonary and fat emboli
dissecting aneurysm
cyanotic heart disease
liver disease
Carcinomas
prostate
stomach
pancreas
acute leukemia
,
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NurSing Intervention for
a patient with DIC
1. Assign the same nurse to
care for Mrs. Monty to
establish continuity of
care and a trusting
relationship between nurse,
patient and family.
2. Give Mrs. Monty the
opportunity to verbalize
fears by telling her that you have time
to listen.
3. Give explanations for signs and
symptoms and for treatment
measures taken.
Before proceeding with any treatment.
explain:
- what the trealment is
- what she can expect to feel
- how she can help with the
treatment.
46
The Canadian NurB8 July 1976
Problem
Goal Nursing Intervention for
a patient with DIC
b)
Apprehension of the
family expressed by
verbalizing anger
at the hospital staff
for "letting her
get sick."
Relief from
apprehension
2
Hemorrhage into joints,
muscles and mucous
membranes.
Recognize and
control bleeding
1. Provide explanatIOn to
family concerning Mrs.
Monty's condition.
2. Suggest ways that Mr.
Monty might participate
in the care of his wife
e.g. reading, helping with meals.
1, Observe lor signs and
symptoms of:
External bleedmg - oozing
from any puncture site
Internal bleeding - restlessness,
agitation, ! BP1 P, low hematocrit and
hemoglobin, petechiae (demarcate
with pen marks), lab results indicating
kidney or liver dysfunction, X-rays
showing fluid collection.
2. During bleeding episodes
. apply cold compresses to the
bleeding site for 5 minutes q1 h
. apply gentle pressure to the site by
completely covering the site with telfa
to prevent sticking then place an ABD
pad over this and secure with Kling
_ . allow Mrs. Monty to rest quietly
without moving while bleeding is
occurring
. any clots that have formed should
not be disturbed
3. Measure abdominal, arm and leg
girth q8h
4. Auscultate lungs to assess for fluid
buildup.
5. Check urinary output q 1 h. If lower
than 30 cc/hr, report to physician.
1. Apply padding to side
rails with flannelette sheets
to prevent trauma.
2. Use small gauge needles
when giving injections or
inserting LV. Lab work
should be restricted to only necessary
tests. Apply pressure to injection site.
3. Maintain skin and mucous
membrane integrity by:
. rinsing her mouth with mild
cleansing solutions, e.g., diluted
H202, using soft applicators q1h.
. lubricating her lips with vaseline
q1h.
. washing her skin with a mild soap,
e.g. Ivory, daily and massage all
pressure points with hospital
dermassage after turning q2h
. with onset of jaundice, no soap
should be used as it causes itchiness
. supporting all limbs and back with
downy pillows
. giving her soft foods with every
meaJ and pushing fluids - 4000 mls in
24 hours.
3
Skin damage due to
hemorrhage in the form of:
1. swelling
2. stiffness
3 sloughing and
blistering of skin
Minimize amount
of skin damage
Problem
4
Complains of severe pain
upon movement due to bleeding
into muscles of arms,
legs and joints
5
Suffers fatigue, weakness and
dyspnea physiologically due to
a decrease in erythrocytes
causing a reduction in the
O
carrying capacity of
the blood.
6
Disorientation to time,
place and person.
Increasing restlessness.
The Canadian Nurse July 1976
Goal
Relief from pain
Fatigue and weakness will
be kept at a minimum.
Protection from self-injury.
Increased level of orientation
Decreased restlessness
47
Nur _'I'}g Intervention for
a . atlent with D1C
1. Give analgesics
as ordered
2. Relieve pressure of
bedding by using a
footboard.
3. Carry out passive range of motion
exercises very gently with arms and
legs before turning q2h.
4, Use an alternating air mattress.
5. Explain that in the long run, not
turning her will add to her discomfort
making her skin sore and her arms
and legs cramped,
6. Assure her you will be as gentle as
possible and encourage herto help by
keeping her body relaxed and limp.
7, Always have two or three nurses to
carry out the turn.
As much as possible,
1. Arrange her nursing care
to allow for rest periods of
30 minutes after any form of
treatment that involves
moving her. e.g. bed bath,
turning, X-ray etc.
2. Allow rest penods in the morning,
afternoon, and evening and allow her
at least 4 hours of undisturbed sleep at
night (conditions permitting).
3. Tell Mrs. Monty that you want herto
let you know when she feels tired.
4. Elevate the head of the bed 60 and
put pillows behind her head and under
each elbow to support her in the
seml-Fowler's position.
5, Give her 02 therapy as prescribed
for dyspnea.
1. Keep room as quiet as
possible e.g. put a sign at
the base of her bed in
large letters "Quiet Please - speak
slowly to patient. '
2. GIve simple and bnef explanations
before all procedures.
3, Orientate her often to her
surroundings and be alert for
Increasing confusion
4. Keep side rails up at all times. Use
soft restraints, e.g. ABD pad. with
Kling only as a last resort. If restraints
are used, check q2h for adequate
circulation (check color, warmth and
movement of hands).
5. Check Mrs. Monty as least q30
minutes.
6. Explain to the family. the reason for
her confusion, the precautions being
taken and how they can help to
orientate her.
. Problem-onented nurSIng care plan used at the Calgary General Hosp
aI adapted tram Mayers. M G
A Systematic Approach to the Nursmg Care Plan New York. Appleton-Century-Crofts (19721
48
The Canadian Nurse July 1976
Information is supplied by the
manufacturer; publication of this
information does not constitute
endorsement.
"1]111(
S Ne\",
t.
.-
,.
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"Ped-o-jet" Injectors for Swine Flu Vaccine
Vemitron's Ped-o-jet (R) is
capable of administering over 800
injections an hour. Quantities of
immunizing agents, diagnostic
solutions and parenteral medications
are automatically metered by the
equipment. It is a foot-powered,
hydraulically-operated multidose Jet
injector working under high pressure
through a tiny jet nozzle, with solution
penetrable to a suitable depth.
Standard nozzles for intramuscular
and subcutaneous injections are
included with the unit. An intradermal
nozzle for smallpox immunization,
tuberculin skin testing and similar
uses is also available. The device
does not use a needle, eliminating the
risk of cross-infection. Its speed in
administering injechpns may aid in
reducing the patient's mental and
physical distress.
The "Ped-o-jet" (R) jet injection
equipment is being considered by the
U.S. Government's Center for
Disease Control, for use in the
immunization of a major portion of the
American public against Swine flu in
September and October of this year.
It has been used in immunization
in Mexico, Brazil, Yugoslavia and the
Philippines against smaJlpox, cholera,
typhoid, measles and meningitis.
For additional information write to
Mr. Benjamin Kittner, President,
Vernitron Medical Products Division,
Inc., 5 Empire Blvd., Carlstadt, N.J.
07072.
7-Day Pill Case
Trouble remembering when to
lake which medication? The
pocket-sized 7-day pill case keeps
each day's pills in their own
compartment to help prevent danger
of taking an extra dose, or forgetting
one. It is useful for all medications,
vitamins, pills, etc.
For details, write: Consolidated
Ripplinger Corporation, Box 293,
Logan, UT 84321.
Vollrath Catalog
A 28-page catalog. designed with
a soft floral theme, contains
illustrations and detailed information
on Vollrath's line of Merry Mint
single-patient plastic utensils. Medical
Blue autoclavable plastic utensils, and
stainless steel items.
To receive a copy of thIs Medical
Catalog (No. 22050), write: The
Vollrath Company, 1236 North 18th
Street, Sheboygan, WI 53081.
Mobile Thermal Drainage Unit
Vernitron Medical Products has
introduced Model2115 "three-in-one"
Sorensen Mobile Thermal Drainage
Unit. Designed for intermittent.
regulated mild-to-Iow volume suction,
and for normal and emergency
requirements, the drainage unit can
be adjusted within a range of 190mm
to 25mm of mercury. Offering
automatic continuous operation, the
intermittent suction action allows the
aspirator to automatically clear itself of
most Levine Tube occlusions,
resulting in reduced need to !frigate.
Among its apphcations, the 2115
can be used for wound drainage,
postoperative intermittent suction in
intensive care areas, and as a
low-volume unit in pediatrics.
For information, write: Vernitron
Medical Products, Inc., 5 Empire
Blvd.. Car/stadt, N.J. 07072.
,
ç
\
--
,
,\
--
Emergency Intubation Kit
Emergency intubations for
resuscitation can be handled quickly
with the Foregger Martin Emergency
Intubation Kit available from Air
Products. The ready-to-use kit is
designed for anesthesiologists and
other trained personnel, and is useful
throughoutlhe hospital, as well as in
doctors' and dentists' offices.
A sturdy box contains a full range
of clear plastic endotracheal tubes,
each referenced with age of patient to
facilitate right-size selection. A
laryngoscope handle is included, as
well as Macintosh and Wis-Hipple
laryngoscope blades.
For information, write: Medical
Products DivIsion, Atr Products and
Chemicals, Inc., P.O. Box 538,
Allentown, Pa. 18105.
') ( ,c
\
Bedside Station
Amencan Zettler, Inc. has
introduced a bedside station featuring
true duplex voice communications.
The American Zettler Patient
Station permits continuous, natural
and uninterrupted speech between
patient and nurse. The patient does
not need to reposition himself or even
look in the direction of the bedside
station as the microphone picks up
even a whisper from anywhere in the
room.
The Patient Station, Model
32.6000, includes an ullrasensitive
microphone, speaker, nurse-call
button, privacy light, and call cord.
Optionally, the station may be fitted
with controls for television, radio
lights, drapes, and even the door.
The patient calls for assistance
from the station with either the bedside
call cord or a panel push button. The
call activates a corridor dome light
outside his room, as well as a
corresponding light at the American
Zettler Master Station. This signal
initiates communications between the
patient and the nurse. When the
patient's call is answered. his TV or
radio sound IS automatically turned off
and his privacy light is turned on, to
Indicate that the microphone is in use
This model is available in three
attractive face-plate styles: durable
simulated wood grain on aluminum;
stain-resistant anodized aluminum;
and lustrous stainless steel, affording
full esthetic flexibility in selection of
cabinet styles and decor.
For information write: Hospital
Systems Manager, American Zettler,
Inc., 16881 Hale Avenue, Irvine,
California 92714.
The CanadIan Nurse July 1976
49
l..jil).-tt.-JJ (TI)(lt1te
The following publications, received
recently by the Canadian Nurses'
Association Library, may be borrowed
from the Library by C.N.A members,
schools of nursing, and other
institutions. Publications marked R
however, include reference and
archive material and are not available
for loan. Theses, also marked R are on
reserve, and are loaned on an
interlibrary basis only.
Loans from the C.N.A. Library
may be requested by a letter stating
the title of the publication, the author's
name, and the item number specified
in the following list, or by a standard
Interlibrary Loan form. Three
publications may be borrowed at one
time. Borrowers are requested to
cover mailing charges for sending and
receiving loaned publications.
If you wish to purchase a book,
contact your local bookstore or the
publisher.
Books and documents
1. AI-Anon faces alcoholism. New
York, AI-Anon, 1975. 285p.
2. Alternative approaches to meeting
basic health needs In developing
countries: a joint UNICEF/WHO study
edited by D. Djvkanovic and E.P.
Mach. Geneva, World Health
Organization, 1975. 116p.
3. American Nurses' Association. A
directory of programs preparing
registered nurses for expanded roles
1974-75. Prepared jointly by. . and
U.S. Dept. of Health, Education and
Welfare, Bureau of Health Manpower.
Bethesda, Md., U.S. Dept. of Health,
Education and Welfare. 1976. 47p.
(U.S. DHEW Pub. No. (HRA)76-31) R
4. Anderson, Grace M. Non-milk
cookbook. Waterloo, Treasure Trove
1976. 92p.
5, Association canadienne
d'éducation. Annuaire d'etudes en
éducation au Canada, 1970/71 -
1974/75. Toronto, 1971-1975. 2v.
6. Association canadienne d'hygiène
publique, 64e Congrès annuel,
Montréal. 24-27 avril, 1973.
L'infirmiere et les programmes
d'éducation portant sur Ie tabac.
Communications présentées
Ottawa, Association canadienne
d'hygiène publique, 1973. 32p.
(Association canadienne d'hygiène
publique. Monographie no 1)
7. Association des inflrmières
canadiennes Mémoire au Mimstre de
la Main-d'oeuvre et de /'Immigration
sur les difficultés rencontrées par
certaines catégories d'infirmiéres à
obtenir les prestations
d'assurance-ch6mage. Ottawa,
1974. 5p.
8. Barnard, Kathryn E. Teaching
children with developmental
problems: a family care approach,
by . . . and Marcene L. Erickson. 2ed.
St. Louis, Mosby, 1976. 182p.
9. Bobath, Berta. Hémiplégie de
I'adulte/bilans et traitement. Paris,
Masson, 1976. 136p.
10. Brown, Barbara B. New mind,
new body. Toronto, Bantam Books.
c1974. 523p.
11. Burgess, Ann Wolbert.
Psychiatric nursing in the hospital and
the community. 2ed., by. . . and
Aaron Lazare. Englewood Cliffs, N.J.,
Prentice-Hall, c1976, 1973. 520p.
12. Burke, C.D. The parasites
outnumber the hosts: a review of
some economic trends and their
impact on public policy for urban,
regional, and natIonal economic
development. Ottawa, Ministry of
State for Urban Affairs: available from
Information Canada, 1975, 48p.
13. Callbeck, Claudette J. ed. A
history of the Prince Edward Island
Hospital School of Nursing
1891-1971. Charlottetown, P.E.I.,
1974. 72p. R
14. Canadian Hospital Association.
Canadian hospItal statIstical review
1975. Prepared by John Crysler.
Toronto, Canadian Hospital
Association, 1976. 175p.
15. Canner, Norma. And a time to
dance. Boston. Plays Inc., c1968,
1975. 1v. (unpaged)
16. Clinical specialists and nurse
clinicians: a reader consisting of
eleven articles especially selected by
The Journal of Nursing Administration
editorial staff. 1 ed. Wakefield, Mass.,
Contemporary Pub.. 1976. 46p.
17. Conférence internationale du
Travail, 62e session, Genève, juin
1976. L'emploi et les conditions de
travail et de vie du personnel infirmier.
Septième question à I'ordre du jour.
Genève. Bureau international du
Travail. 1975. 89p. (Son Rapport 7(2))
18. Curren, Anna M. Math formeds; a
programmed text. 2ed. Seal Beach,
Califorma, Wallcur, 1976. 70p.
19. DeYoung, Lillian. The foundations
of nursing: as conceived, learned,
and practiced in professional nursing.
3ed Sf. Louis, Mosby, 1976. 302p.
20. Donovan, Marilee Ivers. Cancer
care nursing, by. . and Sandra
Girton Pierce. New York,
Appleton-Century-Crofts, c1976.
272p.
21. Eckert, Char1es, ed. Emergency
room care. 3ed. Boston, Little, Brown,
c1967, 1971, 1976. 480p.
22. Fagothey, Austin. Right and
reason: ethics, theory and practice.
6ed. St. Louis, Mosby, 1976. 484p.
23. Fochtman, Dianne, ed. Principles
of nursing care for the pediatric
surgery patient, edited by . . . and
John G. Raffensperger, 2ed. Boston.
Little, Brown, c1968, 1976. 327p.
24. Garb, Solomon. Abbreviations
and acronyms in medicine and
nursing, by . . . Eleanor Krakauer .
and Carson Justice. New York,
Springer, c1976. 122p.
25. Howard-Jones, Norman. Les
bases scientifiques des Conférences
sanitaires internationa/es 1851-1938.
Genève, Organisation mondiale de la
Santé, 1975. 121p. (Organisation
mondiale de la Santé. Histoire de la
santé publique intemationale no 1)
26. International Labour Conference,
61st session, Geneva, June 1976.
Employment and conditions of work
and life of nursing personnel. Seventh
item on the agenda. Geneva,
International Labour Office, 1975.
85p. (It's Report 7(2))
27. International Union Against
Cancer, Summary proceedings of the
International Conference on Public
Education About Cancer, Principality
of Monaco, 28-31 May 1974. Geneva,
International Union Against Cancer,
1975. 134p. (UICC Technical Report
Series, vo1.18)
28. Johnston, Dorothy F.
Medical-surgical nurSing; workbook
for practical nurses, by... andGailH.
Hood. 4ed. St. Louis, Mosby, 1976.
199p.
29. Lancour, Jane M. Nursing care of
the cardiovascular surgical patient,
by , . . and Diane K. Dressler,
Milwaukee, Wis., St. Luke's Hospital,
1975. 150p.
30. Laxer, Robert M. Canada's
unions. Toronto, James Lorimer,
1976. 341p.
31. Living with an alcoholic: with the
help of AI-Anon. New York, AI-Anon,
1976. 176p.
32. Miller, George E. Strategies de
I'enseignement des personnels de
sante, par. . . et Tamas Fulöp.
Genève, Organisation mondiale de la
santé, 1975. 112p. (Ses Cahiers de
santé publique no 61)
33. Mooney, Thomas O. Sexual
options for paraplegics and
quadriplegics, by. . . et al. Boston,
Little, Brown and Co., 1975. 110p.
34. National League for Nursing
Division of Nursing Issues In health
care New York, c1976. 71p. (NLN
Pub. no.14-1599)
35. Organisation mondiale de la
Santè. Bibliographie annotée de
maténels
d'enseignement-apprentissage pour
les éco/es d'infirmiéres et de
sages-femmes Geneve, 1975, 446p.
(OMS Pub. offset no 19)
36. Pétnllo. Madeleine. Nursing
psycho-social en pédiatne, par. . . et
Sirgay Sanger. Traduit par Jacqueline
Bourget-Huel. Montréal, HRW, c1976.
261p.
37. QualIty control and performance
appraisal: a reader consisting of nine
articles especially selected by The
Journal of Nursing Administration
editorial staff. 1ed. Wakefield, Mass.,
Contemporary Pub., 1976. 62p.
38. Robert, Henry Martyn.
Parliamentary law. New York,
Irvington, c1975. 588p.
39. Rodgers, Janet Ahalf.
Psychiatnc/mental health nursing
review, by. . . and Weslee Neary
McGovern. New York, Arco, c1976.
177p.
40. Roe, Joseph Hyram. Roe's
laboratory guide In chemistry. 7ed. St.
Louis, Mosby. 1976. 238p.
41. -. Roe's principles of chemistry.
12ed. Sf. Louis, Mosby, 1976. 399p.
42. St. Mary's Memorial Hospital,
Knoxville, Tennessee. Guidelines to
orthopedic nursing, compiled by
Alyce F Williams Treece. St. Louis,
Catholic Hospital Association, c1975.
183p.
43. Salemi, O. LeRoy. Natural and
synthetic organic medicinal
compounds. Sf. Louis, Mosby, 1976.
316p.
44. Schickedanz, H. Ruth.
Restorative nursing In a general
hospital, by _ . . and Pamela D.
Mayhall. Springfield, III., Charles C.
Thomas, c1975. 212p.
45. Schimmel, F. Néphro-urologie,
par. et P. Jungers. Paris, Masson
1976. 165p. (Cahiers de "infrrmière,
11 )
50
The CanadIan Nurse July 1976
1..JI)l e lt. e !J IT.)(llttt.
46. Steinschneider, R. Pédiatrie.
Paris, Masson, 1976. 210p. (Cahiers
de l'infirmière, 15)
47. Strand, Marcella M. Clinical
laboratory tests' by . . . and Lucille A.
Elmer. St. Louis, Mosby, 1976. 111 P
48. Tourris, Henri de. Abrégé de
gynécologie et d'obstétrique, par. .
et R. Henrion et M. Delecour. 3éd.
Paris, Masson, 1976. 545p.
49. Treece, Eleanor Mae Walters.
Internship in nursing education:
technoterm. New York, Springer,
c1974. 122p.
50. Weldy, Norma Jean. Body fluids
and electrolytes; a programmed
presentation. 2ed. St. Louis, Mosby,
1976. 117p.
51. West, John B. Physiologie
respiratoire; notions essentielles
Montréal, HRW, c1975. 181p.
52. World Health Organization
Annotated bibliography of
teaching-learning materials for
schools of nursing and midwifery.
Geneva, 1975. 446p. (WHO Offset
Pub. no.19)
Pamphlets
53. Alberta Association of Registered
Nurses. Position paper on nursing.
Edmonton, 1976. 11p.
54. Association of Registered Nurses
of Newfoundland. Ad Hoc Committee
on Nursing Education. The transition
in nursing education. Report. St
John's, 1975. 18p.
55. British Commonwealth and
Empire Nurses War Memorial Fund.
To commemorate an untold story.
London. 195? 19p.
56, Canadian Council on Hospital
Moving, being married?
Be sure to notify us in advance.
.
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your last Issue or
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o I hold active membership in provincial nurses' assoc
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Mail to: The Canadian Nurse, 50 The Driveway. Ottawa K2P 1 E2
Accreditation. Aims and objectives
(development, concepts, role, main
objectives, policies) revised. Toronto,
1976.9p.
57. Canadian Public Health
Association. Annual Meeting, 64th,
Montreal, April 24-27, 1973. Nurses'
involvement in smokmg and health
programmes. Papers presented.
Ottawa, Canadian Public Health
Association, 1973. 29p. (Canadian
Public Health Association monograph
no.1)
58. Chater, Shirley. Operation
update: the search for rhyme and
reason. New York, National League
for Nursing, c1976: 23p. (NLN Pub.
no.14-1605)
59. Conseil des sciences du Canada.
Perceptions. Ottawa, Information
Canada, 1975. 1 v.
60. Dartnell Corp. What a supervisor
should know about - improving his
skills in communication. Chicago,
1965, pam. 23p.
61. The General Nursing Council for
England and Wales. Teachers of
nursing, 1975(2). London, 1975. 26p.
62. Irwin, Theodore. How weather
and climate affect you. New York,
Public Affairs Committee, c1976. 28p.
(Public affairs pamphlet no.533)
63. Metropolitan Life Insurance Co.
Metropolitan Life's four steps to
weight control. Ottawa, Metropolitan
Life, c1966. 32p.
64. National League for Nursing.
Council of Home Health Agencies and
Community Health Services.
Accreditation of home health
agencies and community nursing
services; criteria and guide for
preparing reports. New York, c1976.
43p, (NLN Pub. no.21-1306)
65. -, Accreditation of home health
agencies and community nursing
services; policies and procedures.
New York, c1976. 16p. (NLN Pub.
no.21-1612)
66. -. Proposed model for home
health care benefIts. New York,
c1976. 7p. (NLN Pub. no.21-1614)
67. -. Dept. of Associate Degree
Programs. Criteria for the evaluation
of educational programs in nursing
leading to an assocIate degree. 4ed.
rev. New York, c1976. 18p. (NLN Pub.
no.23-1258)
68. Problem-oriented medical
records. A one day conference for
health professionals sponsored by
the continuing education committee,
University of Ottawa, School of
Nursing, Feb. 19, 1976. Background
data. Ottawa, 1976. 3 pts. in 1.
69. Transcultural nursing; a book of
readings, edited by Pamela J. Brink.
Englewood Cliffs, N.J. Prentice-Hall,
c1976. 288p.
70. Wilkinson, Maude E. Red Cross
outposts in pioneer settlements.
Reprinted from Hospital social
service, vol. 17. Toronto, 1928.
p.582-586.
71. Yarborough, Judith. How to
prepare a computer search of ERIC: a I
non-technical approach. California, I
ERIC Clearinghouse on Information
Resources, Stanford University, 1975.
41p_
Government documents
Alberta
72. Dept. of Advanced Education and
Manpower. Task Force on Nursing
Education. Report. Edmonton, 1975.
190p.
Canada
73. Commission du système
métrique. Deuxieme rapport. Ottawa,
1975. 1v.
74 Health and Welfare Canada.
Canadian health manpower studies:
a selected bibliography 1964-1975.
Ottawa, 1976. 111 p.
75. -. Par-Q physical activity
readiness questionnaire. Medical
evaluation kit. Ottawa, 1975. 1 kit.
76. -. Recommended standards for
maternity and newborn care. Ottawa,
Information Canada, 1975. 203p,
77. -. Health Programs Branch.
Health Insurance Directorate.
Guidelines for minimum standards in
the planning, organization and
operation of special care units in
hospitals. Ottawa, 1975. 159p.
78. -. Emergency services in
Canada. A report prepared for the
working group on special care units in
hospitals, the federal-provincial
sub-committee on quality of care and
research, and the advisory committee
on health insurance. Ot1awa, 1975.
80p.
79. Health and Welfare Canada.
Health Manpower Directorate. Supply
and requirements for physicians in
Canada, by Jawed Aziz, Ottawa,
1975. 27p. (Its Health manpower
report no.5-l5)
80. -. Long Range Planning Branch.
The Canadian Nurse July 1976
51
Social sciences and health policies in
Canada, by Thomas J. Boudreau.
Ottawa, 1976. 13p. (Its Staff papers
76-1)
81. - Non-Medical Use of Drugs
Directorate Smoking habits of
Canadians 1965-1974. Ottawa, 1976.
1v. (unpaged)
82. Labour Canada. Women's
Bureau. The law relating to working
women. 3ed. Ottawa. 1975. 26p.
83. National Science Library. Health
Sciences Resource Centre. Canadian
locations of journals indexed in Index
Medicus, 1975. Ottawa, 1976. 273p.
R
84. Santé et Bien-être social Canada.
Normes et recommandations pour les
soins a la mere et au nouveau-ne.
Ottawa, Information Canada, 1976.
205p.
85. -. Direction de la Maln-<roelNre
san ita ire. Besoins en medecins et
effectif au Canada, par .. Jawed
Aziz. Ottawa, 1975. 27p.
(Main-<roelNre sanitaire, son rapport
no 5-75)
86. -. Direction générale des
programmes de la santé. Direction de
I'assurance-santé. Guide des normes
minimales de planification,
d'organisation et de gestion des
umtés de SOInS speciaux dans les
hòpitaux Ottawa, 1875. 173p.
87. Travail Canada. Bureau de la
main-<J oelNre féminine. La legislation
touchant la femme en emploi 3éd
Ottawa, 1975. 27p.
88. Science Council of Canada.
Perceptions. Ottawa, InformatIon
Canada, 1975. 1v.
Ontario
89. Economic Council Education:
Issues and alternatives 1976.
Toronto, 41p. (Its Issues and
alternatives 1976)
90. -. National independence:
Issues and alternatives, 1976.
Toronto, 1976. 41p. (Its Issues and
alternatives 1976)
91. Economic Council. Health: issues
and alternatives 1976. Toronto. 1976.
54p. (Its Issues and altemalives 1976)
92. -. Social security: Issues and
altematives 1976. Toronto, 1976. SOp.
(Its Issues and alternatives 1976)
93. Human Rights Commission. The
Ontario human rights code. Revised
statutes 01 Ontario, 1970. chapter 318.
Toronto, Queen's printer for Ontario,
1976. 23p.
94. SpeCial Program Review Report
of the special program review,
appointed. . . to inquire into ways
and means of restraining the costs of
Govemment. . Toronto, 1975. 402p.
United States
95. Congress House. Committee on
Interstate and Foreign Commerce.
Sub--committee on Health and the
Environment. A discursive dictionary
of health care. Washington, U.S.
Gov"t. Print. Off., 1976. 182p. (94th
Congress. 2d sessIOn) R
96. Dept. of Health, Education and
Welfare. Bureau of Health Manpower.
Health manpower In the changing
Australian health services scene. by
Ruth Roemer and Milton I. Roemer.
Washington, 1975. 87p. (DHEW Pub.
no. (HRA) 76-58)
97. John E. Fogarty International
Centre for Advanced Study in the
Health Sciences. Health care in
Scandinavia Bethesda, Md., U.S.
Dept. of Health, Education and
Welfare, Public Health Service,
National Institutes of Health, 1975.
74p.
98. National Cen1er for Health
Statistics. Comparability of mortality
statistics for the seventh and eighth
revisions of the International
classification of diseases, United
States. by Joan A. Klebla. Rockville,
Md., Dept. of Health, Education and
Welfare, 1975. 93p.
99. -. Health attitudes and behavior
of youths 12 - 17 years, by Dorothee K.
Vogt. Rockland, Md., Dept. of Health,
EducatiOl' and Welfare, 1975. 67p.
100_ -. Selected vital and health
statistics in poverty and nonpoverty
areas of 19 large cities, United States,
1969-71, by Stephanie J. Ventura.
Rockville, Md., Dept. 01 Health,
Education and Welfare. 1975. 63p.
101. -. A study of the effect of
remuneration upon reSDonse in the
health Br>d nutrition e)(,
'nation
study Rockvllle Md Cepartment of
Health, Education and Welfare, 1975.
23p,
Studies deposited in CNA
Repository Collection
102. Allard, Céclle. Effets des
comportements de substitut maternel
lors de ralimentation des enfants
asthmatlques hospitallsés ages de 13
a 24 mois. Montréal, 1973. 61 p.
(Thèse (M. Nurs.) - Montréal) R
103. Allen, John. The applicability of
Herzberg's dual factor theory of lob
satisfaction to registered nurses in the
hospital setting. Ottawa, 1976. 63p.
(Thesis (M.HA) - Ottawa) R
104. Ames, Harold D. The Beaverton
project: a nurse practitioner
attachment to a rural medical practice
- a descriptive study. Beaverton,
Ontario, 1975. 125p. R
105. Jones, Phyllis Edith. A
continuing education programme for
expanding roles of public health
nurses, 1975-76: final report of a
project conducted by the Continuing
Education Programme for Nurses,
University of Toronto, Faculty of
Nursing, by. . and Ethel Irwin.
Toronto, Universrty of Toronto,
Faculty of Nursing, c1976. 66p. R
106. Martin, Claire. La qualité d'aide
du ruban magnétoscoplque pour
développer la fonction d'observatlon
chez fétudiante-infirmiére adulte.
Montréal, 1975. 145p. (Thèse (M.A.)-
Montréal) R
107. Page, Joyce E.K. Report on the
community psychiatric nursing
program project by . . . and Dorothy
M. Green. Victoria, Department of
Health, Mental Health Programs,
1975. 33p. R
108. Paton, Nora. A survey of union
education amongst nursmg
unions/associations in Canada.
Vancouver. Registered Nurses'
Association of British Columbia
Labour Relations Division,
1975. 43p. R
WHEN YOU'RE
IN OTTAWA
BE SURE TO SEE ONE OF CANADA'S FINEST
SELECTIONS OF WHITE AND COLORED
UN I FORMS
at
. MOSfa.Y Wtti1'as
(THE COMPLETE UNI FORM SHOP)
WE ALSO CARRY:
White Shoes
Hosiery
Slip
Panties
Nurses Caps
Bras
BELL MEWS PLAZA. BELLS CORNERS. ONTARIO
Mrs. Catherine Buck. R.T.R. (Mgr.)
P.S. OH YES, WE ARE OPEN EVENINGS
52
Head Nurses
238-bed hospital with expanding
project underway requires a Head
Nurse for 36-bed General Medical
Unit August 1 976: for 40-bed
General Surgery - Urology Unit
September. 1976; and for 40-bed
General Surgery - Orthopedic Unit
September, 1976
Baccalaureate degree preferred,
administrative and clinical
experience an asset.
Salary commensurate with
education and experience.
Please apply to:
Director of Personnel
Red Deer General Hospital
Red Deer, Alberta
T 4N 4E7
Assistant Head Nurses
238-bed hospital with expansion
project underway requires two
Assistant Head Nurses, one
Maternal-child, and one general
surgery and orthopedics.
Positions available August, 1976.
Successful applicants will assume
responsibility for guidance and
teaching of nursing personnel and
serve as a resource person in
patient care.
Baccalaureate degree preferred,
experience in the clinical area an
asset.
Salary commensurate with
education and experience.
Please apply to:
Director of Personnel
Red Deer General Hospital
Red Deer, Alberta
T 4N 4E7
Operating Room
Supervisor
Required for a 650-bed
fully-accredited hospital.
Management experience and
advanced preparation in Operating
Room technique and administration
required.
Please apply giving full resume to:
Director of Personnel
Lions Gate Hospital
230 East 13th Street
North Vancouver, British Columbia
V7L 2L7
The Canadian Nurse July 1976
('Ialssi fïl-(I
.A \<<I,-(a,-t iHl-'II(a'lts
British Columbia
Director of Nursing required tor new acute care 25-bed hospital.
duties to commence Oct 1. 1976 Preference given to applicant wrth
prevIous experience as D O.N.. Head Nurse or Supervisor. Salary In
accordance wIth RNABC pohCles Apphcatlon to: DON. Pnnceton
General Hospital Box 610, Pnnceton, Bntlsh Columbia, VOX IWO
Head Nurse for Intensive Care Umt In 100.bed fully accrec!lted
hosp
al Salary and personnel pohcies In accordance wIth R N A.B. C.
Apply In wntlng to Director of Nursing, Fort Sl. John General HospItal.
9636 - 100 Avenue, Fort St John, Bntlsh Columbia VIJ IY3.
General Duty Nurses for modern 41-bed hospItal located on the
Alaska Highway Salary and personnel IX>lloes In accordance with
RNASC Accommodation available In residence Appl
Director of
Nursing. Fort Nelson General Hospllal. Fort Nelson Bntlsh Columbia
Generøl Outy Nurses for modern 35 bed hospllallocaled In south-
Drn B.C s Boundary Area with excellent reCreation faolrlles Salary
and personnel poliaes In accordance with RNABC Comfortable
Nurse s home Apply D"ec1or of NursIng. Boundary Hospilal Grand
Forks Bn..sh ColumbIa. VOH 11-10
Nova Scotia
Excellent opportunity for couple to administer 3D-bed licensed
NursIng Home In Nova Sc011a with optIon to buy Successful,
well-establIshed busIness. Full detaIls on request. Apply to
AdmInIstrator, Fahle.s NursIng Home LId., P.O. Box 1090. liverpool,
Nova ScotIa BOT 1 KO
Ontario
Re9'sfered Nurses for 34.bed General Hospllal Salary 5945.00 to
$1 145 00 per month plus experience allowance. Excellent personnel .
policies Apply 10 Director of Nursl'lg. Englehart & Dtstnct Hospl1al
Inc Englehart, Ontano. POJ 11-10
Saskatchewan
Oireclor of NursIng requ"ed for a 32-bed hospital in Gravelbourg.
Saskatchewan Supervisory expenence necessary. Apply In writing to
the. Adrmnls'rator. St. Joseph HospItal. Grave1bourg. Saskatchewan,
SOH IXO
Nurse Practitioner or equvalent reqUired for 15-bed Outpost Hospi
tal In native commUnity 400 miles north of Saskatoon Please con'act
D"ector of NursIng, Outpost HoSpItal, LaLoche Saskatchewan
United States
Small hospItal In Hoftywood. capaCIty of 44.beds, reqUIres experi-
enced ICU-CCU nurses. Must have California nurses registration
Every Of her week end off Salary from 511 00 plus 5100. shiff differen.
tlal If Interested. call collect 213-874-6111 or wnte to. Mrs Rita Jones.
Drrector of Nursing. 1233 North LaBrea Ave. Hollywood, California
90038
Nurses - If you are looking for an exciting change then contact us
We are oHeflng RNs and SRNs the opportunity to work In the U.S.A.
for six months or longer. Choice locations available We will pay your
fare and arrange accommodabons tor you. Free Health Insurance and
Visa Sponsorship Write First Girl International. 333 North Michigan
Avenue, ChIcago. illinoIs. 60601
Texas wants you! If you are an RN. expenenced or a recent
graduate, come 10 Corpus Chnstl Sparkhng CIty by the Sea . a CIty
bUlldmg for a better future. where your opportunities for recreation and
studies are hml1.1ess Memorial Medical Center. 500-bed. general.
teaching hospital encourages career advancement and provides
Inservlce onentatlon Salary from 5802 53 to 51.069.46 per month.
commensurate with education and experience. Differential for
evemng Shlt1.s. available Benefits Include hohdays, sick leave
vacations. paid hospitalization. health. life Insurance. pension
program Become a vital part of a modem, up-to-date hospital write or
call: John W Gover. Jr. Director of Personnel. MemOnal Medical
Center POBox 5280. Corpus Chnst.. Texas. 78405
Nurse Educators - PrOject Hope seeks nurse educators In vanOuS
speaalty areas for expandIng programs B.S.N., Masters, Or Ph D
(depending On position) and formalllnformal teaching expenence re-
qUired 24 month appointments. Salanes commensurate with educa-
tion and expenence Sand resume to Sheila Clarke. R.N.. Pro;?d
Hope. 2233 W,sconsin Ave.. N W , WashIngton. DC 20007, phone
(202) 338-6110, ext 68. E 0 E
Post Diploma
Program in Operating
Room Nursing
St. Michael's Campus
George Brown College of
Applied Arts and Technology
A 19-week program to prepare
Registered Nurses to be team leaders in
operating theatres. Combines theory and
practice, using the clinical facilities of the
St. Michael's Hospital Operating Room
Department. The program is offered twice
annually, March and August.
Applicants must be currently registered in
Ontario.
Applications are available from:
The Registrar
St. Michael's Campus
George Brown College
38 Shuter Street
Toronto, Ontario M5B 1A6
(416) 967-1212
Stjohn Ambulance
needs Registered Nurses to volun-
teer their services to teach Patient
Care in The Home. Will Vpu help?
O
St.
Ambulance
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 applicants should
apply to the:
Director of Nursing
Montreal Children's Hospital
2300 Tupper Street
Montreal, Quebec, H3H 1P3.
Foothills Hospital, Calgary,
Alberta
Advanced Neurological-
Neurosurgical Nursing
for Graduate Nurses
A five month clinical and academic
program offered by The Department of
Nursing Service and The Division of
Neurosurgery (Department of Surgery)
Beginning: March, September
limited to 8 participants
Applications now being accepted
For further information, please write
to:
Co-ordinator of In-service Education
Foothills Hospital
1403 29 St. N,W. Calgary, Alberta
T2N 2T9
Head Nurse
with preparation and/or
demonstrative competence in
Psychiatric Nursing and
Management functions, required for
Head Nurse appointment. To be
responsible for participation in the
organization, initiation, and the
management of a New Psychiatric
In-patient Unit.
Please apply, forwarding
complete resume to:
Director of Personnel
Stratford General Hospital
Stratford. Ontario
N5A 2Y6.
Public Health
Nursing Supervisor
Required by the Hamilton-Wentworth
Regional Health Unit.
This job requires an experienced person
to supervise and develop the services of
twelve to sixteen public health nurses and
others.
Qualifications and Experience:
Baccalaureate Degree in Nursing
Public Health Qualification
Several years of public health nursing
practice
University preparation in Administration
and Supervision or equivalent.
Salary:
Competitive and under review.
Apply in writing to:
Miss Dorothy S. Marshall
Director of Public Health Nursing Services
P.O. Box 897
Hamilton, Ontario
L8N 3P6
The CanadIan Nurse July 1976
53
"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
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For detaoled informatIOn
on available positions,
Interested applicants
are invited to complete
Clip and mail this coupon today the attached coupon
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I Name . Personnel Administrator
Medical Services.
I Address . Northwest T erritones
We have openings for II Ity .
;
é
;
:nd
physicians, nurses in II rovlnce .14th Floor
possession of a Public . Baker Centre.
Health Nursing I ostal Code 110025 106 Street.
Certificate or Diploma. ITelephone . Edmonton, Alberta.
Environmental Health I I 5J 1 H2 or call
Officers, X-Ray and . '-JUect Area Code
Laboratory Technicians. ._ _ _ _ _ _ _ _ _ _ _ _ 403-425 6787
Medical Services,
Northwest Temtories
Region. is seeking
Qualified personnel to
fill a number of public
health positions in
locations throughout
the N.W.T.
",...,v/'.:".
54
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The Children's Hospital of Eastern Ontario
req ui res
Patient Care Co-ordinator
Psychiatry and Youth Units
Co-ordinators are clinical nurse specialists and administrators of the
clinical areas, reporting directly to the Director of Nursing. The
psychiatric unit is a 24 bed unit for children up to and including 14
years, staffed by a multi-disciplinary speCIalty group. The Youth Unit is
a 27 bed medical-surgical unitforyouth between the ages of 13 and 17
years.
The applicant should be a registered nurse with:
At leastthree years experience in a paediatric! adolescent!psychiatnc
setting
Proven administrative experience
University preparation
Bilingualism is an asset
Minimum salary is $16,524.00 with a Bachelor's Degree
Position open August, 1976.
For complete information, job description and salary
"]nge.
forward resumé to:
Personnel Department
Children's Hospital of Eastern Ontario
401 Smyth Road
Ottawa, Ontario, K1H 8L 1
Director of Nursing
300-bed teaching hospital is looking
for a director of its Department of
Nursing.
Requirements:
Master's degree in nursing with a
minimum of five years of
administrative experience in a
teaching hospital. The candidate
must also be qualified for registration
in the Province of Quebec.
Salary:
In accordance with published
Government scales (salary class 19)
Please forward resumé to:
The Director General
Montreal Children's Hospital
2300 Tupper Street
Montreal, Quebec
H3H 1 P3
The Canadian Nurse July 1976
r
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I
I
Director of Nursing
Required to organize and administer direct care services in an
accredited 125 bed acute care hospital located in Thompson,
Manitoba which is developing as a regional centre. The position of
Director of Nursing provides ideal growth potential with the successful
applicant being provided with an opportunity to exercise innovative
ability in the design of a health delivery system to meet the unique
needs of Manitoba's northern communities.
We require a nurse who is registered in Manitoba or who meets the
registration requirements. Preference will be given to applicants with
formal administrative education and experience.
Excellent salary commensurate with education and experience. Many
fringe benefits including life insurance, pension plan, dental plan,
income protection and remoteness allowance. Consideration will be
given to assisting with relocation expenses.
Apply in confidence giving details as to experience, education,
and references by writing to:
Personnel Director
Thompson General Hospital
Thompson. Manitoba
R8N DC8
Director of Nursing
Weiland County General Hospital
Applications are invited for the position of Director of Nursing at this
417 bed fully accredited active treatment hospital with a 75 bed
Nursing Home Annex.
The Weiland County General Hospital has a NurSing Assistants
training centre with an annual student enrolment of 25. The hospital is
also a participating member in a Regional School of Nursing.
Preference will be given to applicants having Post-Graduate
University Education in Nursing Service Administration.
The successful applicant will be required to commence her duties,
August 3rd, 1976.
Please address applications or requests for additional
information to:
The Executive Director
Weiland County General Hospital
Weiland, Ontario
L3B 4W6
International Seminar on Terminal Care
November 3-4-5, 1976
"An Examination of the State of the Art of
Palliative Care of Terminal Patients and
Their Families"
This seminar is directed to physicians, nurses, social workers,
administrators and others who are working with terminal patients or
are interested in their care, and those who are presently planning
facilities to improve such care.
The aims of the seminar are: a) to review and discuss three
approaches to meeting the needs of the terminally ill and their families,
as presented by their initiators, and b) to present new knowledge and
skills in specific areas of care.
The programme will include presentations by a distinguished guest
faculty and by senior faculty members of McGill Universi1y and Royal
Victoria Hospital. Participants will be seated at tables for ten, with a
discussion coordinator at each table. The format for each session will
combine formal presentations, discussion at the individual tables, and
open discussion on the floor.
Registration fee: $125.00
For further information write to:
The Post-Graduate Board
Royal Victoria Hospital
687 Pine Avenue, West
Montreal, Québec H3A 1 A 1
Employment Opportunities
Province of
Pnnce Edward Island
Senior Nursing Supervisor
and Head Nurse
Department of Health
a '--' '
" "....1.)
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Position - Charlottetown: Hillsborough Hospital is seeking
supervisors at two levels. The Senior Supervisor will be required to
serve on a rotating shift. while the Head Nurse will be on a day shift.
Senior Nursing Supervisor
Qualifications: Applicants are required to have a recogmzed nursing
degree and/or nursing unit administration, and have had a number of
years responsible supervisory experience, preferably in a psychiatric
setting.
Special Necessary Requirement: Eligibility for membership in the
Prince Edward Island Assoclallon of Nurses.
Salary Range: $13.480 - $16,380 (depending upon experience)
Competition No 56NU5 1 :)
Head Nurse
Qualifications: Applicants must have graduation from a recognized
school of nursing, preferably with a nursing unit administration course
and have expene'lce '/' ... i(lng in a psychiatric setting.
Special Necessary Requirement: Eligibility for membership in the
Prince Edward Island Association of Nurses.
Salary Range: $10,550 - $12,820 (depending upon experience)
Competition No. 56NU211
General: All C,vil Service benefits will be provided. Further
information IS available upon request, by writing the Civil Service
Commission, P.O. Box 2000, Charlottetown, Prince Edward Island
Please refer to the appropnate competition number when applying
The Canadian Nursa July 1976
55
HEAD OF NURSING
ApplicatIOns are Invited for the position of Head of Nursing for
an SCHJed specialized research and teaching hospital affiliated
with the University of Toronto.
Reporting to the Director, the Head of Nursing will assume
overall responsibility for the management of the nursing discipline
In the Clinical Institute. The successful applicant will participate
in the development of programmes and policies for the provision
of optimum patient care and assume direct leadership In the
development of research and education programmes for the nursing
staff. The Head of Nursing will co-ordinate a general nursing
education programme in conjunction with Faculties of Nursing In
Toronto and elsewhere in the Province, as well as assuming an
active role in ensuring the integration of the nursing discipline
into our multi-discipllnary treatment programme. Consideration
will be given to a cross-appointment to the nursing faculty of a
recognized teaching institution.
Applicants must be eligible for registration as a nurse in Ontario
and have graduated with a recognized degree in Nursmg Science
at the Master's level or above. Interest and demonstrated ability
in administration will be required. Experience and training in
research and 'or educatIOn will also be required. An attractive
salary and fringe benefits package is available to qualified
applicants.
Applications will be accepted until July 31st, 1976.
Please send application and resume including date available to:
,
. ,
The Chairman r
Search Committee, Head of Nursing,
c 0 Executive Director's Office,
Addiction Research Foundation,
33 Russell Street,
Toronto, Onto M5 S 2 S 1
,.
Director of Nursing
Service
The Victoria General Hospital, Halifax, Nova Scotia, IS a
large teaching general Hospital owned and operated by
the Province of Nova Scotia. The Hospital provides
services in all of the clinical specialties with the
exception of pediatrics and obstetrics,
The Hospital is seeking a Director of Nursing Service,
which is a senior management position reporting to the
Executive Director. The duties Include participation in
the general management of the Hospital and
responsibility for the total nursing service program.
Accordingly, applications will be welcomed from
individuals with a strong background in Nursing who
also have the academic qualifications necessary to
participate at a senior level in the teaching programmes
of the Schools of Nursing at Dalhousie University and
the Victoria General Hospital.
The appointment offers excellent compensation and
fringe benefits. Applications should be directed to the
Executive Director. Victoria General Hospital, Halifax,
Nova Scotia,
56
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Medical Services Br.anch I
I f
1'- Department of National I
. i'
Health and Welfare
I , 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: I
City: Prov: _
-______________J
. . Health and Welfare Sante et Blen-ëtre SOCial
Canada Canada
The Canadian Nurse July 1976
Index to
Advertisers
July 1976
Abbott Laboratories Limited
Addiction Research Foundation
Equity Medical Supply Company
House of Appel Fur Company Limited
ICN Canada Limited
J.B. Lippincott Company of Canada Limited
- -
Mostly Whites Limited
Posey Company
Reeves Company
W,B. Saunders Company Canada Limited
Schering Corporation Limited
Uniforms Registered
.
Covers 2, 4
55
33
11
2
28,2 9
51
13
7
5
44
Cover 3
Advertising Manager
Georgina Clarke
The Canadian Nurse
50 The Driveway
Ottawa K2P 1 E2 (Ontario)
Gordon Tiffin
2 Tremont Crescent
Don Mills Ontario
Telephone: (416) 444-4731
Advertismg Representatives
Richard P. Wilson
219 East Lancaster Avenue
Ardmore, Penna. 19003
Telephone: (215) 649-1497
I3E.:J
Member of Canadian
Circulations Audit Board Inc
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
.
'76
The Canadian Nurse
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Sizes 12-20
Pristine Royale
White, Mint
About
$28.00
I"S I VUHITE
SISTER
pp our npw linp of Whitps and Water Colours at fine stores across Canad
HE DIFFE. NT
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Only ACTIFED combines pseudoephedrine HCI
with triprolidine HC!. the potent antihistamine
discovered in The Wellcome Research Loboratories
Orally effective ACTI FED reaches areas nose
drops can t-for long-term symptomotic relief of
allergic and vasomotor rhinitis the common cold,
hoy fever and allergic asthmo.
ACTIFED. The different one for initial treat-
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tolerant to other antihistamine combinations
the year-round way to stop
sneezes and sniffles
ACTIFED
Tablets/Syrup
Triprolidine HCI/Pseudoephedrine HCI
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SOME STYLES ALSO AVAILABLE IN COLORS
SOME 3Y2 -12 AAAA-E, ABOUT 23.95 to 32.95
For a complimentary pair of while shoelaces, folder showing all the smart Clinic styles, and list of stores selling them, write:
THE CLINIC SHOEMAKERS. Dept. CN-8. 7912 Bonhomme Ave. . St. Louis. Mo. 63105
Tha Canachan N.... Augual1976
3
8 76
Input 6
A tnbute to Margaret Kerr 10
News 12
Calendar 16
Names and Faces 58
Research 60
Audiovisual 62
Books 63
Library Update 65
The Canadian Nurse
The official journal of the Canadian
Nurses' Association published
monthly in French and English
editions
Volume 72, Number 8
Protest: Photostory S Emond
1976 CNA Annual Meeting and Convention
Part I - Quality of Life
Part" - Down East Hospitality
Part III - Introducing your new executive
- A retrospective assessment
- A report to membership
- Board of directors meeting
- Resolutions
The Sleep Assignment: A Way
to Learn Problem Solving
Understanding Neurotransmil1ers
and Related Drugs
Refresher Perspectives
Diary of a Retread
Dilemma
19
20
24
26
27
28
31
32
A Choi-Lai
34
B. Doughty,
J. Crozier
38
43
47
51
B. Scheffer
H. Nelson
-'"
N.L Rudd, B.M. Youson
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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
Lilerature, Abstracts of Hospital
Management Studies, Hospital
Literature Index, Hospital Abstracts,
Index Medlcus. The Canadian Nurse
is available in microform from Xerox
University Microfilms, Ann Arbor,
Michigan, 48106.
Nurses running for the health of it
Early risers in Halifax during the recent
CNA annual meeting included this
grol.p of RNAO members who started
each day with a few laps around the
park. Sporting T shirts boosting the
national association's next biennial
meeting in Toronto in 1978, are: (left to
right) Kay Glennie, Debbie Harding,
Barbara Brown, Donna Rowe and
Gayle Van Horne.
Photographer Terry Waterfield of
Wamboldt-Waterfield in Halifax took
the cover photo, as well as all others
featured in the convention coverage
which begins on page 20 of this issue
A Canadian Nurses' Association,
50 The Dnveway. Ottawa, Canada,
K?P 1 E2
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.
Subscnpuon 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 provinciall
territorial nurses' association where
applicable. NOI 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
The Canadian Nur.. Augual1976
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Guest editorial
It is an honor and a privilege to have
been asked to write this editorial as my
first duty in the office of presidenl of
the CanadIan Nurses Association. I
shall reflect briefly upon two key
issues, one of which is organizational
and refers to the operation of the CNA
itself; the other is professional and
refers to the potential role of nursing in
the deVeloping system for the delivery
of health care.
Many people have observed that
large associations, such as CNA, find
it difficult to declare their positions on
specific issues. When they do. it may
be at a moment when interest is
flagging and commitment diminishing.
It is apparent that this situation
occurs in part because the organized
11(>> I-t>> i II
.
,
,
,
nursing profession is many things to
many people. Varied goals, interests,
and responsibilities may result in more
inputs into the CNA "system" than it
can process or than it can handle in
the most logical sequence. In the
jargon of the systems analyst this is a
condition of "system overload_"
What happens when the system
is overloaded? Adaptive responses
are of two types: to allocate less time
to each input or to disregard those of
low priority. In both of these responses
there lies considerable risk of
depriving individual members of a
sense of direct contact and
spontaneous integration into the
professional association. The latter
becomes, so to speak, impersonal
and irrelevant to each nurse.
Moreover, when the association fails
to create an integrated position from
disparate opinions on important
issues we are perceived by related
institutions and social organizations
as lacking in credibility.
One of the immediate tasks of
each new executive working in
concert with provincial directors is to
develop and articulate a context within
which inputs can be absorbed so that
the association does not become
swamped and ultimately paralyzed
into inactivity. Failure to respond in an
appropriate manner at an opportune
time simply because consensus
As this issue goes to bed, we'd like to
think that each and every one of you
will find something of special interest
to read when you get your copy. For
those who attended the CNA annual
meeting and for those who want to
keep up with what their national
association is doing for them -
there's a detailed picture story on the
Halifax convention.
Then, there's a useful information
package in the form of an article on
"Neurotransmitters and Related
Drugs," a look at the controversial and
timely topic of amniocentesis
in "Dilemma," and one
nurse-teacher s approach to problem
solving, in "The Sleep Assignment"
Finally, for any of you thinking of
brushing up on your continuing ed
credits. there s an explanation of the
BCIT experience In "Refresher
Corrn....,...;.'''... " ......11................. ..... . ,..
light-nearted account of what it's like
to go back to school in "The Diary of a
Retread. "
Next month, The Canadian Nurse
will feature the first in a three-part
series focusing on the cardiovascular
system - in health and disease. The
September issue will include a review
of normal cardiovascular
development and congenital
abnormalities, and a discussion of the
role of the nurse in primary prevention
of cardiovascular disease.
Subsequent issues will deal with
emergency treatment, hospital
management and rehabilitation of
patients with cardiac problems.
If you want to brush up on the
fundamentals of cardiology, the
September issue of The Canadian
Nurse should be a good beginning.
cannot be reached can seldom be I
regarded as a virtue even in an
Imperfect world.
Another issue to which your
board must direct itself in this
biennium is to more clearly identify th I
responsibility of CNA members to th
citizens of Canada for the
development of strategies and
programs in the field of family healt I
care. Notions of family and communit I
health, while not novel to many
nurses, are only now receiving the
attention from governments, public
bodies, and health care professional-
that they deserve. Even during the
1976 Convention we were implored t
assume a more forceful and dynamj
presence in this area.
We are cognizant of our need Ie
explore our potential for family care, tc
research issues of individual and
family health, and to develop a body 0
knowledge and set of skills which wi I
permit us to take a leadership role I
among health care professionals. W
cannot lose this opportunity to makE
what may be a highly significant
contribution to the changing system:
of health care delivery.
The talent and commitment of thE
board which you have elected at
national and provincial levels augur
well for the type of leadership requirec
to move Canadian nursing in the
direction of novel solutions to the
problems that will arise during this
biennium.
- Joan M. Gilchris'
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
FOR
AMNIOTOMY
the AmmHook. amniotic
membrane perforator reduces
the chances of Injury to
mother and fetus because of
its protected point.
TRY THEM ...
AT OUR EXPENSE
O AMNIHOOK"
amnlollc membrane perforator
HOLLISTEÅ
en you are,
CONVENIENT
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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 Whars
more, our disposables don t crimp your budget. Irs
possible to perform amniotomy, clamp the baby's
umbilical cord. footprint him and circumcise him
for as little as 93<t.
FOR
UMBILICAL
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LIGATION
the Double-Grip' Umbilical
Cord-Clamp maintains a
constant pressure on the
cord until It dries
Designed for easy. one-hand
application
FOR
CIRCUMCISION
the Plastibell" CirCUmCISion
device permits clean. fast-
healing CirCUmCISions In as
few as three minutes
(Now available also
In the Hollister
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FOR
NEWBORN
IDENTIFICATION
the Disposable FootPrinter
conSistently delivers
high-quality. permanent
prints on Hollister Newborn
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IF=- =--------
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Please send me samples and literature on the products
checked below. I understand they will be sent to me free
and without obligation
D DOUBLE-GRIP'
Umblhcal Cord-Clamp
O PLASTIBELL'
circumCISion device
name UJlease prffll,
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MAIL TO
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332 CONSUMERS RD.
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COPYRIGHT 1975 HOLLISTER INCORPORATED ALL RIGHTS RESERVED
70ne
8
The Canadian Nurae AugUBI1976
1.11)11 t
Caring for the whole client
The public now demands a high
quality of nursing care with emphasis
on the individuality of the client. To
meet these needs, the nurse must
assume the following roles: team
member, colleague, liaison,
generalist, clinical specialist,
administrator, researcher, teacher,
counsellor, nursing and community
leader, and client sponsor and
supporter. She must be a flexible
person who has a general but
enriched education.
What kind of flursing education
curriculum can meet these varied
needs? First of all, the nurse must be
primarily a generalist. Her education
should include principles from the
humanities, behavioral and
bio-medical sciences. The problem
with nursing education tol:1ay is that no
connection is made between
disciplines. If these subjects are not
interwoven and presented as
Information relevant for assessing
client needs, the student will not apply
the principles of her education.
The B.N. curricula are mainly
centered around varying
concentrations of the arts and
sciences. There is no doubt in my
mind that each orientation is equally
important but, because the programs
are fragmented, the student often
responds by minimizing the
importance of interpersonal
relationship skills, or emphasizing her
interpersonal skills with a minimum of
interest in the blo-medical sciences.
Yet, a balance is possible. Rather
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NURSES ARE PRIVILEGED TO BUY ALL FUR GARMENTS
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Cut down the high cost, avoid
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BUDGET if you wish at no
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Famous brand of genuine leather
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119 Spadina Avenue
10th Floor
Toronto, Onto
M5V 2L 1
Tel.: 363-7209
Show Room Hours:
Daily 8 A.M. to 6 P.M.
Sat. 8 A.M. to 2 P.M.
.
..
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ill
-
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-
than debating the concentration of
bio-medical sciences or behavioral
sciences and humanities in the
curriculum, educators should focus on
unifying both main branches of
knowledge. Thus, the nurse will be
able to approach her client using
the 'whole person' orientation. Since
she is examining man in
psychological-sociological-bio-medical
terms, she is able to relate with, teach
and learn from her client. Because of
her knowledge of herself and the
'whole person' in her client, both the
nurse and client can experience much
satisfaction from -their encounter.
If nursing courses could be used
to interrelate the principles of the triad
of the disciplines, then nurses. could
cater to the 'whole person.' She would
then be a professional who is expert in
interpersonal relationships and would
be equipped to enhance and enrich
the health and lifestyle of her
"people. "
- Sharron Gallagher, B. N., Montreal,
Que.
Handmaidenlsm rejected
We wish to comment on the
article by F. Jo Logan (May, 1976.) We
take exception to the suggestion that
"nursing educators must retain
handmaiden skills in the curnculum
until they are not so urgently
required." On the contrary,
handmaiden ism fosters the traditional
subservient nurse-doctor relationship
and prevents the development of the
nurse and doctor working as
colleagues for the goal of patient care.
A large part of the mystical power
of the doctor is contained in the form
and in the carrying out of "doctor's
orders." We advocate that doctor's
orders be abolished and a "patient
treatment plan" instituted. This would
encourage all members of the health
team to participate in planning, and we
would be rid of a large stumbling block
to a "colleagueal approach" to patient
care.
We need innovative ideas coming
from recent graduates and seasoned
nurses. There is no direct relationship
between creativity and length of
service.
- Gail Gitterman. R.N., B.A.,
Instructor, Nursing Department,
Ryerson Polytechnical Institute,
Michael Gitterman, B.Sc., M.D.,
Toronto.
Nurses save lives
The nurses of the Renal Dialysi
Unit of the University of Alberta
Hospital in Edmonton have
undertaken a project to attempt to
increase the number of donor cadavE I
kidneys available for renal transplal'1
The project is being developed witt-
the support and guidance of the
Edmonton Chapter of the Kidney
Foundation of Canada. With the
approval of the Medical and Nursifll'
Administration of the University of I
Alberta Hospital, the nurses have
organized a program with the
following objectives: I
- to educate the general public abou
the need for organ donation and thf
need for carrying an organ donor car(
- to educate members of the medic;;
nursing and associated profe
sions
about the need for organ donations
and the method of preserving and
transporting donor kidneys.
We hope to relay the need to tt-
public by poster campaigns (poster:
to be made by our patients), and bj
setting up information booths in
shopping centers, and at convention
and group meetings. We have beer
asked to conduct inservice sessions i
various hospitals and public health
clinics and also hope to make use of a
aspects of the media - radio talk
shows television news, and articles
F
r further information write: Thf
Kidney Foundation of Canada,
Edmonton Chapter, Box 1011,
Edmonton, Alta.
- Phyllis Kalynchuk, R.N.,
Edmonton, Alberta.
Special delivery
This is an open letter in
appreciation of the library services
that the Canadian Nurses Associatio
provides. Recently our ICU group
presented a seminar on the various
aspects of death. I wrote t.he CNA
librarian, who proceeded to find
material for us. The only available
material was a tape. on loan from thl
Medical Services Branch, Health arn
Welfare Canada. Due to the
closeness of the presentation d.ate.
the library undertoòk the cost of
responsibility for the tape so that it
could be forwarded immediately to us
- Bev Fortner,(Supervisor), Prince
Rupert Regional Hospital, Prince
Rupert, B. C.
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10
The CanadIan Nurae AugUBI1976
Margaret Kerr
On June 27, 1976, Margaret E Kerr, editor and
executive director of The Canadian Nurse for 21
years, died in Vancouver.
Born in Ontario, a graduate of the Vancouver
General Hospital School of Nursing, the University of
British Columbia, and Columbia University, Kerr left
a 14-year teaching position at U.B.C. to become
editor of the journal in 1944. At this time, the mailing
list for The Canadian Nurse stood at 5000
subscribers, and Kerr undertook a vigorous 'selling'
program to increase circulation and awaken each
CNA member to her responsibility for the journal.
As early as 1944, Kerr discussed the idea of
subscription through association fees with the
Editorial Board of the journal. By 1949, her idea
received approval, and she began to put her
campaign into effect. Kerr believed that subscription
through fees would stimulate an interest and
understanding of recent professional developments
for nurses across Canada. Her campaign called for
thousands of miles of travel, countless talks and
formal addresses on her part, and asked for the
approval of the plan by each provincial association.
By 1959, a considerably enlarged subscription list
told the tale of Kerr's hard work and enthusiasm.
The success achieved by the journal under
Margaret Kerr's guidance won for her the admiration
of nursing editors internationally. By 1965, The
Canadian Nurse was reaching 113 countries outside
Teacher, Editor, Colleague, and Friend
...
Canada. Her advice and opiniOJlS were sought by
editors around the world. She was recognized by the
journal Board as an able businesswoman, of sound
judgment and acute insight. As a public speaker, her
warmth, sincerity, and conviction won the approval of
many for her cause.
Kerr was also deeply involved in the
professional activities of many provincial
associations, often in relation to the development of
registration acts. Within the CNA, she served as an
observant and watchful counsellor.
She was known for a generous nature; open to
criticism, willing to compromise, possessing a warm
sense of humor.
Kerr's objective was to further the cause of her
profession, to develop a t.?ody of well-Informed
nurses. She encouraged them to write so that others
might benefit from their experience.
Margaret Kerr will be remembered by many
people in many different ways - as a teacher, editor,
colleague, and friend.
The "right moment" will doubtless come, when fitting tribute
to the life and work of Margaret Kerr may be appropriately
attempted. Now, we are too close for perspective; too
conscious of loss. Nevertheless, our thought today must be
- "Thanksgiving" - for her rich and generous qualities of
mind and heart. These are locked into nursing's heritage.
They may, confidently, be left "in the lap of time."
Dorothy M. Percy, former Principal Nursing Officer,
Health and Welfare Canada.
Margaret Kerr, dear friend and close associate for 11 years
When her counsel was sought. it was given clearly,
concisely and cheerfully. We mourn her loss.
Penny Stiver, former executive director of CNA.
To her work with the Journal, as in other facets of her lifE I
she brought her vision, the strength of her convictions, i
deep sense of commitment, her loyalty, sound judgement
and her many personal attributes as administrator, editor
and nurse, leavened with humility, sensitivity, and a senSE
of humor. She was a leader. She helped to make, and
herself became a part of, the history of her profession ir
Canada.
Jean E. MacGregor, former assistant to the editor, CNJ
In view of the fact that she considered French-speaking
nurses to be members of CNA in their own right, Kerr
wanted them to be informed of the activities of their national
association, but she was just as eager to make
English-speaking nurses aware of what was happening If
the nursing fif'ld in Québec. In pursuing this goal. she I
maintained a remarkable enthusiasm and tenacity.
Suzanne Giroux, former executive director, ONa.
The CanadlBn Nurse AugUBI1976
11
The Canadian Nurse
from 1905 to 1966
1905 - in March, The Canadian Nurse begins
publication. Mary Agnes Snively,
superintendent of nurses of the Toronto
General Hospital, wins support for the idea.
The journal begins under the Commercial
Press, and the first editor is a doctor, Helen
MacMurchy, Minnie Christie, a graduate
nurse, is the business manager. The
journal is a quarterly publication, with an
editorial board composed entirely of
nurses.
1907 - The Canadian Nurse becomes a monthly
publication.
1910 - in May, Bella Crosby, a graduate nurse, is
appointed associate editor of The
Canadian Nurse. Crosby begins to meet
with nurses throughout Ontario and in
Montreal to stress the national character of
the journal and solicit support for it.
1916 - The Canadian Nurse is purchased by the
Canadian National Association of Trained
Nurses (later to become the Canadian
Nurses' Association). The editor of the
journal is Helen Randall, a graduate of the
Royal Victoria Hospital in Montreal. The
subscriber list at this time is 1,800.
1924- Randall resigns, with the subscription list at
1,950. Jean S. Wilson becomes executive
director of the CNA and editor of The
Canadian Nurse.
1932 - CNA headquarters moves to Montreal.
1933 - Ethel Johns of the Winnipeg General
Hospital becomes full-time editor and
business managerofThe CanadIan Nurse
Johns' concern is with ways to increase
subscriptions., She makes changes in the
format of the journal and improvements in
advertising contracts.
1944 - Johns retires, and the mailing list stands at
5,000 subscribers. Margaret E. Kerr
becomes editor, a position she is to hold for
21 years.
1946 - at least one article and releases from the
National Office, are to be in the French
language for every issue of the journal.
1949 - Kerr begins her campaign for subscription
through association fees.
1955 - the first full-time assistant editor is
appointed to the journal, as well as a
circulation manager and advertising
manager.
1958 - Kerr's title is changed to executive director
and editor of the journal Editorial advisors
are appointed, with each province
appointing one member (two from
Quebec).
1959 - in June, the first issue of L'infirmière
canadienne is published. The mailing list
stands at
English: 48,797 subscribers
French: 7,958 subscribers.
1965 - the journal is reaching 113 countries
outside Canada. Margaret Kerr resigns as
editor. The number of subscriptions has
risen to 59,985 English subscriptions, and
14,196 French subscriptions
1966 -On April 1, the entire CNA operation was
centralized in the new CNA House in
Ottawa.
he qualities I will remember most vividly about Margaret
err are her love of people and the high value she placed on
riendship. As a nurse-teacher and editor, these qualities
nabled her to give a kind of leadership that developed the
.. ndividual talents of many nurses. I can think of no higher
ribute than to say that she made a lasting contribution to
er profession through the personal enrichment of many
ndividuals.
. sobel MacLeod, former CNA president.
. eflecting on the life of Margaret Kerr one is reminded of
he advice of the poet, Rilke, to a young girl - "We must
lalways hold to the difficult - in the difficult we must have
our joys, our happiness, our dreams." This was Margaret's
þhilosophy which resulted in distinguished service to the
flursing profession. Despite serious objections she
,extended the circulation of The Canadian Nurse to every
tmember of the Canadian Nurses Association, and made
this publication a truly professional journal. Courageous,
forthright, and frank, always a staunch friend, Margaret
holds a special place in the annals of Canadian nursing.
RAa rhJHi,.... ...........a. ......el..... ...,.."e..ltant wun
When I first knew Margaret Kerr, The Canadian Nurse
carried only a few pages of French texts. In spite of the
financial deficit involved in launching a French edition, she
struggled to help us attain this goal. Margaret Kerr was a
very intelligent and open-minded person.
Alice Girard, former CNA president
None of us who heard her lectures at Vancouver General
Hospital school of nursing can ever forget this vibrant
woman who taught us to see that nursing extended beyond
the walls of the hospital. She was a nurse who seemed to be
free of the stiff restraints of nursing, who lived an exciting life
in nursing, and who broke down that barrier between
teacher and student with her warmth and enthusiasm.
Helen K. Mussallem, executive director, Canadian
Nurses Association.
12
The Canadian Nurse AugUBI1976
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CNA House, symbol of the unity of
Canadian professional nursing
organizations, now belongs - in fact
as well as intent - to the national
federation of provincial and territorial
associations of nurses across the
country.
To celebrate the occasion, a
symbolic burning of the mortgage
ceremony took place during the
recent convention. EA. Electa
MacLennan, who was president of
the national association during the
1962-64 biennium when plans for the
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national headquarters were finalized,
presided at the once-in-a-lifetime
event. In her remarks to the audience,
the former CNA president and life
member of the Association reminded
nurses that "for more than 50 years,
CNA was a tenant in other people's
houses, subject to all the
uncertainties and limitations of tenant
life. I was present and responsible
when this debt was assumed on
behalf of CNA and it is therefore most
pleasant and agreeable to be present
when it is committed to the flames. "
Nursing Publication
and Research Award
The Nurses' Association of the Clarke
Institute of Psychiatry, Toronto, has
approved a budget of $500.00 a year
to be awarded to nurses at the Clarke
for nursing research and publication.
The Association hopes that the award
will encourage nurses at the Clarke to
engage in research relevant to
nursing, especially in the field of
psychiatry. It is also hoped that the
award will be a vehicle for opening
communication lines
between 'psychiatric' nurses and
others in the nursing community.
The Association, whose primary
role is collective bargaining, stresses
the role of professional development
and views research and publication as
a means to that end.
The Nurses' Association at CIP is
interested in knowing if such a
program has been undertaken
elsewhere and with what effect. They
feel that their approach could be an
incentive for other groups to institute
similar programs. They welcome
comments and questions. Contact:
Mrs. J. Stanley, Clarke Institute of
Psychiatry, 250 College Street,
Toronto, Ontario.
Support grows
for scholarship agency
"
The Canadian Nurses'
Foundation took a new lease on life at
its 14th annual meeting this year.
Outgoing president, Helen Taylor,
pointed out that, when they were
elected two years ago, CNF Directors
were faced with one major question -
is the Canadian Nurses' Foundation a
viable organization? This doubt
prompted a period of fruitful
re-examination before the Board
concluded that the CNF still has an
important role to play in supporting
Canadian nurses in advanced nursing
studies. If numbers are any indication,
this year's enthusiastic turnout
marked strong support for the Board's
conclusion.
Efforts by the outgoing Board to
trim the budget over the past two years
were evident in their report of a $5000
per year drop in operating costs from
1974 to 1975. One austerity measure
was the decision to reduce the size of
the Board of Directors from nine
members to five. A new Board of
Directors, elected at the meeting
consists of: Margaret McLean, ARNN
(president); Louise Too, MARN
(vice-president); Hester Kernen,
SRNA; Shirley McLeod, RNANS; and
Barbara Archibald: RNAO.
One particular area of concern
discussed by the president, and later
worked into a resolution, was the fact
that, with the current unemployment
situation, postijraduate nurses who
have been awarded scholarships
often find it difficult to get jobs in their
specialty area. At the same time,
some areas of nursing such as nursing
research and community nursing are
experiencing difficulties finding
qualified leaders. The suggestion that
CNF not limit scholars to work in
Canada was countered with a
resolution that the CNF Board
consider the feasibility of alloting a few
scholarships per year to nurses who
wish to study in certain priority areas of
development in nursing practice.
In the coming year the Board will
also review and clarify voting rights
and privileges in relation to the various
categories of membership. At present
there are 805 voting members, 23
sustaining members and one patron.
was suggested that the by-law be
changed to give the vote to patrons
and sustaining members.
The report of the research
committee that a grant had been
.awarded to CAUSN marked the first
time CNF had given money to another
agency for research. A total of $500(
was voted at the May meeting for
CAUSN to undertake research to
develop a tool for use in the
accreditation of university programs ir
nursing education.
The award was presented by
Helen Mussallem, CNA executive
director, at the annual CAUSN
meeting in Quebec city in June.
SRNA holds
Annual Meeting
The Saskatchewan Registered
Nurses' Association elected three ney.
members of Council and a new
president during their annual meetin
held in Prince Albert in May
Sheila Belton, assistant director
of clinical nursing at the Plains Health
Centre in Regina, was elected
president of the SRNA for the next two
years.
The three council members will
also hold office for the next two years.
They are: Betty Hailstone, director 01
nursing at Pasqua Hospital, Regina-
president-elect; Margaret J. (Peggy)
Rosso, education and research
coordinator at the Plains Health
Centre, Regina - second
vice-president; Jean Keast, director of
nursing at Canora Union Hospital,
Canora - chairman of the Committee
on Nursing.
Dr. Jerome Lysaught. professor
at the School of Medicine and
Dentistry of the University of
Rochester, was the keynote speaker
at the annual meeting. His address,
entitled Expectation for Nursing -
The Impossible Dream of Impending
Destiny,involved different aspects of
nursing - clinical practice, teaching,
and research.
Lysaught stressed the
importance of a unified effort by
nurses to improve their professional
status and emphasized the value of
research in nursing practice.
The Canadian N.... Augual1976
13
Non-health system
concerns N.S. nurses
"Restrictive budgeting in health
matters has very grave and
dangerous overtones," Sister Marie
Barbara, president of the Registered
Nurses' Association of Nova Scotia,
told nurses attending the
Association s 67th Annual Meeting
held in Halifax.
"There is a national concern for the
escalating costs of health care
services and nurses share in this
concern," she said. "Nurses agree
that governments and all those
involved in the health care system
must take steps to contain
expenditures. However,
representallves of your association,
while accepting the role of responsible
leadership and cooperation in
continuing expenditures, must speak
out forcefully when budget cuts result
in deterioration of essential health
care services."
Sister Barbara suggested that if
hospital services must suffer cutbacks
in acute care areas "perhaps we may
be more successful in convincing
governments that they can provide
less costly alternatives to acute care.
We have been called to account in the
past and can expect that our
accountability will increase as the
publiC and public officials become
more and more disenchanted with the
present cumbersome unproductive
'non-health' system."
"How will the decision to effect
cutbacks in student enrollmenl in 1976
be Judged when and if another nurse
shortage is provoked several years
hence? Who will be held
accountable?" she asked.
"It is appreciated that these are
frustrating and distressing times for
administrative personnel in hospitals
and schools of nursing who must
continue to meet the public's level of
expectation for services on limited
budgets. But the RNANS views with
concern what it considers precipitate
action that may only assure short-term
goals. The associallon rightly feels
that it should have a more equal share
in health care decisions that may
affect nurse manpower supply and
subsequent health care of citizens."
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The 22nd of June, 1976 was a
significant day in the history of the
Canadian Nurses Association and its
newest member, the Northwest
Territories Registered Nurses
Association. The date marked the
official admission ofthe NWTRNA into
the national association, and
participants at the 1976 convention in
Halifax witnessed an impressive
ceremony to commemorate the
occasion. Slides showing the vast
expanses of the northern frontier and
some nurses at work gave the
audience a glimpse into the lives of
their northern colleagues. The crowd
responded enthusiastically and
welcomed the 10 representatIVes
from NWTRNA with a standing
ovation.
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Huguette Labelle, outgoing
president of CNA. presented
founding president, Leone Trotter,
with a gavel as a symbol of the new
member's official admission into
CNA After a short speech, Trotter
passed the gavel on to the
association's new presid
nt, Barbara
Bromley, who read congratulatory
messages from the Commissioner of
the Northwest Territories and from
other associations, and briefly
outlined the goals of the NWTRNA As
a special tribute to the new member
assoclaton, Louise Miner, past
president of the CNA, closed the
ceremony by leading the audience in
the singing of the Northwest
Territorres theme song, "North of 60".
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The official admission of the
NWTRNA into the national association
marks the culmination of a long effort
to achieve recognition, which began
in 1956 when the first meeting of a
group of nurses took place in
Yellowknife. Recognition of the group
as a full-fledged association was
achieved m January, 1975
The 10 NWTRNA members who
came to Halifax despite the
unpredictability of air travel, were
Loretta Abernathy, Barbara Bromley,
Sharon Collms, Ann Hendry,
Catheflne Keith, Janet Lindquist,
Ethel MacPherson, Mary Lou Pilling,
Lois Torrance. and Leone Trotter.
Mrs. Gladys Smith, director of
nursing at the Glace Bay General
Hospital is the new president of the
association. Other officers are:
Marilyn Riley, Halifax, 1st
vice-president; Patricia Fraser,
Waterville, 2nd vice-president; Jean
Dobson, Kentville, 3rd vice-president;
Margaret Power, Halifax, Recording
Secretary; Jane Buckley, Halifax.
Chairman, Nursing Service; Ellen
Murphy, Antigonish, Chairman,
Nursing Education; Leota Daniels,
Windsor, Chairman, Social and
Economic Welfare.
Membership in the RNANS now
stands at approximately 6,000
registered nurses.
Did you know?
Travelling down south this year? The
Canadian Public Health Association
has published a small booklet
desCribing what a person going to
warm climates should do before he
leaves and what Immunizations are
required. Write to: Canadian Public
Health Assoc., 55 Parkdale Ave.,
Ottawa, Onto K1Y 1E5
14
The Canadian Nur.. AugUBI1976
Xt>>\\"S
CHA 9th Annual
Convention
The high cost of health care was the
theme of the Canadian Hospital
Association's 9th national convention
held at the Chateau Laurier in Ottawa
In June.
The keynote address, by Maxwell
Henderson, former Auditor General of
Canada, set the tone for the three day
convention. Henderson told hospital
officials attending the the conference
that the government's role in health
care should be cut back to deal only
with capital funding on hospitals and
equipment, leaving the major
responsibilities for health care to
hospital administrators and patients.
Henderson outlined the growth of
government health care expenditures
in Ontario over the past ten years and
said that the public now expects the
government to bear the responsibility
for maintenance of health services. He
said that patients "should pay for the
services they need according to their
ability with the government picking up
the tab for the indigent. If they cannot
pay entirely, then they should be
assisted through either a means test
or income tax credit."
The conference involved many
speakers, with many alternate
solutions to the present costly health
care system. Many of these speakers
spoke in favor of decentralization and
the return of responsibility for health
care to individual administrators,
health care personnel, and patients or
'clients. '
Jean Lupien, Deputy Minister of
Health, suggested that health care
dollars be diverted from hospitals to
related services and preventative
medicine.
Seminar in
Occupational Health
Close to 40 nurses. the majority from
Nova Scotia, but some from New
Brunswick and one from Labrador.
attended the Spring Seminar for
Occupational Health Nurses in
Halifax. Sponsored by the Registered
Nurses Association of Nova Scotia,
the seminar was planned to help
nurses who are carrying out health
programs in industry or hospitals, to
bring them up-to-<1ate on particular
aspects of their work, and to give them
an opportunity to share experiences
and knowledge.
Some program highlights of the
two-day seminar were: "The Cardiac
at Work," Dr. C.R. May, Director,
Occupational Health, Dept. of Public
Health; "Safety," J. D. Fleming,
Chairman, N.S. Chapter, Canadian
Society of Safety Engineers;
"Emergency Treatment of Burns,"
and "Industrial Dermatitis," Dr.
Jennifer Kotz, Consultant in
Dermatology, Dalhousie University.
Coordinators of the Planning
Committee were Margaret Grice,
Nurse-in-Charge, Public Health Unit,
Health and Welfare Canada, Halifax,
and Brenda Penny, Supervisor,
Health Services Branch, Cape Breton
Development Corporation.
Good Samaritan Law in
Effect in Saskatchewan
ThOse practising emergency aid at the
scene of an accident are now
protected from liability by law in the
province of Saskatchewan. An Act
Respecting Emergency Aid became
law in Saskatchewan on May 7, 1976.
Section 3 of the Act states
"Where, in respect of a person who is
ill, iniured or unconscious as a result of
an accident or other emergency:
a) a physician or registered nurse
voluntarily renders emergency
medical services or first-aid
assistance and the services or
assistance are not rendered at a
hospital or other place having
adequate medical facilities and
equipment; or
b) a person other than a person
mentIOned in clause (a) voluntarily
renders emergency first-aid
assistance and that assistance is
rendered at the immediate scene of
the accident or emergency;
the physician, registered nurse or
other person is not liable for damages
for injuries to or the death of that
person alleged to have been caused
by an act or omission on the part of the
physician, registered nurse or other
person rendering the medical services
or first-aid assistance, unless it is
established that the injuries or death
were caused by gross negligence on
his part."
American Lung Assoc.
Nursing Fellowship
Nu rsing fellowships for graduate study
In respiratory disease are being
offered by the American Lung
Assocation.
Training fellowships directed
towards a career as clinical specialist,
teacher, or researcher in the care of
patients with respiratory conditions
are offered to graduates of accredited
baccalaureate schools of nursing.
The fellowships are in the amount
of $6,000 per year with the possibility
of one renewal for a maximum of two
years of support.
Awards are limited to U.S. and
Canadian citizens or holders of
bona-fide permanent visas for study in
U.S. institutions. Completed
applications must be received by
March 15, 1977.
Awards are also being offered to
University Programs in Nursing forthe
development of Respiratory Clinical
Nurse Specialty Programs leading to a
Master's degree.
The objective of the program IS to
prepare professional nurses to
assume leadership roles in the care of
individuals with lung disease and also
to prepare academic specialists,
The awards are In the amount of
$25,000 per year with the possibility of
renewal for a maximum of three years
of support. Completed application
must be received by November 1,
1976. Address inquiries to: Marilyn
Hansen, Consultant in Nursing,
American Lung Association, 1740
Broadway, New York, N. Y. 10019.
RNANS meets with
Health Minister
Minister of Health, Allan Sullivan, and
the Deputy Minister, Dr. Peter Nichols,
recentty met with Gladys Smith,
President of the Registered Nurses'
Association of Nova Scotia, and other
members of the Association to discuss
mutual problems with particular
reference to the current restraint
program.
Concern was expressed by the
nurses that without long-range
planning, and with few alternatives to
acute care, the restraints may cause
increased difficulties for people to
secure health care when needed.
They felt too, that an additional
backlog of elective treatments may, ir
the long term, result in costty crises.
Among other topics discussed were:
basic nursing education, in-service
development, health education in
schools and regulations for nursing
homes.
Smith pointed out that nurses are
in a unique position to influence life
styles and promote health. She
expressed the need for nurses to be
active participants in planning for
health care and in solving current
problems related to nursing practice.
To facilitate communications
between the Ministry and the Nursing
Association, a Nursing Advisory
Committee will be established to meet
with the Minister and the Deputy
Minister on a regular basis.
Did you know?
In 1973 in Northern Ireland, an
Integrated Health System was
established which took responsibility
for the totality of Health and Social
Services in Ulster.
The main government
department is divided into four Boards
that establish policy. Each Board is
subdivided into districts. Each district
board consists of a multidisciplinary
team - a doctor, nurse, social worker,
chairman of the Medical Advisory
Board, and administrator - who
function equally within the team and
whose task it is to administrate and
coordinate all health services in their
district.
Kathleen Robb, District
Administrative Nursing Officer for
North and West Belfast, visited CNA
House recently. She explained that
her district looks after the total health
needs of the population - not an easy
task since her district includes the war
torn areas of Belfast. Emergency care,
general hospital care, community
care, social service etc. are all within
the boundaries of the team. ThIS
means that expertise from all areas of
health and social welfare can be
utilized for the better application of
facilities and personnel. She stressed
the nurse's role in this team as being
equal in importance to that of all the
other team members.
GENEROUS NEW GROUP DISCOUNTS on all
Items shown, for group IJlJrchases. graduatIOn gifts. favors. etc.
6-11 Same Items, Deduct 10%; 12-24 Same Items, Deduct 15%
25 Dr More Same Items, Deduct 20% H
1lN
'_
...;-Bm
r-------------------------------------.
I IT'S EASY TO ORDER REEVES NAME PINS FOR YOURSELF OR FRIENDS! I
I Choose styte you Wlnt shown rliht Print name Land 2nd bot1om nght Attach
J:triil sheet for add.tuxwl pins I
I lone 01 desIred) "" datted '""" beJow_ Check olh.r InfO In "On SAYI"'S 011 2 10EII11CAl PillS . _ . ... .......i.nl. I
I boxes on chlrt. clip thiS Section and attach to coupon sÞn .n ClII ,f loss. I
LETTERING_______________________ 2nd lINE.________________1
I CllOOSl DßCItfflO" IACKGIOUIIII LET1U111C rtItES. I 1 Pill
.=
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II METAL fRAMED . Smoothpqstlc back.
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f
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The Lettering.. 03.1905.29
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SCISSORS and FORCEPS
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e: :.t;.I..
LISTER BANDAGE SCISSORS
31.'2" Mil..semlr. Tiny, handy, slip Into
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e_ Choose Jewefel'1
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h
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No. 3500 3'2 MinI........ 2.75
No. 4500 4'2" size, Chrome onl, . . . 2.95
No. 5500 5 V 2" size. Chrome onl, . . . 3,25
No. 702 71J4" size. Chrome ani)' . . . 3.75
For engraved inib.ls add 60. per instrument
3"'"
4"'"
5"'"
1\1."
KELLY FORCEPS
0..-- So hendy lor e..ry nurse'ldeo' '"' .lampillf!
off tubi" etc Stainless steel, 5'h"
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traiRhI, BOl Lo.k . . . . . 4.69
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No. 741 Thumb Drnslnl Fo
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MEDI-CARD SET Hond,.,' roler,
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sculptured caduceus emblem Full name
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NO. 3502 Chrome 9.95... Na. 6602 121<1. G.F. 13.95 ea.
PIN GUARD Stulptured oaduceu', .hained '<-
to your protessKIRII Jetttrs, Neh WI111 pmback I
wet)' catch Or seþlacf! either Witlth class pm Gold ,.,
finish 11ft bo-Ied Choose AN LPN or LVN
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<@[
f"-EXAMINING PENLIGHT
Wh,l. ..."el wi1fI uduoe", '"'!I'm!. Itv-
mlnum band II1d clip 5" long. U.s made, batteries
included frepLtcement batteries available any store)
No. NL,10 Penllrnr, . . 3.95 ea. In,lills enpl..d. add 60..
Bzzz MEMO-TIMER T'm. hol pI.ks, /i>:, ---
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j
signs. live medication. etc. Lightweight. compact.. .
ny," d,Ü ..Is 10 buu 5 10 60 m'n_ Key "ng_
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Oependable Timex "ursa PIIJsometer CJlendar Watch
:r"t:
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resistant Glft-boJed. 1 year warrantee Initials Urn".
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No. 237761 Nu"e.' WII.h _ . . _ . 19_95 ea.
1 Line
l."."... _ 0 2.69 04.49
2 Lines
l."."ns _ 0 3.49 05_79
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lenerJ"I
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Free Initials and '--
free Scope Sack with your own
Littmagn Nursescope!
Famous Littmann nurses'
diaphragm stethoscope
a fine precision instrumenl
with high sensItivity for
blood pressures, apical pulse
rate. Only 2 OlS., fits in
pocket, with gray vmyl anti,
collapse tubing, non-chilling
epoxy diaphragm. 28" over.
all. Non rotating angled ear
tubes and chest piece beau- No: 2160. Nursescope
t,fully styled in choice of 5 m
l_udmi Free
jewel.like colors. Goldtoee, Initials and Sack
Silvertone, B/ue, Greol, Pillt" Duty Free... 16.95 ea.
.11IIP0ATAlCT, N.w 'Me<Iollion' styling IlIO'udes tub'ng '" c:olors 10 molth
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Your intials engraved FREE on
chest piece; lend individual
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loss FREE SCOPE SACK neatly
carries and protects Nurse-
scope. Heavy frosted vmyl, with
dust-proof press type closure_
LITTMANN COMBINATION STETHOSCOPE
Maximum sensitivity from thiS fine professIOnal Instrument Con-
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Two '" II /, pngr "" chesl pI.... Rl, <r"P[ SACK INCLUO[IJ
No. 2100 Combo Steth . ..32.10 _ Duty Free
CLAYTON DUAL STETHOSCOPE
Llghtwelgl1t dual scope Imported from JIPIJI: highest
sensìtlvlly for aprea' pulse- rate. Chromed blnaurlls.
chnt p,ec
W1tiJ 1
" hell and 1 Yt" diaphragm,
lTey anti-Coliapse tubing. 40L, 29'" lonJ ú1ra _
ear plugs Ind diaptuigm Included. r... Initials C1!Æ)
.nl"'....d froe rREE SCOf'!: SAC
'"CI.UDED-
No. 413 Dual Stelh . , . 17.95 ea.
LOW-COST STETlioS'éõPE
Our lowest cost pr!C1Slon stethoscopel Smile dllphragm n 7,," dl.J
Otoose Blue, Green, Red. Silver or Gold tubinglnd chestp;ec.,. SlJyer
blnaurll,. ""Iy 3 Ol Three '"/1,"1, elllr..ed Iree FAEE SCOPE SAC
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LUGGAGE TAGS
OR PLAQUES
Bnpt c:olorlu' I
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chips With your name address deeply
.nlmed 13 lines, up 10 25 I."." (;
spaces per IInel. TII with heed chlm
led Ihru 2 ho'o, so Ilw,ys 100" oul
or plaque version with self-adhesive '.
....k 10 mount on flit surfoce Choose
Aed, o.lnl., Y.IIow, CocoI, Blue, Green
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T.300 (bead chain' or
T -400 (self.adhe.i.e' . . . 1.98...
Each .ddltionalltem with same
wordinR " 1 50 ea.
--
.-"
-..
--
.... --
-..... -
...-
... ..
..
MRS. R. F. JOHNSON
SUPERVISOR
-
III
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IN
=
CHARLENE HAYNES
-
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-\
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51.
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NURSES PERSONALIZED SPHYG.
Now in Fashion Colors! ,
A superb aneroid sphy'C esp<<.ally des1ped
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'" W _ Germany. Eesy Io-.1ltath V.lero o <uti,
hK11twelK111. compact, fits Into soft sim
luther llpper CiSe 2
" ... 4"" I 7" 0111-
ulrbt.ted 10 320nJn, IO-ye.or OCQIrocy
re:=t
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ked
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IS
engraved on manometer and eokl
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with Chrome metal manometer. or
BLUE. GREEN or BEIGE Wllh plosbc:
mana. housing, tubTnK. OJ" and case
"I c:olor-coord<n,ted ('peclfy "" c:oupon).
No. 106 Sphn" . . 39.95 el.
Duty Free
"-----
,'
,
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BLOOD PRESSURE SET
An outstandmilineroid sphyg. made
in lopon espeoillly lor A..... Meets
III U-S_ Go.. 5jJeC3, :!:3non Itcurocy
D ""rlnleed 10 ye.ors Block end
chrome manometer. cal to 30Jmm
Volero" Ir.y cull, bl.od< tubina:. soli
e
= I'iff: Serv
ed
nJ
e..r needed. Cllyton 110 4140
SI.lhesc:ope 1s,1w." end Stope Sod
inolucledls.. photo left) FRn lold
"""- --- init.als on case Here IS I sensib
,
t
';'
:
I. kll /1151 "cht
No. 41'100 B.P. Set...
Duty Free 33.95 set complete
Sphn. only No. 108 . 27.95 w,lh use
CAP ACCESSORIES
CAP TOTE keeps your tIpS .r.... end .I..n
flellble clear plastic w1ute trim. zipper. ClrT}lnl
,Irep. hene Ioop_ Stores lilt. Also lor willets.
..rI.", el<: 8
" dll. 6" hIp
No. 333 Tote.. .295 el.
Gold init. add 6Oc.
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"'-' :> WHITE CAP CLIPS Holds .lpS
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No. 529 Clips 85. per bol (min. " boll"
w
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-----------
TO: REEVES CO., Box 719- C, AttleborD, Mass. 02703
DRDER ND. ITEM CDLDR QUANT. PRICE
METAL CAP TACS 'air 01 dlinly
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Cod_us or Pilln Cod........ Gift bole,S-
No. CT,IISpe.ir, Inil,l. . . . . No. CT.3 IRN
Cad.1 . , No. CT,2 (Plain c.a.). . . 2.95 pro
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Use extra sheet for addlbonalltems or orders
INITIALS as desired:
TD DRDER NAME PINS, fill out all inlon-nalion in bol, lop
left, <lip out ano attaCh to thl' coupon
\ Please add 50<< handlin" pos
,.
t enclose $ I on orders to
lIin, under $5.00
No COD's or bIlling to individual. Mass res,,:lents add 3% S_ T_j
Master Charge and BankAmericard charg
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orders lotalinK $5. or more. Please submit complete Card I
r#t
:
terbank il. úJ)lratlon Date. and
Send to ..
Street
C,tv ..
.Stal.
_. _.l'D _
Iii
The Canlldlan Nurse Augulll1976
(jalell(1111-
August
Ninth International Conference on
Health Education will be held at the
Skyline Hotel, Ottawa, Ontario, Aug.
29 - Sept. 3. Theme: "Health
Education and Health Policy in the
Dynamics of Development." For
information, write: Canada's
Organizing Committee, Ninth
International Conference on Health
Education, c/o CHESS P.O. Box
2305, Station D., Ottawa, Ontario
K1P 5KO, ,
Critical Care Nursing: an eight-week
program offered five times a year, to
those registered or eligible for
registration in the Province of Nova
Scotia. The next program begins Dec.
.6, 1976with an application deadline of
August 30, 1976 For further
information, contact: Group Leader,
Critical Care Program, Continuing
Education, Victoria General Hospital,
Halifax, Nova Scotia, B3H 2Y9.
September
Respiratory Week - 1976
Educational Forum, at the Calgary
Inn Hotel, Calgary, Alberta. Sept.
1 - 3, 1976. Contact: Ms. E Lord,
Registration Chairman, 6528 - 23
Ave. N.E., Calgary, Alberta, T1Y 1V4.
Annual Conference: Emergency
Nurses Association of Ontario to be
held at the Royal Yorl< Hotel, Toronto
from September 8 - 10, 1976.
Contact: Mrs. Mary Arntfield, 897
Baltimore Ave., Mississauga, Ont.,
L5J 2R4.
Annual Meeting of the Atlantic
Provinces Psychiatric Assocation
to be held in Saint John, New
Brunswick on Sept. 16 - 18, 1976. For
information contact: J. D. McLean
M.D., 66 Waterloo St., Saint Joh
,
New Brunswick.
"Nursing end the Law" with
Lome Rozovsky at McMaster
University Centre, Hamilton, Ontario
on September 18, 1976. For
information, contact: Miss D.
McClure, Educational Co-ordinator,
Hamilton General Hospital, Barton St
E, Hamilton, Ontario L8L 2X2.
RNAO - 20th Annual Conference
at Honey Harbour, Georgian Bay,
Ontario. Four unique programs: Sept.
20 - 24,1976, You as a Person; You
as a Team Leader; You as a Manager
of Change. Sept. 18 - 25, 1976,
Advanced Program in Group
Leadership. Contact Professional
Development Department, RNAO, 33
Price St., Toronto, Ontario, M4W 1Z2.
The Present Status and Future
Di'rections of Residential Treatment
for Disturbed Children to be held at
the Chelsea Inn, Toronto on
Sept. 22-24, 1976. The Symposium
will feature talks and wOrkshops
conducted by experts in the field 01
children's mental health. For further
information contact: Dr. Philip Ba
er,
Thistletown Regional Centre, 11 'arr
Ave., Rexdale, Ontario, M9V 2A...
The Computer and the Nurse, to be
held at Mountain View, California, on
September 23 - 25, fee $135.00.
Contact: Institute of Nursing
Consultants, Fay Bower, 874 Miranda
Green, Palo Alto, California 94306.
Creating A Climate For Care -Role
of the Director of Nursing Service at
the Statler Hilton Hotel, 16th and K
Streets, N., w., Washington, D.C.
20036, September 24 - 25. Contact:
CONVENTION SERVICES, National
League for Nursing, 10 Columbus
Circle, New York, New York, 10019.
Association of Registered Nurses
of Newfoundland - 22nd Annual
Meeting to be held at the Holiday Inn,
St. John's, Sept. 27 - 29, 1976. For
further information, write: ARNN, 67
LeMarchant Road, St. John's,
Newfoundland.
"Recent Advances in Respirology
for Family Physicians" at McMaster
University Medical Centre, Hamilton,
Ontario on September 29, 1976. For
information contact: Dr. N.L. Jones,
Professor, Department of Medicine,
McMaster University Medical Centre,
1200 Main Street West, Hamilton,
Ontario L8S 4J9.
October
Association of Canadian Medical
Colleges - Annual Meeting to be
held at the Bayshore Inn, Vancouver,
B.C., Oct. 3 - 5, 1976. The
Association of University Schools of
Nursing, and of Rehabilitation, are two
associations holding meetings in
conjunction with ACMC. Information:
Mr. C.A Casterton, Executive
Secretary, Association of Canadian
Medical Colleges, 151 Slater Street,
Ottawa, Canada, K1 P 5H3.
Canada Safety Council - 8th
Annual Conferenée to be held at the
Skyline Hotel - Holiday Inn, Ot1awa,
Ontario from Oct. 3 - 6, 1976. Topics
to be discussed include: Occupational
Safety, Public Safety and Traffic
Safety. For information contact:
Conference Department, Canada
Safety Council, 1765 St. Laurent
Blvd., Ottawa, Onto K1G 3V4.
The Profeaalonals and Public
Polley. A national conference
sponsored by the Law and Economic
Program, Faculty 01 Law, University of
Toronto. Guest Speaker: Dr. Ivan
lIIich. Includes plenary and workshop
sessions. To be held at the Onlario
Institute for Studies in Education,
Toronto on Oct. 15 - 16, 1976.
Registration fee: $120.00. For further
information, contact: Conference on
the Professions and Public Policy,
Conference Office 12th Floor, OISE,
252 Bloor St. w., Toronto, Ontario,
M5S 1 V6.
Assertiveness Training Workshop
to be conducted by H. Fensterheim
and J. Baer, authors 01 "Don't Say Yes
When You Want to Say No" and G.V.
Kroetsch and G.D. Pulvermacher. To
be held at the Hotel Bonaventure,
Montreal, Quebec on Oct. 16 - 17,
1976. For information write: Centre for
Behaviour Therapy and Assessment,
3029 Carling Avenue, Ste. PH-2,
Otta wa, Ontario K2 B 8 EB.
Five Year Reunion - Lethbridge
Community College R.N. Graduates.
To be held on Oct. 23 - 24, 1976.
Contact: Joy Stenbeck, 434 - 12 Ave.
North, Lethbridge, AltB-, T1H 1P3.
Fifth Annual Pediatric Refresher
Course for Primary Care
Physicians to be held at McMaster
University Medical Centre, Hamilton,
Ontario on Oct. 29 - 30, 1976. For
infonnation contact: Dr Ross Parker,
Associate Professor, Department of
Family Medicine and Pediatrics,
McMaster University Medical Centre,
1200 Main St. West, Hamilton,
Ontario, L8S 4J9.
November
Every Physician A Geneticist. A
two-<1ay course on the practical
approach to the recognition and
management of genetic problems
seen in the physician's office.
Sponsored by the Post Graduale
Board for Continuing Medical
Education of McGill University and
The Montreal Children's Hospital.
Approved for credits.
Nurse-practitioners are welcome to
register. To be held at Le Quatre
Saisons, Montreal on Nov. 4 - 5,
1976. Fee: $125.00. For information
contact: Dr. H. Goldman,
Post-Graduate Board, Montreal
Children's Hospital, 2300 Tupper St,
Montreal, Quebec.
Health Care Delivery Systems In
North America: The Changing
Concepts 18th Canadian-American
Seminar to be held at the University 01
Windsor, Windsor, Ontario on
Nov. 11 - 12, 1976. For details write:
J. Alex Murray, Director
Canadian-American Seminar
University of Windsor, Winds
r,
Ontario, Canada N9B 3P4.
Clinical Application of Intra-Aortic
Balloon Pump (IABP) (Second
Annual Postgraduate Course) at the
University of Miami School of
Medicine, Miami, Florida on
Nov. 12 - 13, 1976. Sponsored by the
Division of Thoracic and
Cardiovascular Surgery and
Cardiology, Department of Medicine,
in cooperation with the Heart
Association 01 Greater Miami. AMA
accredited. Information: Division of
Continuing Medical Education,
University of Miami School of
Medicine, P.O. Box 520875, Miami,
Florida 33152.
- Su · ica Sponges
X-ray · etectable
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A Subs>draryot atllOf'\3l t het ßJ
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Tha Canlldlsn Nurse August 1976
19
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The week of June 14, was declared demonstration week by the Public
Health Nurses of Ontario. During that week, 350 nurses, employed by 26
health boards, assembled In front of the Parliament Buildings in Toronto to
urge elected representatives of the public and government to take action to
provide compulsory arbftration for the orderly resolution of unresolved
contract items. Since 1965, nurses in Public Health Units have had to resort
to strike action four times in an attempt to resolve the" contract disputes.
Their message is that they are fed up with strikes, with lockouts by their
health umt, fed up with leaving patients. The Public Health Nurses want the
same rights as other nurses in the province who are classIfied as essential
workers and as such are prohibfted from strike action.
Anne Gribben, executive director of DNA, who met with Labor Minister
Dr. Bette Stephenson and Health Minister Frank Miller, told the nurses that
neither minister would answer the nurses' demands for arbftration
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Annual Meeting and Convention,
Canadian Nurses' Association
June 20 - 23 1976,
Hotel Nova Scotian, Halifax
The skirl of pipes and the laughter of nurses
from all across Canada, as they reminisced
with one of Canada's best known story tellers,
set the tone for the opening ceremonies of
CNA's annual meeting and convention in
Halifax this year.
W.O. Mitchell, author of "Who Has Seen
The Wind" and the Jake and Kid radio series,
carried his happy audience back into Prairie
childhood days as he recalled that "trail-blazer
in the field of mental health, Melvin Arbuckle",
and the "first known use of shock therapy."
Newfoundland president, Roberta Clegg,
who introduced the speaker, thanked him for
his contribution to the convention of "some of
the best medicine in the world - laughter".
Delegates received official greetings from
the Prime Ministerof Canada. Telegrams were
also received from officials of the Pan
American Health Organization/World Health
Organization and the executive director of the
American Nurses' Association, Eileen Jacobi
on behalf of the ANA president and board of
directors. Nova Scotia Premier Gerald A.
Regan, who brought greetings from the
provincial government, reminded delegates
that the right to adequate health care.
regardless of financial means, is an important
and often overlooked part of the quality of
Canadian life. He pointed out that free drugs
for senior citizens and financial aid for students
are two of the factors that play an important
part in determining the quality of life for many
people.
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to the city of Halifax by Mayor Edmund Morris
and the deputy mayor of Dartmouth, L.M.
Fredericks. Second vice-president of the
International Council of Nurses, Margaret
Scott-Wright, extended an invitation to
Canadian nurses to attend the International
Congress in Tokyo next spring and told them
that Canada now represents one of the largest
groups belonging to the ICN. Dr. Scott-Wright,
who was the first person to be appointed
professor of nursing studies in the United
Kingdom, has carried out several temporary
assignments for WHO and recently accepted
the position of director of the school of nursing
at Dalhousie University in Halifax.
Several associations and special interest
groups in the health field sent official
representatives to the opening ceremonies of
the CNA meeting. These included: the
Canadian Hospital Association, Canadian
Medical Association, Canadian Council on
Hospital Accreditation, Department of the
Secretary of State, Psychiatric Nurses
Association of Canada, Canadian Division of
the International Association of Enterostomal
Therapists, Canadian Association of Practical
and Nursing Assistants, Canadian Dental
Association, Canadian Pharmaceutical
Association, Canadian Association of
Neurological and Neurosurgical Nurses, and
the Canadian University Nursing Students'
Association. The recently elected president of
the Nova Scotia Nurses Association Gladys
Smith, welcomed CNA members on behalf of
tho 1:1"'1.1\ "'Ie::
During an interview following the opening
::eremonies, Watson commented that the
Canadian Nurses Association, because of
the numerical strength of its membership
and the fact that its members
represent "the cream of the educational
crop," is potentially a very significant
organization. "Jf they can get it all
together," the broadcaster commented,
"nurses can make things happen for them.
Potentially, they represent a mighty force
in the field of health care."
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"Every human being is the repository of an
enormous bank of knowledge and experience
- the only problem lies in finding out how to
get in touch with this experience," according to
Patrick Watson, well known Canadian public
affairs broadcaster. He believes that in our
culture, there is too much emphasis placed on
certification of educational qualifications and
too little recognition of the importance of the
spontaneous capacity for individual
examination of actual experience. He urged
his audience of close to 1 ,000 nurses
attending the first session of the CNA
convention to use this knowledge and
experience with confidence to serve the cau
e
of humanity. "Whether you like it or not." he
said, "as professionals, you are exemplars
and therefore influential in your community.'
Watson's address set the tone for the
three days of events that followed. He
substituted as keynote speaker when Ralph
Nader. originally scheduled to speak on
the "Quality of Life," was not able to get to
Halifax because of the airline strike.
Watson reminded the nurses that their
concern for the quality of life must go beyond
hospital wards and clinics. "As soon as you
begin to engage in one social problem, if you
are true to your spirit, you end up by being
engaged until time and spirit run out. You
cannot stop with the quality of life in the
medical environment. You have to be involved
with your community, town, city, country, the
whole world." He described Canada as having
a strong tradition of relying on certificates
awarded at the completion of training "to show
you can do the job" and suggested that nurses
should not rely on thIs criteria in the evaluation
of members of their profession. "The onlv way
to assess a person's true value, IS through
human contact," he said.
Watson suggested that "the single most
important advance In medicine in recent years
has not been in the field of technology but
rather in the slow, not dramatic, transformation
of the role of the doctor in relation to his
patients from a God-like authority to a human
being. We created the seductive myth of the
infallibility of the physician." he said, "and until
recently, doctors have not tried to change it."
Senator predicts
new direction for nursing
'The future of nursing appears to he more in
the community and less in the hospitals than
has been the case in the past." This was the
message delivered by Senator Alasdair
Graham on behalf of the Hon. Marc Lalonde to
CNA delegates on the second morning of the
annual meeting. Senator Graham delivered
the address for the Minister of Health and
Welfare who remained in Ottawa to vote on the
question of abolition of the death penalty In
Canada. "Nurses can exploit the time that a
person is in hospital, to teach that person
Augusl1976
21
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about healthy lifestyles, but in the future their
work will probably lie more extensively in the
community," Senator Graham said. He urged
nurses to consider the alternatives of going
into the home, schools and industry in order to
improve the quality of life and affect the
behavior of individuals before it becomes
detrimental to life and health. "Above all," he
said, "you must be where the people are."
The senator pOinted out that occupational
health has been identified as a priority area by
the latest Federal-Provincial Conference of
Health Ministers and said that preventive
measures are being stressed. "There is
obviously great need for safety surveillance
and education, industrial hygiene surveillance,
improved first aid programs and good
occupational health services - all areas
where nurses can be involved" He predicted
that nurses would also encounter increasing
opportunities to care for the growing numberof
elderly in the population. many of whom could
be moved to more appropriate and less costly
nursing homes. "At no other time has it been
so important to look at alternative forms of
health care," he stated. "The country cannot
afford for very much longer the type of rise In
health costs that has been expenenced in
recent years It has been shown that pouring
more money into health care does not
necessanly translate into better health. In
other words, the quality of life is the cntical
factor In health and in the avoidance of
unnecessary illness and premature death."
The senator called on nurses to take a
22
The Cansdlsn Nurse August 1976
.
A highlight of the final day of the convention
was a round table discussion on the quality of
life in the work world of the nurse, Participants
were: Ginette Rodger, director of nursing
service and education at Notre Dame Hospital
in Montreal; André Payeur, Montreal lawyer;
Mary Vachon, mental health consultant at the
Clarke Institute of Psychiatry; and Anne
Gribben, chief executive officer of the Ontario
Nurses' Association.
Due to the air strike, Anne Gribben was
not able to participate in the discussion but her
paper on the socio-economic pressures on the
'lurse was presented by Linda Gosselin, also
of aNA. Ginette Rodger dealt with the
difficulties a new graduate faces when.she first
enters the work force. The present and future
possibilities for legal protection of the nurse
were discussed by André Payeur. Mary
Vachon presented a paper on the "Enforced
Proximity to Stress in the Client Environment."
reprinted next month in The Canadian Nurse.
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more active and influential role in the
decision-making process. "Possibly" in the
past, you were content to minister in the sick
rooms of the nation and did not make much
effort to seize the initiative, but this situation is
r.hanging very rapidly. The nurse's role has
been expanding with the acceptance of new
goals for women and, on the other hand, an
increasing number of men are entering the
nursing profession, as sex-typing of career
roles diminishes. Now is the time for tl]e
nursing profession to consider taking on a
broader orientation. It is time there were more
nurses on the boards of hospitals, and more
than that, the boards of universities, and
industries. "
Nurses debate preservation of life
The dilemma concerning the quality of life in its
final stages and the preservation of life at all
costs is central to the professional philosophy
of all nurses. Each nurse must decide for
herself the nature of the care and support she
can offer the dying patient. Some of the
considerations that may enter into this private
decision were formally aired during the CNA
annual meeting by four nurses who took part in
a public debate on the subject.
The resolution presented for discussion
was
'Resolved that nurses have 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-sustaining
intervention." Two speakers - Brenda Allt,
RNANS. and Sheila O'Neill. aNa,
represented the affirmative side of the debate.
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Some members of the round table discussion, pictured
above, are (left to right). Ginette Rodger (speaking), Jeannine
Telher-Cormier (moderator); Mary Vachon: and Linda
Gosselin.
On the opposite page, Patrick Watson talks to (from left to
right) Ruth May, Shirley Post, Cathlyn Macaulay and Pamela
Poole.
Members of the opposing team were Margaret
McLean, ARNN, and Suzanne Brazeau,
RNAO. Apolline Robichaud, past-president of
the New Brunswick Association of Registered
Nurses. chaired the debate. She reminded the
audience that the beliefs and actions of nurses
regarding the preservation of life are.subject to
increasing pressure and controversy because
of the pace of current technological
developments. Within the time limits set by the
chairman, the participants raised a series of
considerations both in favor and against the
resolution. Among the points they discussed
were:
. the factors that enter into the patient's
ability to give informed consent based on
reason, argument and belief;
. the inability of professionals to measure
death and the need to define it in terms of the
current state of knowledge;
. the pressures placed on the family of a
dying patient during a crisis situation and how
this affects their decision-making process;
. the fact that individual nurses must lose
their own fear of death in order to offer
adequate support to patients who are dying;
. the belief that an important aspect of the
nursing process is the ability to offer the patient
the care and support that enables him to have
the kind of death he needs or wants.
The quality of life, a personal approach to
some important problems
One of the highlights of the '76 CNA
convention was an interview by Patnck
Watson with four nurses who are making
significant and unique contributions to the
quality of life for Canadians. New approaches
to palliative care, maternity and child care,
nursing research, and the personal
responsibility of each individual to seek
solutions to problems around him, were
discussed by Cathlyn Macaulay, Ruth May,
Pamela Poole and Shirley Post. The accounts
of their experiences and their answers to
Watson's probing questions raised some of
the basic issues that nursing leaders are now
faced with and prompted a discussion that
continued for an hour after the interview was
scheduled to end.
Cathlyn Macaulay described a team
approach to nursing dying patients where the
patient is leader of the team and the nurse
works with the patient and his family
as "unique individuals with unique needs,
including pain and symptom control and the
resolution of emotional, interpersonal. spiritual
and financial difficulties." Macaulay is head
nurse of the Palliative Care Domiciliary
Service, Royal Victoria Hospital, Montreal.
The unit opened in January 1975 as a two-year
pilot project.
The nurses in the unit are specialists in
the control of intractable pain; under a doctor's
order they have the freedom to administer
analgesics, in the form of Brompton's cocktail,
The Canadian Nurse AugU811976
23
in the strength necessary so that dying
patients can maintain their capacity for
:enjoying life until the actual physical moment
of death. The nurses are supported by three
'fine" doctors who will make home visits when
asked to do so.
Macaulay stressed that the quality of life
of patients. what is important to them, "may be
completely different from yours," But it is the
preservation of the patient's unique enjoyment
in life that is the goal of her unit. "Attention to
detail is what is important to people who are
dying;' she said. She recalled a lady "who was
nearly blind, very ill with cancer. She lived in a
room in a boarding house, an atrocious
situation really. But for her, to stay there, at
home, was the most important thing in her life.
We managed to keep her at home with her own
medications, using enormous signs so she
would take them at the proper time. "
In treating the patient and his family as a
unit, the nurse must work in many dimensions,
practicing psychology, giving spiritual help,
and offering practical financial advice. As well
as helping the family come to terms with the
fact that their loved one is dying, the nurse may
be called on to help with funeral arrangements.
to get in touch with clergy, orto say a prayer at
the end,
The nurse who works with dying patients
must come to terms with her own feelings
about death and suffenng, but Macaulay says
the rewards are great. When asked how her
work affects her personal life. she answered, "I
have learned a great deal as a person.., I am
much more aware how precious life really is... 1
enjoy my life all the time. You become very
aware of everything that, within yourself, is
important in your own life .,
Ruth May, assistant professor and
lecturer in outpost nursing at Dalhousie
University, dealt with the other end of the
birth-death spectrum when she talked about
the role of the nurse-midwife in the maternity
process.
Canada is onr: of a very few countries that
do not use midwives as a normal part of
matemity care, she said. Yet a study of
perinatal mortality figures indicates that we do
not compare well with countries such as
Sweden, Denmark, Norway, Britain and the
Netherlands, where midwives are used as the
backbone of maternity care. She cited a study
in rural Mississippi, where the introduction of
nurse-midwives in the '70s reduced mortality
rates to below the national average, as proof
that the use of a nurse-midwife can reverse
this trend.
She stressed that tnere is an important
and unique role for the nurse-midwife in
Canada to provide comprehensive care for
mother and baby throughout a normal
pregnancy. "Canadian women everywhere
are looking forthe kind of counselling they can
get beyond the physician s office," the care
that physicians, who are busy IOOkinQ afterthe
complications of pregnancy, haven t the time
to give.
But concrete research is needed to
answer a number of questions. Is there a need
for the nurse-midwife in urban as well as in
rural areas? What are the im lications for the
medical profession? "What we need is
demonstration projects, adequately funded,
so that there is a sound basis for research
about the role of the midwife in Canada," she
said. One such project was carned out by a
group of Winnipeg physicians in 1971. The
group hired a nurse-midwife as a full associate
in practice and paid her a salary to provide
counselling for patients with routine
pregnancies. Although the service did not
enlarge their practice, patients were
enthusiastic and felt they received better care.
A question by Patrick Watson about the
obstacles to the acceptance of
norse-midwives in maternity practice drew
spirited comment from the audience. It was
pointed out that many OB IGYN specialists are
hesitant to accept the nurse-midwife as an
associate because it may mean a threat'to
their practice. At present, there is no provision
for payment of the nurse-midwife except
through the specialist s earnings, and it is
unlikely that the practice will be enlarged as a
result of this addition. May stressed that,
although support for the nurse-midwife IS
increasing, the primary obstacle is financial
due to our system of health care payments.
What can one person do to better the
quality of life? Shirley Post, a health care
consultant from Ottawa and former Director of
Nursing at the Children's Hospital of Eastern
Ontario, believes that every individual has a
personal responsibility to improve the quality
of life for all. She stressed that nurses need
more self-confidence to fight for the things they
believe in, and that the best place to start
making a contribution is "wherever you're at,,.
Every public reform began as a private
opinion." Nurses are in a good position to see
possibilities for improvements in areas such as
nutrition, immunization and community health
care, and to become instrumental in getting
these Improvements implemented.
Her own experience of . fighting city hall"
began when she moved to a subdivision and
organized a petition for more and better
sidewalk facilities. Her success convinced her
that one person can make a difference. and
she started to agitate for better quality health
care services fqr children in the community.
This involvement blossomed into a large and
powerful movement and seven years later the
Children's Hospital of Eastern Ontario opened
in Ottawa.
Comments from the audience focused on
the idea that nurses must first like themselves
and have the strength of their convictions in
order to pursue their goals in the face of
opposition. The rewards of taking risks and
fighting for a better life were summed up by
Patrick Watson as the satisfaction of
"personal, spiritual survival."
In some cases, however, it is not lack of
commitment but lack of know-how in procuring
the necessary funding that stops many
worthwhile projects in the planning stages.
Pamela Poole, Chief of the Information and
Evaluation Division of the Research Programs
Directorate at Health and Welfare Canada,
outlined some of the funding mechanisms
available through her department that can
make it possible for concerned citizens to have
an effect on health care.
With federal funding, available from the
Research Programs Directorate, It is possible
for nurses, even if they are not experts at
research, to create experimental models in
such areas as health care distribution and
health promotion. She described a few of the
projects the Directorate has been involved in,
including one in B.C. launched by a group of
women who were concerned about the lack of
sensitivity on the part of doctors to distinctly
female health problems. With the assistance
of the program, the group, which is led by a
nurse, set up the Vancouver Women's Health
Collective, a cancer prevention clinic designed
to teach women to examine their own breasts
and do their own Pap smears.
Patrick Watson, committed in his own way
to commumcations, stressed the importance
of sharing new ideas and experiences to
stimulate change and improve the quality of
life at all levels.
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While participants at the 1976 CNA Convention in
Halifax spent a good part of the three days in serious
discussion and business, a group of nurses from the
RNANS were busy behind the scenes making sure
that not all the time was spent working.
Opening night entertainment included a
musical welcome from the Dartmouth Junior Pipe
Band, the Halifax City School's Ukelele Band, the
Acadian Chorale and a hijacking by the Jolly Tars,
ending the evening with a Welcome to Nova Scotia
Punch P arty. For those who may have been inclined
to sleep in after Sunday night's punch party,
Monday morning's session was opened by Nova
Scotia nurses dressed in Sou' Westers singing a
rousing chorus of "Black Rum and Blueberry Pie. ..
To give visitors a preview of the cultural
attractions in Nova Scotia, an artistic representation
of the quality of life theme, presented Wednesday
morning, featured actors Joan Orenstein and David
Renton from Halifax's famed Neptune Theatre,
Acadian singer Marie-Paule Martin and pianist John
Robie.
Monday and Tuesday nights, association
members had an opportunity to relax at their choice
of three functions, A tour to Peggy's Cove ended
with a lobster dinner (two lobsters each!!) and
dancing at the Legion Hall in the seaside village of
Prospect. A water tour of the Halifax harbour
featured a shore dinner at the Clipper Cay
restaurant on historic Privateer's Wharf. Or, for those
who preferred the charm of the old country, a
Scottish Ceilidh and buffet dinner was held at the
Chateau Halifax. At all three events song sheets
were provided, and warmth, laughter and song
brought friends and colleagues from all parts of the
country together.
By the end of the three-day convention guests
had, indeed, experienced a taste of "down East
hospitality." Some were so won over that, when
homeward flights were cancelled, they simply
relaxed and made plans to visit more of the
province. If you have to be stranded somewhere,
what better place than Nova Scotia?
./7
211
Tha Canadian Nurse August 1976
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Introducing a a a
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Canada's national nursing organization enters
the 1976-1978 biennium with a strong vote of
confidence from nurses across the country,
the promise of increased financial support from
its eleven member associations, and a newly
elected executive determined to bring the
causes and concerns of the nursing profession
before a national forum and to try to find
effective solutions to contemporary problems,
The president for the coming biennium,
Joan M. Gilchrist, receiving the chain of office
from outgoing president, Huguette Labelle,
expressed it this way: "The potential
magnitude of the responsibility of this office
and the isolation of the presidency can only be
redeemed by the commitment of CNA
directors elected today. It is with the conviction
that concerted and effective action is possible
that I accept this prèsidency." Professor and
director of the McGill University School of
Nursing, Gilchrist headed the slate of CNA
officers elected during the association's recent
meeting. In her acceptance speech she paid
tribute to the personal and professional
qualities of former president, Huguette
Labelle, and touched on some of the key
issues forthe next biennium. She spoke ofthe
critical need for large associations to make
their position on important issues known to the
public so that they do not destroy their
credibility. "At the same time, we must find
ways to handle the input of our enormous
membership so that the organization does not,
if it has not already done so, deprive our
members of direct contact with their elected
representatives. "
The new president, was formerly director
of nursing and principal of the School of
Nursing at the Jewish General Hospital,
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Members of CNII's new Executive Committee
for the next two yeé1rs, elected by voting
delegates during the 1976 meeting in Halifax,
are: (left to right) Barbara Racine, Shirley
_ Stinson, Joan Gilchrist (seated), Sheila
O'Neill, Helen Glass, Linda Gosselin, Lorine
Besel anp Helen Taylor
Montreal, and supervisor of Mount Sinai
Hospital, Toronto. She is currently working on
her Php. in Sociology.
Gilchrist is chairman of the Canadian
Association of University Schools of Nursing
Committee on Structure and also a member of
the Council of Deans and Directors. She is a
member of the Special Committee on Nursing
Research ofthe Canadian Nurses Association
and, for the past two years has been
president-elect of the CNA.
Other officers elected for coming
biennium are: president-elect - Helen
Taylor, director of nursing, Montreal General
Hospital, Montreal and vice-chairman of the
Board of Directors of the Canadian Council on
Hospital Accreditation; first vice-president
-Shirley Stinson, professor, School of
Nursing, and Division of Health Services
Administration and graduate program
coordinator, University of Alberta;
second vice-president -Sheila O'Neill,
nursing director, Medical Pavilion, Royal
Victoria Hospital, Montreal;
- Barbara Racine, assistant executive
director, Nursing Practice, Royal Columbia
Hospital, New Westminster, B.C.,
member-at-Iarge for nursing administration;
- Helen Glass, director, School of Nursing,
University of Manitoba, member-at-Iarge for
nursing education;
- Lorine Besel, director of nursing, Royal
Victoria Hospital, and assistant professor,
McGill University School of Nursing, Montreal;
member-at-Iarge for nursing practice;
- Linda Gosselin, employment relations
officer, Ontario Nurses Association, Toronto,
member-at-Iarge for social and economic
welfare.
The CanadIan Nurse August 1976
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A retrospective
assessment
CNA's retiring president, Huguette Labelle, in
her address to delegates on the second day of
the annual meetIng, issued a strong plea to
nurses not to lose sight of the "fundamental
element of nursing - the care and support the
profession provides forthe peop
e it serves" in
the midst of their concern over expanding into
new roles in the years ahead.
She expressed concern over the 'trade-
off" that occurs when functions formerly
assumed by members of tht: IIledicaf
profession are transferred to nursing and
\'idmed of the danger of losing sight of the
fundamental care and support activities that
are the basis of the nursing process.
"More than ever, we must live up to the
statement that nursing is the 'conscience' of
the hf'alth care system,"she said. "Our
'conscience demands a strengthening of our
caring role that continues to lead us towards
the elusive grail of quality care."
In her review of activities during the
biennium when she provided leadership for
the national association, Labelle described
some of the changes that have taken place
and attempted to identify changing needs and
trends for the months ahead. Among the
contemporary concerns she identified were
precarious employment situations for both
new and experienced nurses, the need to
develop alternative health services and to
prepare nurses to fill Ihese roles in the
community. She stressed that nurses must
become more directly involved in the planning
and development of health care policy and
services so that they are in a position to act
rather than react and wamed that, "unless we
develop better mechanisms for forecasting
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accurately, there could be another 'shortage'
within a few years if natural attrition is not
compensated by a new supply of nurses."
"For those who are unable to obtain wor\<, it
is certainly an anxious time and as a
responsible professional association we must
be actively concerned, We need to study ways
of reducing the impact of unemployment and
of preventing such occurences in the future.
We cannot condemn recruiting of Canadian
nurses by other countries since we have done
the same in the past but loss of nurses from the
current pool combined with decreased
enrolment in diploma schools of nursing could
make the pendulum swing from shortage to
oversupply within a few years."
She called on nurses to take advantage of
this period of relatively stable employment
pattems to develop better nursing services in
acute care settings and to demonstrate that
"nursing, good nursing, does make a
measurable difference in patient care." She
stressed also the need to prepare "front-line"
nurses to function in altemate settings and
predicted that it would be as "health
practitioners" that nurses would emerge in
important new roles, "We now have an
outstanding opportunity to identify altemative
services and to determine how and in what
situations, nurses can benefit the population.
The question we must answer now is how we
can increase our impact on the quality of
Canadian life."
Labelle, who served on the CNA Board of
Directors for six years, was given a standing
ovation at the conclusion of her address.
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The Canadian Nurse August 1976
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One of the responsibilities accepted by CNA
directors is that of "reporting fully to the
Association at each annual meeting." In
Halifax this June, executive director, Helen K.
Mussallem, reported to membership on behalf
of the Board of Directors. Highlights from this
report are presented here for your information.
A report to membership
Membership
Admission of the Northwest Territories Registered Nurses
Association in December, 1975, brought the total number of
CNA association members to eleven and the number of
directors of the corporation to nineteen Individual
membership in CNA through member associations (not
including the NWTRNA) reached a new high of 111 ,846 in that
same month.
Action on Resólutions From 1974 and 1975 Annual
Meetings
. Members of the Board of Directors assumed
responsibility for reminding their jurisdictions of the
importance of submitting resolutions to CNA as early as
possible. Resolutions submitted prior to the end of March
appeared in tho April issue of The Canadian Nurse and
L'infirmière ca/Jddienne. Those received by early May were
reproduced and distributed with voting delegate kits mailed to
all association members one month prior to meeting.
Resolutions received after that time, or during the annual
meeting, were distributed - in accordance with present
procedure - to members attending the annual meeting.
. A Health Promotion Program for Nurses was developed
to raise the level of awareness of nurses to lifestyles
conducive to optimum health. This program was designed in
collaboration with Recreation Canada and the Canadian
Public Health Association and received a grant of $18,500
from Recreation Canada.
. The Board of Directors authorized a study to provide a
current description of the practice of nurses functioning in the
expanded role. Directors believe that a description of practice
is required prior to establishing guidelines for preparation.
continuing competence to practice, responsibilities, legal
protection and remuneration for nurses in an expanded role as
requested by membership. This project, named as a priority by
the Board of Directors, has received funding from Health and
Welfare Canada - Health Research and Development
Program Grant.
. The Board of Directors took action to encourage the
development of courses in geriatrics and long-term care for
registered nurses through discussion and communication with
appropriate bodies such as Canadian Association of
University Schools of Nursing. Association of Canadian
Community Colleges, Canadian Association of Gerontology
and member nurses' associations.
. The Association was in communication with the Minister
of National Health and Welfare to urge that sufficient qualified
staff be engaged to provide, upon request, multidisciplinary
consultation services to persons engaged in the development
and implementåtion of Health Research Projects. The
Minister has advised that his Department is exploring ways of
meeting the need for multidisciplinary consultative service in
connection with research services. In addition, Health and
Welfare Canada has provided CNA with a roster of present
Senior Health Research Scientists and copies are available.
. The Nursing Studies Index was published in 1974 and an
addendum to the Index was published in 1975. The pnce of
the Index, which covers cost of printing only, is $5.00 and the
addendum $1.00.
. A directive .....that the CNA adopt the practice, to the
extent possible, of using given and surname only for all
identification purposes" was implemented by Association
staff in journals. corporate documents and correspondence.
. A new formula for payment of fees was accepted at the
1975 annual meeting and became effective 1 January 1975.
Projects and programs
Early in this biennium, the President identified four main
priority areas. The Directors. their committees and staff
collaborated to make significant progress in each area Some
are long-range projects or programs that will continue beyond
The Canadian Nurae August 1976
29
this biennium; some were begun prior to this two-year period.
The major ones are:
. National Survey of Nurses
A national postal survey of nurses is underway to determine
responsibilities, practice setting, education, remuneration and
legal protection !status of nurses worl<ing in various
community settings. A random sampling of about 8,000 of the
estimated 14,000 nurses in these settings have received a
questionnaire, Analysis of the returns is currently being
carried out and will yield national baseline data on nurses
practising in community-based health services. The analysis
is scheduled for completion by December 1976 and a final
report for early 1977. These data should provide a basis for
further national studies.
. Health Promotion Program for Nurses
A follow-up program on nurses who completed the Health
Hazard Appraisal at the 1974 annual meeting was undertaken
and a health promotion program was developed in
collaboration with Recreation Canada. A pilot project
on "Health Promotion for Nurses" was implemented, with the
cooperation of RNAO, at the Toronto General Hospital,
Nursing Staff Development Department. The project was
aimed at raising nurses' awareness of their own health
standards and promoting changes in their lifestyles. Some of
the measurement tests demonstrated at the convention in
Winnipeg (1974) were used by the participants to determine
their state of health. They were then provided with fitness
programs suited to their individual needs.
A national program, with a "workshop on fitness and
lifestyles," initiated at CNA house in February 1976, has as its
major aim the measurement of the "health status" of individual
nurses and assistance to change their lifestyle in a way
which will promote better health. This workshop was attendea
by a representative from each provincial nurses' association
and one from NWTRNA and it included participation in fitness
tests and presentations on various aspects of fitness as a
method of disease prevention. Participants leamed how to
administer the Health Hazard Appraisal questionnaire and the
Canadian Home Fitness Test in preparation for planning
regional workshops. With this experience and the aid of a
grant from Recreation Canada, representatives then set up a
Health Promotion Program for nurses in their home province
or territory.
. National Standards for Nursing Education
The Board of Directors appointed an Ad Hoc Committee on
Standards for Nursing Education. This Committee's report
was presented to the Board of Directors meeting, held
immediately prior to the annual meeting. At the time of writing,
the Committee was in the final stages of preparing the
document which will set out: a rationale for preparation of
standards; definitions of terms used in the document;
statements of the various steps to be taken by educational
instituions in the planning, implementation and evaluation of
nursing education programs. Accompanying the draft
document will be recommendations regarding: feedback from
Canadian nurses regarding the document; revision and/or
modification of the document as necessary in the light of
reactions; mechanisms through which the final document
could be circulated; and mechanIsms or strategies through
which educators can be helped to make use of the standards.
. Development of Standards for Nursing Practice
The development of standards for nursing practice was
identified as a priority by the Board of Directors in Feburary
1975. An ad hoc committee on development of a definition of
nursing practice and development of standards of nursing
practice was established in April 1975 and alternate strategies
for accomplishing the task were presented to the Board of
Directors. Member nurses' associations have actively
collaborated in the work to date and their assistance will be
required by the Project Director.
. Health Status Indicators
In February 1975, the Board of Directors accepted a
recommendation of the Special Committee on Nursing
Research that CNA, in collaboration with other professional
associations, sponsor a conference if outside funding can be
obtained: a) to determine what research needs to be done to
develop and test health status indicators; and b) to encourage
research projects on this subject.
. Consumer Rights in Health Care
The Board of Directors accepted a recommendation of the
Special Committee on Nursing Research that CNA, in
collaboration with CHA, CMA and CPHA, explore the
feasibility of initiating a national project on "patients' rights.'
. Development of Comprehensive Examinations
A major project of the Testing Service is the development of a
comprehensive examination - in French and English - for
candidates writing registration examinations,
. Library and Archives Projects and Programs
Many projects initiated overthe past 10 years have developed
into an impressive program during this biennium. Serving all
CNA members, students and staff, the Library provides some
of the most visible "products" this Association has to offer.
CNA Library is a unique and invaluable resource center for
members. Board of Directors, committees, staff, teachers,
health practitioners and researchers in Canada and abroad.
Services are also provided to both the public and private
sectors. The National Nursing Archival Collection is growing
gradually and now contains a large number of pins, caps,
uniforms, medals, stamps, rare books, instruments, gifts from
international associations, prints of historic events,
photographs, etc.
. Nursing Abroad Program
CNA's Nursing Abroad Program is carried on by staff in
collaboration with, and under the auspices of, the International
Coundl of Nurses. This program's purpose is to facilitate the
movement of nurses from one country to another for reasons
of employment, study or observation. The service is offered
with the cooperation and assistance of CNA member
associations and nursing associations throughout tt'le world.
The volume of correspondence, espedally with nurses from
developing countries seeking study or employment in
Canada, increases yearly. During the past year,
approximately 1,200 letters were written by staff to foreign
nurses seeking study or employment in Canada; 42 visits
were made by foreign nurses to Canada; 52 Canadian nurses
requested assistance in studying, observing or finding
employment in 20 foreign countries; and more than 20
intemational visitors were received at CNA House.
Visitors to Canada, under the auspices of the World Health
Organization, their government or agency, are also
welcomed at CNA House. Their requests for information on
nurses and health in Canada are numerous and span a wide
spectrum.
. Program of the Secretariat
The on-going program of the secretariat may be considered a
"core" function of CNA. The secretariat ensures that all
requirements, as set forth in the letters Patent and By-law are
carried out. Staff members provide secretariat services to the
Board of Directors, Executive Committee, special and ad hoc
committees, make arrangements for annual meetings,
election of officers and maintain corporate and financial
records.
30
The CanadIan Nurse Augusl1976
. Statistical Program
Countdown, the pioneering project of CNA to c
lIect
up-to-date statistics on nurses and nursing in Canada, has
been recognized. This program was started in 1964 and
Countdown was published annually by CNA up to 1974 when
an agreement to publish nursing statistics was negotiated with
Statistics Canada.
A publication resembling Countdown 1975 and Statistiques
1975 went to press recently. This will eliminate the need for
CNA to print Countdown. However, the collection of some
data - particularly those related to basic nursing education -
has reverted to CNA due to budgetary cutbacks by the federal
government CNA will continue to seek the cooperation of
provincial registering bodies in obtaining this information. We
anticipate that Statistics Canada will carry out this project for a
three-year period. Its continuance thereafter will depend upon
a budgetary assessment.
. To date, CNA has compiled and maintained a Resource
Card File on about 14,000 Canadian nurses who have a
baccalaureate, master's, or doctoral degree. Each year,
information is collected on nurses who have received their first
or higher degree. Information gathered includes: year degree
obtained, university granting degree and the major area of
study. The need to obtain information on the Canadian nurse
population with special expertise has been recognized for
some years. CNA receives numerous requests from
govemmental agencies and voluntary associations for nurse
representation on committees, panels, etc., as well as for
assignments in Canada and abroad. CNA now has the
capability of maintaining an up-to-date list of several thousand
nurses with special expertise and this project is in the
developmental stage.
. Communications Program
This program touches all aspects of the Association but,
specifically, includes production of the two monthly journals,
public relations and translation services.
During this biennium, journal policy, format and content have
received special attention from the Board of Directors, its ad
hoc committee on the journals and staff. Several important
recommendations have been implemented. Within the
limitations of budget, every effort is being made to ensure that
the journal will become a more valuable and visible
communication tool. Similarity of format and content between
French and English editions is growing. CNA continues to be
the only national health-related association that provides each
member with a separate monthly edition in the language of
choice.
. Others
A number of other programs and services are available to
members, but only two are noted here. One is the CNA
Retirement Plan (CNARP) for nurse members and employees
who do not have access to a pension plan. The second is the
CNA Loan Fund. CNA provides this service to its members to
enable those who qualify to undertake post-basic
(baccalaureate or higher) studies in nursing. The total amount
available for loans, per year is $8,000 - 10 loans of $800
each.
Liaison Activities
As the national voice for Canadian nursing, the liaison role of
CNA is increasing daily. The volume of requests for
assistance, information, nursing representation on
committees and nursing viewpoints on current social issues or
developments has never been greater. They come from
international, national, provincial and local organizations, the
media, and federal and provincial governments. All
organizational units of CNA are involved in meeting these
needs.
Much time and effort has been devoted to this function since
directors and staff agree that it is through cooperation with
external agencies and communication with the public that the
contribution of nursing, as a profession, will be recognized.
Great strides have been made in promoting the policies and
beliefs of Canadian nurses and the Canadian Nurses
Association. The contribution and willingness of nurses from
all across Canada to serve on committees and task forces is
acknowledged and appreciated by directors and staff.
Directors, appointed representatives and staff have been in
active communication with about 50 national organizations,
more than 24 govemment departments, in addition to Health
and Welfare Canada, and more than 20 international
organizations. CNA is a member or affiliate member of a
number of these organizations. Details are available on
request.
Joint Committees
In addition to these liaison activites, CNA is involved in the
work of two important joint committees:
. CHAICMAICNA Joint Committee: Committee
composed of executive officers of three associations. Agenda
items discussed at the last meeting, included: Patients' Bill of
Rights; ethical aspects of life-sustaining measures;
implications of Bill C-68 and Bill C-72; role of midwives;
utilization of hospital facilities and influence of health
promotion on the cost of health care; transfer of medical
functions and endorsement of Medic-Alert
. Joint Committee on Extension Course in Nursing Unit
Administration: CNA and CHA have four representatives
each. CNA representative is current chairman. To date, over
7,000 nurses have taken this course and, at present, 600
nurses are enrolled. The course is offered in English and
French. In addition, the course is offered in Zaire, Haiti and
Lebanon. A request from Botswana is being considered.
......................................
CNA MEMBERSHIP at December 31.
Association Year
1973 1974 1975
Registered Nurses' Association
of British Columbia 13.389 14,646 15,251
Alberta Association of
Registered Nurses 10,060 10,698 11,410
Saskatchewan Registered Nurses'
Association 6,470 6,617 6,898
Manitoba Association of
Registered Nurses 6,007 6,284 6,794
Registered Nurses Association
of Ontario 13,183 14,534 16,398
Order of Nurses of Québec 35,196 38,084 40,954
New Brunswick Association of
Registered Nurses 4.339 4,540 4.476
Registered Nurses Association
of Nova Scotia 5,263 5,360 5,723
Association of Nurses of
Prince Edward Island 803 842 865
Association of Registered Nurses
of Newfoundland 2,442 2.519 3,077
Northwest Terntorles Registered (not
Nurses' Association reported)
Total 97,152 104,124 111,846
The Canadian Nurse August 1976
31
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from the meeting of CNA directors
in Halifax Jun
18 -19, 1976.
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. Bill C-68 (An Act to Amend the Medical Care Act): A letter, scheduled. The Committee also reiterated its concern .
. reiterating CNA s position concerning alternatives to acute regarding the high cost of developing the examination in two .
care and development of preventive services, was sent to the languages and asked for suggestions regarding possible
. Minister of National Health and Welfare. Copies will be sources of funding, A blueprint for the comprehensive .
. forwarded to member associations. It was suggested that examination, in English, has been developed and presented
CNA could best influence this legislation through to the Committee on Testing Service. It is anticipated that the
. representation and clarification at the provincial level and blueprint for the French examination will be completed by .
through providing data to provincial spokesmen at the next mid-August.
. federal-provincial ministerial conference in the Fall. .
. Canadian Council on Hospital Accreditation: According to
Report of Principal Nursing Officer: The Principal Nursing CNA representative, Helen Taylor. an increasing number of .
. Officer identified major issues facing the nursing profession, survey surveys have been conducted across the country and .
Including; present nursing manpower situation; the need for one area of concern has been identified: the proportion of
. CNA to consider re-stating its position on basic nursing large teaching hospitals that have received a lower rating or .
. education: and the problem of relating the philosophy of provisional accreditation has become almost twice that of .
nursing service to the provision of optimum nursing care. non-teaching hospitals. Medical review and medical records
. Recommendations and findings of the recently published are areas of special concern. The trend seems to be towards .
report of the Canadian Task Force on Cervical Cancer accrediting hospitals for two years instead of three. Medical
. Screening Programs were discussed and directors agreed audit has become a requi rement for accreditation in the United .
. that this document required further study. States and this may become a criteria in Canada as well. .
CCHA IS also attempting to promote the nursing audit. The
. Special Committee on Nursing Research: Members of the Mental Health Guide for accreditation of mental health care .
. board voted to initiate a discussion among representatives of institutions has been revised and is available from CCHA It is
the Canadian Nurses Association, Canadian Nurses anticipated that an additional seat for CNA on the CCHA .
. Foundation and Canadian Association of University Schools Board may become a reality in the Fall. .
of Nursing to review the development of nursing research In
. Canada and to suggest a plan for its orderly development in Nominations for ICN Board of Directors: Board members .
. the future, in terms of the policies and responsibilities of the approved the nomination of the following as members of the
different organizations involved in nursing research, the ICN Board of Directors: president, Eloise Duncan, Liberia;first .
. preparation and development of nurse researchers, the vice-president, Verna Splane, Canada; member-at-large, .
opportunities essential for critiquing research projects and any Nicole Du Mouchel, Canada; area representative, Eileen
. other aspectthe discussion group might deem necessary. The Jacobi, U. S,A. .
. Special Committee on Nursing Research was authorized to .
establish a subcommittee that will serve as a planning Kaspar Naegele Education Fund: CNA and provincial
. committee for the National Colloquium on Nursing Research nurses' associations contributed generously to this fund, .
sCheduled for 1977. which was established on the death of Dr. Naegele to ensure
. that his children received university education. CNA has been .
Committee on Testing Service: The Committee on Testing advised that all three children have completed, or are
. Service has postponed the intended implementation date for completing, their education. Dr. Naegele directed a study on .
. the comprehensive examination, scheduled for August 1978, nursing education in Canada, published in 1966 under the title .
due to insufficient time to produce a quality examination. A "A Course for the Future"
. revised date for initial use of the examination has not been .
. .
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32
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The Canedlan Nurse August 1976
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Resolutions chart
new course
for national association
in 1976 - 78
The Canadian Nurses Association received a strong
endorsement of its policies and projects at this year's annual
meeting. A proposed increase in membership fees was
accorded priority and was moved to the beginning of a long list
of resolutions considered by members.
The increase, necessary to keep the association solvent,
received the strong support of most members. A lively debate
gave rise to several amendments to the original resolution that
called for a hike to $12.00 in 1977 and $15.00 In 1978. Finally,
a resolution was passed:
. That the membership unit fee in CNA be $12.00 for
1977 and $18.00 for 1978.
Debate on the other 30 resolutions was kept short and to
the point due to an air strike which disrupted plans and left the
question of homeward travel "up in the air." Delegates,
anxious to catch chartered flights, buses and trains back to
their homes, passed a record number of resolutions covering
subjects from patients' rights to occupational health, all in
record time. The resolutions that were carried, outlining CNA's
official policy, directed:
. That an amendment be made to the letters patent
incorporating the Association to change the name
from "Canadian Nurses'Association - Association des
infirmières canadiennes" to "Canadian Nurses
Association- Association des infirmières et infirmiers
du Canada" and that paragraph D be amended to include the
Northwest Territories Registered Nurses Association in
its list of 11 association members.
. That sections of the by-law be amended to include the
following changes; 1) five members-at-Iarge be elected to
represent the fields of nursing administration, nursing
education, nursing practice, social and economic welfare and
nursing research; 2) one executive director be appointed by
the board and given responsibility and authority for
implementation of all Association policies, including the
Testing Service; 3) a three-member committee of
nominations be elected at an annual meeting of the
Association; 4) the Testing Service Committee be
established as a standing committee and thus be safeguarded
against dissolution other than by a membership vote at an
annual meeting.
. 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
starting point for discussion.
. That this assembly urge CNA and association members
to exert pressure on governments to enact legislation making
it mandatory for employers to make available a health
maintenance and promotion service for their employees;
and
That governments and employers be made aware of the
network of nursing services available in their communities as
well as the options this network provides in the delivery of
occupational health services.
. That CNA pursue with legal counsel the feasibility of
bringing tobacco under the Canadian Food and Drugs Act
and that any action be in collaboration with the Canadian
Council on Smoking and Health.
. That CNA encourage and promote a program of public
awareness regarding the day-to-day physical, social and
emotional needs of children and youth whether they be sick
or well; and
That CNA ask the Minister of Health and Welfare to give
priority consideration to the health care and health protection
of our children and youth when considering policies and
programs that will implement the report A New Perspective on
the Health of Canadians. Ottawa 1974.
. That the necessary resources continue to be allocated to
ensure that the project on national standards for nursing
education be completed; and
That this project be a priority in the biennium, 1976 - 1978.
. That the necessary resources continue to be allocated to
ensure that the project on national standards for nursing
practice is completed; and
That this project be a priority in the biennium, 1976 - 1978.
. That CNA seek funds to conduct a program for nurses to
further their skills in multi-risk health counselling in the
biennium 1976 - 1978
. That the CNA Board of Directors continue to urge
member associations and ordinary members of CNA to initiate
and conduct projects that will advance the development of a
knowledge base, and of the practice of nursing.
Tha Canadian Nur8e Augu811976
33
. That all CNA members be urged to support the Canadian
Nurses Foundation so that it can carry out its mandate.
. That this assembly support CNA in its efforts to provide
statistical data related to registered nurses in Canada and
recommends that every effort be made to:
1) maintain statistical tables in a consistent manner so as to
maximize their usefulness;
2) fix a publication date that will ensure the availability of
current relevant data;
3) revert to the publication of this statistical information in the
original format of Countdown.
. That CNA in conjunction with member nurses
associations and other appropriate health professionals,
develop a position statement regarding a realistic distribution
of educational programs for nurse-midwives in Canada
. That CNA take leadership in seeking funds to support
member associations in the holding of symposia on the
subject of pharmacotherapy to raise the level of awareness
of nurses to their responsibility for being knowledgeable in this
aspect of their practice; and
That the holding of such symposia be contingent upon
extemal funding,
. That CNA support Canada's position that each future
UN Conference remain constant to the purpose of the
Conference and not be distracted by political issues and
differences that rightfully belong in the General Assembly and
the Security Council; and
. That CNA support the Habitat Conference resolution on
the provision of clean water for all communities; and
That CNA endorse Canada's efforts for a target date of 1986
for the provision of clean water, and for a commitment as to
budgetary allocations by supporting nations; and
That CNA support the resolutions passed by the International
Non-Govemmental Organizations (NGO) Conference calling
for new institutional arrangements with the UN, including NGO
and governmental participation in any future action relating to
human settlements.
. That CNA request the Canadian Government to
implement the World Plan of Action of International Women's
Year to further the equality of women In all aspects of
national life throughout the 1976 - 1986 decade.
. Whereas, Bell Canada has plans to introduce a new style
receiver, the Balanced Armature Receiver, (B.A. A.), that will
not provide the electro-magnetic field required to activate the
present hearing aid design utilized by persons with hearing
disabilities, and since hard of hearing persons will then be
denied the benefits of telephone communications, CNA
should support the steering committee "Telephone
Receivers and the Hearing Impaired" in their discuSSions
with Bell Canada to have all B.A. Receivers equipped with
"Fluxcoil" so that those with impaired hearing may have the
same access to the telephone as they now have,
. That CNA acknowledge the concern of current English
language nursing graduates in Quebec for their future in
the practice of nursing in Canada.
'<J
rf -->
\::;="'i
'0;d)fl
.JP
. That CNA go on record as expressing concern to
government for the maintenance of existing programs
promoting health; and
That CNA urge government to allocate funds for the further
development of health promotion and maintenace
programs.
. That CNA take the necessary steps to ensure that
continuing education for nurses be a priority during the
1976-78 biennium.
. That Canadian nurses through their professional
organizations wor!< dosely with federal and provincial
governments to develop creative alternatives to the present
health services by implementing cost effective health care
programs which would provide greater choice and flexibility;
and
That Canadian nurses, through appropriate channels, call for
changes in the health care delivery system to ensure that a
full range of health programs is readily accessible to
Canadians.
. That the CNA Board of Directors consider the problem of
inconsistent French translation of CNA documents and take
the necessary steps to improve translation.
. That CNA take the initiative in inviting all existing special
interest groups which are of a national character and which
are comprised of ordinary CNA members, to become official
affiliates of the Association.
. That CNA actively encourage the establishment and
development of additional special interestgroups.in nursing
which are comprised of CNA members; and
That CNA be prepared to offer at least limited financial
assistance to such groups for organizational purposes and
up to their first two years of operation.
. That the CNA Board of Directors consider reconstituting
the Special Committee on Nursing Research in order to
change its designation from a special to a standing committee,
. That CNA support the continued involvement of the
public health nurse in school health programs.
. That CNA initiate cooperative action with all relevant
nursing groups to ensure th at doctoral programs in nu rs ing
are established to maximize the utilization of scarce resources
and accommodate the wide range of educational needs and
geographic locations of nurses in Canada.
Two other resolutions were referred to the CNA Board of
Directors for consideration:
. That nurses bring to the attention of CNA products
detrimental to health and that CNA take action towards
having these products removed from the market.
. That Canadian nurses, through their professional
organizations, promote increased use of existing community
nursing services to trace persons with sexually transmitted
diseases and to help families cope with problems related to
these diseases."
34
The Canadian Nurse Augusl1976
..-
q ttf 5lffP cnsslanMfnT:
A WA
( 10 L EARN
PROß L EM SO LV ING
In her professional environment, the nurse must continually work towards the solution of the problems that
confront her l . In fact, it is only by mastering this basic skill as a student nurse that she becomes competent to
meet the challenge of advancing technology. In this article, the author describes how she introduced her
students to a group experiment in the practical application of problem solving techniques that added appreciably
to their skills in this critical area.
Agnes T. H. Choi-Lao
An introduction to the concept of problem
solving, which is regarded by many authors as
the unique function of the professional nurse 2 ' 5 ,
comes early in the first year for most basic
baccalaureate students. Ideally, it is then
reinforced by patient assignments in clinical
areas throughout the remainder of the
program. Most educators, however, would
agree with this author that there is room for
improvement in current methods of teaching
problem solving. Although classroom lectures
provide the theoretical framework, clinical
patient assignments intended to reinforce the
concept are often too complex to make good
supplementary learning models. Because
their time and resources are limited, students
tend to focus only on the patients for whom
they must provide direct patient care and to
compartmentalize pattent problems into need
deficits. In their attempts to apply problem
solving techniques in everyday nursing
practice, these students rely on a variety of
sources for the answers they need. These
include:
- the theoretical grounding they have
received;
-guidance from their peers and supervisors;
- intuition;
- other coping mechanisms.
Convinced that more meaningful
experiences in practicing techniques of
problem solving could be found, the author
looked for a group project for her second-year
students that would be based on nursing care
and would also represent refinements of
learning situations found in everyday life. She
decided that the investigative question to be
answered by problem solving techniques
should deal with physiological needs since
these are the most fundamental of all human
needs and require constant satisfaction.
Further htought also suggested that the topic
should be relevant to current classroom
instruction since this would encourage
immediate application of theory. With these
considerations in mind, she formulated this
project. "An Assessment of Patients' Sleep
Needs."
The project
The specific problem chosen for the
project was an attempt to answer the
question, "How do patients sleep during their
hospitalization?". The purpose of the study
was to examine the factors affecting the sleep
of patients during their hospitalization (as seen
by these patients) and to determine:
. whether or not the sleep needs of these
patients were being met;
. if yes, how?
. if no, why not?
All clinical groups of the class participated
in the project which was designed as a group
assignment. Each group was required to
eY<:Imine the sleep needs of one patient in their
drticular clinical area. This method was
chosen because it was believed that for the
second year students, group effort would be
fruitful in problem solving. Also, the mutual
support obtained from group members would
provide the sense of direction they needed for
a new and challenging experience.
As soon as the students began to
examine the problem, they realized that there
were an almost infinite number of related
questions they must answer before they could
draw a meaningful conclusion. First, a total
understanding of the patient's sleep routine at
home was essential. Also, the students must
examine how the patient's health problems
had affected his sleep, both at home and in
hospital. Third, they needed to investigate the
hospital environment to see if it had any effect
on the patient's sleep pattern. Once the
students had listed all the possible areas they
must examine for data collection, they soon
realized that it was important for them to definE
"normal sleep." Did they mean the duration 0
sleep as experienced by the patient, or as
observed by others, since a discrepancy
between the two could occur?
The task of data collection was divided
among the group members who were allowec
to choose the method they preferred. The
interview method was the one common to all
groups. Patients' charts were also thoroughl
studied. Some students observed patient
activities and others investigated
environmental factors, in relation to sleep.
Hospital and ward manuals, were also
examined to obtain relevant data. Before
completing the project, students were requi rec
to describe their findings and
recommendations, These written projects
were submitted to the teacher for appraisal
and the cases were presented in class for
discussion.
Findings
Since the initiation of the project two years
ago, a total of 16 patients have been
investigated by two classes, These 16 patients
voiced a total of 96 complaints overtheir entire
period of hospitalization. Complaints were
grouped into five areas in order of decreasing
frequency:
1. Health problems
2. Environmental interferences
3. Uncoordinated daily activities
The CanBdian Nurse August 1976
35
L Psychological factors
i. Changed personal habits
. Health problems: Patients complained
Iboutpain more than any other single health
Jroblem. They stated that pain prevented
hem from falling asleep, and that they often
Iwoke from sleep with pain when the effect of
malgesics began to diminish. Restricted
)ositioning and dyspnea were cited as the
;econd and third most significant factors
;ausing sleep loss. Patients who were
roubled by frequency of micturition and
jiarrhea also suffered from varying degrees of
estlessness at night.
. Environmental interferences: Almost all
Jatients compained about noise. Intercom,
:Iectrovox, elevators, delivery carts,
llachines, telephones, and other
loise-producing operations are used
:onstantly during the day and, at times, in the
light. One patient remarked; "After a while,
:wen the Addressograph becomes a
lUlsance. "
One group of students used a cassette to
record the noise on the ward at about 13;00
lours - a time considered inactive by the
taft. When the five-minute recording was
played back later in class, it sounded like a
busy railway station. One patient, in response
to the questionnaire, wrote: "I find it incredible
that radios are allowed to blast constantly... I
can't rest, relax or think. I am grateful that I am
not seriously ill, for the radio nOise would be
very debilitating to my recovery."
3. Uncoordinated daily activities; Patients
,were almost as bothered by the haphazard
Itlmlng of daily activities on the ward as they
were by psychological problems. They felt that
these routine activities, scattered throughout
the day, were not coordinated with a view to
permitting them to obtain their rest and sleep,
I All patients commented on the poor ward
organization and complained about the
frequent interruptions which resulted in
inadequate sleep. Two patients questioned
I the necessity of having to be awakened one
hour before the arrival of breakfast trays; two
other subjects pointed out that missing
afternoon naps certainly lessened the total
amount of sleep obtained. Only one patient
thought that lack of exercise might be one of
the major causes for his wakeful nights.
4. Psychological factors: Most of these
comments related primarily to unidentified
anxiety. Two patients were deeply disturbed
by the knowledge of their illness, One
expressed this feeling directly by saying: "I
know I am going to die," Financial worries and
concern over family members were also
among the factors that caused loss of sleep.
One lady said: "The very fact that you are
away from home is enough to keep you from
sleeping." Another patient reported that a
frivolous comment made to him by an orderly
had caused him to lose a night's sleep.
Results
Changes in personal habits and daily
routine that occur as a result of admission to
hospital can also cause sleep deprivation, but
few patients commented on this aspect of the
study. Results and examination of the data
revealed that all patients suffered to a certain
degree from sleep deprivation, and all subjects
expressed the desire to sleep more.
Students who participated in the project
were unanimous in their opinion that action
should be taken to reassess and met the
sleep needs of hospitalized patients. They
listed in order of priority a number of nursing
measures that could be taken to minimize
sleep loss. These measures were then
grouped into the following eight areas:
. meeting the patient's need for comfort
. meeting the patient's psychosocial needs
. administration of medications as
prescribed following nursing assessment
. better coordination of nursing activities
. adjustment of physical environment to
meet individual sleep need
. meeting the patient's need for elimination
. meeting the patient's need for activity and
recreation
. meeting the patient's dietary need
ObservatIons and suggestions: Comfort
measures such as positioning, back rubs, a
warm bath at bedtime, and comfortable
bedding were recognized as important by all
the students. The satisfaction of both comfort
needs and psychosocial needs was
considered by the students to take
precedence over the accurate administration
of medications, mostly analgesics, sedatives
and tranquilizers. They recognized that,
although pain was the most frequently cited
cause of sleep loss, it was important to meet
the other needs of the patient first. Better
coordination of nursing activities could do
much to improve a patient's daily life while
hospitalized, Students proposed that
treatments and procedures be organized so
that patients could room together according to
their level of illness, in order to facilitate
nursing care, A rest period during the day was
perceived by many student investigators as
mandatory. They felt strongly that ward
manuals and policies should provide
guidelines for meeting the patient's sleep
needs. Students readily recognized the need
to regulate room temperature and humidity,
and to rearrange curtains and lighting to meet
individual demands.
There was a great deal of discussion
about methods of reducing the level of noise
on the wards. One group of students even
investigated the cost of using a bell boy paging
system instead of the existing Electrovox and
intercom systems. Others investigated the bus
route in front of one of the hospitals and
concluded that the route should be chanQed.
Frequency of micturition caused some
sleep loss. Lack of activity could reduce the
need for sleep. Students viewed the promotion
of proper activity and recreation as interrelated
with promoting sleep. The provision of
flexibility in meeting patients' dietary needs
was also discussed. One patient remarked
that he would sleep better if bedtime snacks
were available. Since all wards have unit
kitchens, this problem was not difficult to solve
Summary
The project revealed that hospitals clearly
could and should do a better job of meeting the
sleep needs of their patients. The most
significant finding. however, was that the
majority of problems identified could be
corrected simply by modifications in the
nursing modus operandi. The students took
great pride in their ability to improve nursing
care, and they also proposed, for future
nursing practice, the following six
recommendations:
1 THAT ward routine be organized to promote
patient-centered nursing care.
2 THAT a rest period in the aTternoon be made
available to all patients requiring it.
3 THAT the noise level on wards be reduced to
a minimum in order to provide a restful
envi ronm ent.
4 THAT the physical environment be made
conducive to sleep.
S THATthe individual patient's sleep pattern at
home be inquired into and recorded on
admission in order to identify needs.
6 THAT in-service programs be initiated to
educate and update hospital personnel to
sleep needs of patients.
It is eVident to the wnter that the students
were responsive to the existing problems in
nursing and were oriented to the application of
the first level of research. All of th e participants
in the project acknowledged that their skills in
problem solving had definitely improved; the
experience and knowledge gained was unique
and meaningful. Like all projects, the sleep
project will be continuously refined.
Eventually, it is hoped that it will help to make
problem solving an inseparable part of the
nursing curriculum and a natural and most
fundamental part of nursing practice. ...
Agnes T.H. Choi-Lao is a lecturer and
coordinator of Medical-Surgical Nursing at
the School of Nursing, University of Ottawa
She obtained her B.Sc.N.Ed. from Ottawa
University and her M. Sc. N. from the UniversIty
of Western Ontario.
References
1 Henderson, Virginia The nature of nursing: e
definition and its implications for practice, research
and education. New York, Macmillan, 1966. p. 4.
2 Abdellah, Faye G. Better patient care through
nursmg research, by ... and Eugene Levine. New
York, Macmillan, 1965. p. 12.
3 Lindeman, Carol A. Nursing research: a
visible, viable component of nursing practice. J.
Nurs Admin. 3:2: 18-21, Mar./Apr. 1973.
4 Nolan, Mary G. Problem solving is research in
action. AORN J. 20:2:225-231, Aug. 1974.
5 Downs, Florence S Research in nursing -
the genie in Florence Nightingale's lamp. Nurs.
Forum 12:1 :48-57, 1973
The author wishes to express her
appreciation to her colleagues and to the
students of Classes 1976 and 1977, School of
Nursing, University of Ottawa, for their
participatIon in this project.
r
LEADERSHIP IN LEARNING
Brady, R. I. Company. Brady's
PROGRAMMED INTRODUCTION TO
MICROBIOLOGY. Lippincott. 174 Pages.
Illustrated. 1969. $6.50.
Brooks, S. M. BASIC FACTS OF BODY
WATER AND IONS, 3rd Edition, Springer,
127 Pages. 1973. $4.95.
Chaffee, E. E. et al. BASIC PHYSIOLOGy
AND ANATOMY, 3rd Edition, Lippincott.
559 Pages. Illustrated. 1974. $13,95.
Chaffee, E. E. et al. LABORATORY MANUAL
IN PHYSIOLOGY AND ANATOMY, 3rd
EditIon Revised. Lippincoll. 236 Pages
Illustrated. 1974. Paper, $5.75.
Dean, W. B. BASIC CONCEPTS OF
ANA TOMY AND PHYSIOLOGY, A
Programmed Study. LippincOII. 346 Pages.
Illustrated. 1966. Paper, $5.95.
Jensen, I. T. PHYSICS FOR THE HEALTH
PROFESSIONS, 2nd Edition. Lippincott.
249 Pages. 1976. $6.95.
Memmler, R. L. STRUCTURE AND FUNC,
TlON OF THE HUMAN BODY. Lippincott.
240 Pages. 69 Illustrations. 1970. $4.25.
Memmler, R. L THE HUMAN BODY IN
HEALTH AND DISEASE, 3rd Edition.
Lippincott. 388 Pages. 75 Illustrations.
1970. Paper, $4.70. Cloth, $6.50.
Memmler, R. L WORKBOOK FOR THE
HUMAN BODY IN HEALTH AND
DISEASE. Lippincott. 237 Pages. 75
Illustrations. Paper, $5.75.
Olero, R. B. LABORATORY EXERCISES
IN MICROBIOLOGY, Lippincotl. 165
Pages. 1973. $4.95,
Selkurt, E.. E. BASIC PHYSIOLOGY FOR
THE HEALTH SCIENCES. LIllie, Brown.
662 Pages. 1975. Pap. $11.50. CI. $16.50.
Snivelv, W. D. Ir. TEXTBOOK OF PATH.
OPHYSIOLOGY. lippincott. 410 Pages.
115 Illustrations. 1972. $10.75.
Volk, W. A. BASIC MICROBIOLOGY, 3rd
Edition. LIppincott. j92 Pages. Illustrated.
1973. $14.50,
Carlson, C. E. BEHA VIORAL CONCEPTS
AND NURSING INTERVENTION. Lippin-
coli. 341 Pages. 1970. Paper, $5.90. Cl01h,
$ 7.5 O.
Fuerst, E. V. et al. FUNDAMENTALS OF
NU RSING, 51h EditIon. LIppincott. 450
Pages. Illustrated. 1974. $10.95.
Hein, E. C. COMMUNICATIONS IN NURSING
PRACTICE. Little, Brown. 242 Pages.
1971. S6.95.
LewIs, L W. FUNDAMENTAL SKILL:. IN
PATIENT CARE. Lippinlott. 495 Pages.
1976. Paper, $9.90.
Little, D. L, Carnevali, D. L. NU RSING CARE
PLANNING, 2nd Edition. Lippincoll. 325
Pages. Paper, $ 7 .50.
Locke, E. A. A GUIDE TO EFFECTIVE
STUDY. Springer. 200 Pages. 1975. $4.50,
Mass. Gen. Hmp. Dept, of Nursing. MASS-
ACHUSETTS GENERAL HOSPITAL:
Manual of Nursing Procedures. little,
Brown. 389 Pages. Illustrated. 1975. $8.95.
Nordmark, M. T., Rohweder, A. W. SCIEN-
TIFIC FOUNDATIONS Of NURSING,
3rd Edition, Lippincott. 480 Pages. 1975.
$7,50.
Sutterley, D. C. PERSPECTIVES IN HUMAN
DEVELOPMENT. Nursing Throughout the
life Cycle. Lippincott. 331 Pages. Illus.
trated. 1973. $8,25.
Armington, c., Creighton, H. NU RSING OF
PEOPLE WITH CARDIOVASCULAR
PROBLEMS. little, Brown, 310 Pages.
1971. $10.95.
Behnke, H. D. GUIDELINES FOR COMPRE-
HENSIVE NURSING CARE IN CANCER.
Springer. 400 Pages. 1973. $8.95.
Brunner, L. S.. R.N., M.S., Suddarth, D. S:, R.N.,
M.S.N. THE LIPPINCOTT MANUAL OF
NURSING PRACTICE. Lippincott. 1457 Pgs,
Illustrated. 1974. $21.50.
Brunner, L. S. TEXTBOOK OF MEDICAL-
SURGICAL NURSING, 3rd Edition.
Lippincott. 1156 Pages. Illustrated. 1975.
$19.75.
Caughill, R. E. THE DYING PA TlENT: A
SUPPORTIVE APPROACH. little, Brown.
228 Pages. 1976. Paper, $6.95.
Hall, I. E., Weaver, B. R. NURSING OF FAM-
ILIES IN CRISIS. lippinCOII. 264 Pages.
1974. Paper, $6.95.
Krueger, I. M. MONITORING CENTRAL
VENOUS PRESSURE, A Programmed
Sequence. Springer. 104 Pages. Illustrated.
1973. $3.75.
Long, I. M. CARING FOR AND CARING
ABOUT ELDERLY PEOPLE, A Guide
to the Rehabilitative Approach.
lipplncolt. 127 Pages. 1972. $3.90.
McCaffery, M. NURSING MANAGEMENT
OF THE PATIENT WITH PAIN. Lippincott
248 Pages, 1972. Paper, $4.90.
Metheny, N. M. NURSES' HANDBOOK OF
FLUID BALANCE, 2nd Edition. lipplncoll
Illustrated. 1974, Paper, $8,75.
Miller, M. E. ABOUT BEIJSORES, What You
Need to Know to Help Prevent and Treat
Them, lipplncott. 45 Pages, Illustrated.
1974. Paper, $5.40.
Morton, B. VD: A GUIDE FOR NURSES AND
COUNSELORS. litlle, Brown. 275 Pages.
Paper, $8.95.
Neelon, F. A" Ellis, G. A SYLLABUS OF
PROBLEM-ORIENTED PATIENT CARE.
Llltle, Brown. 121 Pages. $4.95.
Plumer. A. L. PRINCIPLES AND PRACTICE
OF INTRAVENOUS THERAPY, 2nd
Edition. Little, Brown. 1975. 349 Pages.
Paper, $6.95.
Roaf, R., Hodkinson, L. I. TEXTBOOK OF
ORTHOPAEDIC NURSING, 2nd Edition,
Blackwell. 592 Pages. 220 Illustrations.
1976. $18.50.
Sharp, L., Rabin, B. NURSING IN THE
CORONARY CARE UNIT. lippincott.
213 Pages. 89 Illustrated, 1970. $8.75.
Smith, D., Germain, C. P. H. CARE OF THE
ADUL T PATIENT, Medical-Surgical
Nursing, 4th Edition. lippincoll. ] 228
Pages. Illustrated. 1975. Paper, S 1 5.50.
Cloth, $19.75.
del Bueno, D. I. CASE STUDIES IN
PHARMACOLOGY. Liltle, Brown. 170
Pages. Illustrated. 1976. $5.95,
Ferster, M. ARITHMETIC FOR NURSES.
2nd Edition. Springer. 128 Pages. 1973.
$5.50.
Garb, S. UNDESIRABLE DRUG INTER-
ACTIONS, 1974-1975 Edition. Springer.
572 Pages. Paper, $9.50. CI01h, $13.95,
Modell, W. DRUGS IN CURRENT USE AND
NEW DRUGS 1976. Springer. 192 Pages,
1976. $5.25.
Rodman, M. I., Smith, D. W. CLINICAL
PHARMACOLOGY IN NURSING.
lippincott. 701 Pages, 1974. $11.75,
INCLUDED: Kennedy, D. R. "IURSES'
GUIDE TO CANADIAN DRUG LEGIS.
LA TlON. lippinCOlt. 1973.
Rodman, M. I., Smith, D. W. PHARMA-
COLOGY AND DR\JG THERAPY IN
NURSING. LippinCOlt. 738 Pages. Illus'
trated. 1968. $11.50.
Scherer, I. C. INTRODUCTORY CLINICAL
PHARMACOLOGY. lippincott. 367 Pages,
1975. $8,75,
Weaver, M. E. PROGRAMMED MATHE.
MA TICS OF DRUGS AND SOLUTIONS,
With Revisions. lippincolt. 109 Pages.
1966. Paper, $2,75.
Anderson, L., et al. NUTRITION IN NURSING
Lippincott. 406 Pages. Tables and Charts,
1972. $9.75.
Church, C. F., Church, N. Bo....es and Church's
FOOD VALUES OF PORTIONS COM.
MONL Y USED, 12th EdItion. Lippincott.
195 Pages. 1975. $6,90.
Fischer I. E. TOTAL PARENTERAL NUTRI,
TION. LIttle, Brown. 454 Pages. Illustrated.
$25.00.
Massachusetts General Hospital Department of
Nursing. 01 ET MANUAL. Little, Brown.
Appro", 150 Pages. Spiral. Ready Summer
1976.
Mitchell, H. S., et al. NUTRITION IN HEALTH
AND DISEASE, 16th EditIon, lippincott.
Appro". 750 Pages. April 1976, Cloth,
$14.50.
FROM LIPPINCOTT
DiVincenti, M, ADMINISTERING HEALTH
SERVICE. lillie, Brown. 340 Pages.
1972. S8,95.
Franck, P. NURSING MANAGEMENT: A
Programmed Texl. Springer. 170 Pages,
IliusHa\ed. 1974. S6,50.
Kraegel, J. M., et .11. PATIENT CARE
SYSTEMS. L,ppincOII. 219 Pages. Tables,
Charrs. 1974. S 10.95,
Levey,S.. et .11. HEALTH CARE ADMIN,
IS TRA TlON, A Managerial Perspective.
LippIncott. 603 Pages, 1972. S 17,00,
Notter, L. E" Ed. D., R.N. ESSENTIALS OF
NURSING RESEARCH. Springer. 147
Pages, 1974. Paper, S5,25. Cloth, S8.50,
Notter, L. E., R.N., M.A., Ed,D., et .11. PROFES-
SIONAL NURSING. Lippincott. Abt, 600
Pages. July 1976. Paper, Abl. S9.50. Cloth,
Abl. SI2.50.
Price, E. M. STAFFING FOR PATIENT
CARE-A GUIDE FOR NURSING
SERVICE. Springer. 190 Pages, 1970. S5.95
Walter, J., e\ .11. DYNAMICS OF PROBLEM
ORIENTED APPROACHES, Pa\lent Care
and Documentation. Lippincott, Abr. 225
Pages. 1976. Abt. S 7.50,
Woolle
, F. R. PROBLEM-ORIENTED
NURSING. SPringer. 176 Pages. 1974.
Paper, S5,25. Cloth, S8.50.
IH
Hall, J. E., Weaver, B. R. NURSING OF FAM.
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Starr, B. D., Goldstein, H. S. HUMAN
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Bates, B, A GUIDE TO PHYSICAL EXAM-
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38
The Canadian Nurse August 1976
Chemical neurotransmitter substances are released at the axon terminals of the central, autonomic,
and peripheral nervous systems of the human body. The most well-known of the neurotransmitters
are acetylcholine, norepinephrine, dopamine, and serotonin, It is these substances that facilitate the
conduction of nerve impulses throughout the body, allowing the coordination of body functions and
enabling response to the environment. The effective action of neurotransmitters makes the
difference between health and disease states. A nurse's understanding of neurotransmitters and of
many common drugs influencing their function is essential to safe nursing practice.
Understanding
Barbara Doughty and Julie Crozier
The nervous system and the endocrine system have the task of
maintaining coordination of the many activities of the body and of
preparing its responses to the external environment. Nerve impulses
are transmitted along a network of nerves with many
interconnections in all parts of the body. Here we shall examine
chemical neurotransmitters, the agents that make possible the
transmission of impulses from one nerve cell to the next, and the
effects of common drugs on these neurotransmitters.
How Nerve Impulses Travel
The basic structural and functional unit of the nervous system is
the nerve cell or neuron. It is on this cell that all nervous function
ultimately depends. The neuron consists of a cell body with a group
of extensions called nerve fibers emanating from it. (See figure 1)
The nerve fibers can be divided into two groups:
1. the dendrites - the multiple branched extensions conducting
nerve impulses toward the cell body.
2. theaxon - a single long extension branching into many fine nerve
terminals and conducting nerve impulses away from the cell body.
Conduction of a nerve impulse depends on its transmission
from one cell to the next. It is at the synapse, the junction between
the axon of one neuron and the cell body and dendrites of another
neuron that chemical neurotransmitters are released to allow for
transmission of the impulse.
The synapse, the junction between two neurons, is specialized
to allow the electrical activity of one neuron to influence the
excitability of a second neuron temporarily. A nerve impulse is
conducted along the axon to the synaptic knob. a slight swelling at
the end of the presynaptic neuron. (See figure 2) A narrow
extracellular space called the synaptic cleft between the presynaptic
and postsynaptic neurons prevents direct transmission of the impulse
from one cell to the next. It is at this junction that the electrical
potential of the nerve impulse IS transformed into chemical activity.
Impulses travel from one neuron to the next in the following way:
1. The nerve impulse, oraction potential, in the presynaptic neuron
reaches the axon terminal and depolarizes the synaptic knob.
2. Quantities of chemical transmitter are released into the synaptic
cleft by diffusion. (These transmitters are stored in vesicles in the
synaptic knob).
3. The transmitter combines with reactive sites on the postsynaptic
cell.
4. There IS a localized change in cell membrance permeability
resulting in the movement of sodium and potassium ions across the
membrane.
5. The chemical impulse begins again in the postsynaptic neuron,
and continues as an electrical impulse.
More recent theories suggest that the transmitters are produced
in the cell body itself and are carried down the axon by axoplasmic
flow to be stored in the presynaptic knob. 1
Specific enzymes break down these transmitters in the synaptic
cleft. Once the transmitters have depolanzed the postsynaptic
membrane, they are destroyed by these enzymes, leaving the
neuron to be repolarized for a subsequent impulse.
Synapses do not OCcur exclusively between neurons and
neurons. They also occur between neurons and motor end plates
and between neurons and smooth and cardiac muscle cells.
Depending on the function of the neurons involved, different
chemical transmitter substances are released. They function either
to encourage the postsynaptic neuron to produce nerve impulses
(excitatory) or to discourage nerve impulses (inhibitory).
Table 1 indicates some of the better known neurotransmitters,
their sites of release, breakdown, and the body responses they are
thought to effect.
Alterations in the concentrations of neurotransmitters
contribute to disease states. Parkinson's Disease and Myasthenia
Gravis are two commonly known conditions associated with such
changes, Less common conditions include the poisoning effect of
strychnine, muscarine of certain mushrooms, the venom of snakes
and Black Widow spiders, and tetanus toxin,
Synapses are vulnerable to many drugs and toxins which can-
· modify the synthesis, storage, or release of the transmitter
substance
· interiere with the breakdown of the substance so that its action
is abnormally prolonged
· block reactive sites on tne postsynaptic membrane to prevent
combination with the transmitter.
Many ofthese drugs are commonly used; therefore their actions
in relation to the normal function of neurotransmitters ought to be
understood by nurses to ensure the safe administration of such
drugs.
The CanadIan Nurse August 1976
39
11EIJ
IJT
flrJsrnITTE
S
,
'and related drugs
Figure 2 Synapse at the
Neuro-muscular
Junction
Figure 1 Several neurons
CELL BODY
DENDRITE
AXON
PRE-SYNAPTIC
NEURON
SYNAPSE
PRE-SYNAPTIC
MEMBRANE
VESICLES
CONTAINING
ACETYLCHOLINE
TERMINAL
BUTTON \
POST-SYNAPTIC
MEMBRANE
CHOLINESTERASE
RECEPTOR
SITE
40
Table I
The Canadian Nurse August 1976
Transmitter Substance
Acetylcholine
Site of Action
- released at
a) the neuromuscular
junction
b) the preganglionic
terminals of the
autonomic nervous
system
c) the postganglionic
terminals of the
parasympathetic
nervous system
d) the postganglionic
terminals of the
sweat glands in
the sympathetic
nervous system
- released by cholinergic
neurons
Bre akdown
- by the enzyme
cholinesterase
Body Response
---
a) skeletal
muscular
contractions
b) parasympathetic
responses, ego
- decreased heart
rate and
contractility
- pupillary constrIc-
tion
- increased
gastrointestinal
secretion and
motility
- increased sweating
The Catecholamines
1. Norepinephrine
2. Epinephrine
- secreted by the
adrenal medulla
- released at the
sympathetic
postganglionic
junctions
- released by adrenergic
neurons
- rapidly removed
from the synapse by
M.A.O. (monoamine
oXidase)
- therefore has shorter
effect tha n
acetylcholine
- broken down into
inactive products
- end product V.M.A.
(vanillylmandelic acid)
measured in the urine
as a test of
catecholamine
breakdown
- sympathetic "fight
or flight" response
ego
- increase in heart
rate and contractility
- constriction of
peripheral blood
vessels
- dilation of
bronchioles
- dilation of
pupils
3.
Dopamine
(precursor 01
norepinephrine
formed by the
chemical reactions
of amino acids
phenylalanine and
tryosine)2
- found In high
concentrations in the
putamen and caudate nuclei
in basal ganglia of the
cortex
- dopamine accumulates.
due to a lack of enzyme
to convert it
to norepinephrine
- released by dopaminergic
neurons (cell bodies in
substantia nigra, end in
corpus striatum)
- thought to relate
to motor function
and aggressivity
ego Dopamine
concentration in
basal ganglia low
in Parkinson's
Disease 3
- exact role unknown
Serotonin
- central nervous system
neurotransmitter
- found in pineal
gland, hypothalalmus
G.I. tracts, blood
platelets
- by MAO. into
5HlAA
- (5-hydroxyindole -
acetic acid)
5HlAA is
measured in the
urine to indicate
degree of
serotonin
metabolism
- function poorly
understood
- may be involved in
temperature
regulation. sleep,
mood and behavior
The CanadIan Nurse August 1976
41
Transmitter Substance
Site of Release
Breakdown
Body Response
GABA
(gamma amino
butyric aCId)
- transmitter at
Inhibitory synapses
- Inhibitory effect
on cerebrum and
cerebellum but
not on spinal cord 4 .
- thought that seizures
are a result of
decreased levels of
GABA.
Others:
histamine.
substance P.
vasopressin,
oxy1ocin,
releasing factors of
the hypothalamus,
prostaglandins
. Two main modes of action' system depends on which penpheral
Cholinergic Drugs 1. drugs competing for receptor sites receptors the drugs innervate There are
with acetylcholine at the motor end plate eg thought to be two receptor sites:
. Chemicals actmg at the Curare. Atropine, Belladonna Alkaloids, 1- alpha receptors - responsible for
same sites as acetylcholine and Scopolamine also compete for vasoconstriction, mydriasis and pilomotor
receptor sites at the posti)angllonic contractron
to increase the body's parasympathetic synapses. They are more 2 beta receptors - responsible for
parasympathetic responses readily accepted by receptor sites than vasodilation, cardiac acceleration, and
acetylcholine at smooth muscle, cardiac bronchial relaxation 7
. Two main modes of action: muscle and exocrine glands, causing a Epinephrine, a direct derivative of
decrease in sweating, salivation, and gland .
1. direct-acting drugs structurally secretion. Atropine also causes a reflex norepinephrine, acts on both alpha and
related to acetylcholine, or synthetic vasodilallon, These drugs are commonly beta receptors, and so is used as a
substances that substitute for acetylcholine used as pre-anaesthellc agents, as vasoconstrictor and bronchodilator in
ego Urecholine has selective action for the antidotes for cholinergic drugs, and in the asthma anacks It also Increases cardiac
GI and urinary tracts treatment of bradycardia Artane and performance by increasIng the heart rate,
2. indirect-acting drugs. causing an Cogentin, cholinergic blocking agents, are force of contraction and rate of conduction
increase In the release of acetylcholine by used in the treatment of tremors in through the ventricles. In bronchioles
inhibiting the release of enzymes which Parkinson s disease. The presence of constricted by histamine. cholinergic drugs,
destroy acetylcholine ego Prostigmine and tremors in Parkinsonism IS thought to or nervous reflexes. the administration of
derivatives such as T ensilon and Mestinon involve a hyperactivity of the cholinergic epinephrine causes rapid bronchodilallon.
are used in the diagnosis and treatment of system due to lack of inhibitory It also reduces vascular congestron by
Myasthenia Gra"is Although the exact influences,5 vasodilation, thus Increasinp vital capacity.
ellology of Myasthenia Gravis is disputable, 2. drugs preventing muscular Because of its rapid rate 0 catabolism,
this disease is characterized by an contraction due to a persistent epinephrine is useful in emergency
abnormal fatiguability of muscle, and is depolarization which eventually renders the situations, but is unsuitable for prolonged
thought to be the result of poor transmission motor end plate inexcitable 6 and thus administration
of acetylcholine across the synapse. Drugs causes flaccid paralysis to develop. ego . Other adrenergic drugs appear to have
like Mestinon inhibIt cholinesterase. thus Anectine
prolonging the activity of acetylcholine. more selective sites of action
. These drugs are dangerous. Nursing Vasopressors act pmnanly on alpha
. Atropine is an antidote for cholinergic responsibllilles include: receptors to Increase the blood pressure
drugs. -{)bserving the patient for slQns of Newer bronchodllators, such as
respiratory distress Salbutamol (Ventolln) affect only beta
-monitoring pulse and blood pressure receptors so that their action IS specific to
Neuromuscular Blocking carefully the bronchloles, and does not produce
-having resuscitation equipment and other physiological responses, such as
Agents antidotal drugs such as Neostigmine cardiac acceleration
available . In the central nervous system, drugs act by
. Drugs inhibiting the altering the levels of catecholamines In the
transmission of nerve Adrenergic Drugs brain. Autonomic nervous system
impulses at the stimulators, primarily amphetamines
cause the release of noreplnephnne
neuromuscular junction, Drugs augmenting resulting in Increased alertness and mood
thus prohibiting the . elevation. 8 Because of their secondary
catecholamine activity to vasopressor properties, and their tendency
contraction of muscle produce sympathetic to produce dependence, they are no longer
Can produce tatal effects due to respiratory widely used as ' psychic energizers in
. responses. Canada
paralysis ego Curare, and the toxin of
Clostridium Botulinum (Botulism) . The response of the sympathetic nervous
42
M.A.O. Inhibitors
. Drugs inhibiting the
breakdown of
catecholamines and
serotonin, causing an
elevation of these levels in
the brain, sympathetic
ganglia, and peripheral
tissues.
. Clinically used as anti-<!epressants, ego
Niamid, Marplan, Nardi!, Parnate. The
increased levels of norepinephrine and
serotonin have been experimentally
associated with mood elevation. However,
these drugs are being used with less
frequency since they cause adverse
reaction with many foods that contain the
chemical tryamine (eg. found in aged
cheese, pickled herring, chicken liver,
some broad beans, beer, and certain
wines). Instead, tricyclic compounds, such
as Tofranil and Elavil are being used as
antidepressants. Their action interferes
with the uptake of released norepinephrine
by adrenergic fibers, thus prolonging the
action of the neurotransminer and elevating
norepinephrine levels in the brain.
Adrenergic Blocking
Agents
. Drugs blocking the
catecholamines at either
alpha and/or beta receptor
sites, producing specific
effects.
. Alpha blocking agents. ego Regitine and
Priscoline, act on alpha receptor sites to
block the vasoconstrictor effect of
norepinephrine, resulting in vasodilation
and a decreased blood pressure. Such
drugs have been used in the past as
antihypertensives and for peripheral
vascular disease, but now drugs with a
more di rect effect on arterioles have proven
more efficient in these cases.
. Beta blocking agents compete with
norepinephrine at beta receptor sites and
have their effect on cardiac activity. They
act in two ways:
1. by blocking sympathetic innervation
to the heart, to produce a decrease in heart
rate and contractility ego Inderal, used for
cardiac arrythmias, for the reduction of
frequency of ectopic beats, for decreasing
the heart rate and slowing impulse
conduction.
2. by depleting catecholamines and
preventing their release 9 to produce a lower
level of amines in the nervous system and
consequently, a decreased sympathetic
response. ego Reserpine, Ismelin, and
Aldomet, used as antihypertensives.
. Hypnotics and anti-anxiety drugs are under
investigation to discover if induced low
levels of catecholamines are related to their
The Canadian Nurse
Augusl1976
sedative effects ego Reserpine depletes
catecholaffilnes, and Chlor
romazine
(Largactyl) blocks dopamine activity and
can produce Parkinson-like symptoms.
Drugs Affecting Serotonin
. A neurotransmitter under
recent investigation.
. It has been linked with temperature
regulation in the hypothalamus, sleep,
mood, and behavior. Research has been
based on evidence that the hallucinogenic
drug L.S.D. Inhibits serotonin. Therefore,
low serotonin levels are linked to psychotic
behavior with hallucinations.' 0
. Recent experiments show that serotonin
levels and sleep are related, " suggesting
that hypnotics and sedatives, ego
barbiturates, alter the level of serotonin.
Much of the research also indicates that
sedative-hypnotics decrease levels of
norepinephrine, epinephrine and dopamine
as well.
Drugs Affecting Dopamine
. A neurotransmitter included
in the catecholamines,
characterized by selective
activity that differentiates it
from norepinephrine.
. Dopamine is primarily found in the basal
ganglia and low concentrations of it are
associated with Parkinsonism.
. Within recent years drugs have been
synthesized to elevate levels of dopamine
and treat some of the symptoms of
Parkinsonism ego bradykinesia and rigidity.
Since dopamine does not cross the
blood-barrier to the brain, direct
administration is ineffective. However, its
precursor, L-dopa is able to cross the
barrier and can therefore be used to elevate
dopamine concentrations. The discovery of
L-<!opa has revolutionized the treatment of
Parkinsonism and allowed patients
previously severely handicapped to live
more active lives. More recently a new
preparation - Sinemet has emerged on
the market. This drug has the same benefits
as L-<!opa but reduces some of the
unpleasant side effects, particularly nausea
and vomiting.
Barbara Doughty (R.N., Atkinson School
of Nursing, Toronto Western Hospital)
worked for one and a half years in the
neurological and neurosurgical unit at
Toronto Western Hospital, and spent
some time as a general duty nurse in a
small hospital in Huntsville, Ontaf/o.
Doughty completed the post-graduate
course in Neurology at the Montreal
Neurological Institute in 1975 and
presently works in neurology at the
Sunnybrook Medical Centre In Toronto.
Julie (;rozler (B.Sc.N., Queen's
University, Kingston, ant.) worked at the
Sunnybrook Medical Centre before
attending the post-graduate COurse in
neurology at M.N.1. in 1975. Crozier is
presently working in the neurosurgical
unit at St. Michael's Hospital in Toronto. 1
Bibliography
1 Barr, MurrayL. The human nervous
sýstem: an anatomical viewpoint. 2ed.
New York, Harper and Row, 1974.
2 Chatfield, Paula. Fundamentals of
clinical neurophysiology. Springfield, II.,
Thomas, 1957.
3 Gilroy, John Medical neurology, by
... and John S. Meyer. London,
MacMillan, 1969.
4 Ganong, William F. Review of
medical physiology. 4ed. Los Altos, Ca,
Lange, 1969.
5 Goth, Andres Medical
pharmacology. 7ed. St. Louis, Mosby,
1974.
6 Koella, Werner P. Sleep: its nature
and physiological organization.
Springfield, II., Thomas, 1967.
7 Minckler, Jeff ed. Introduction to
neuroscience. St. Louis, Mosby, 1972.
8 Musser, Ruth D. Pharmacology ant
therapeutics by ... and John J. O'Neill.
New York, MacMillan, 1969.
9 Root, Walter S. Physiological
pharmacology: a comprehensive
treatise. Vol. 1 The nerVOus system, Part
A. london, Academic Press, 1963.
10 Vander, Arthur J. Human
physiology: the mechanics of body
functions, by... et al. Toronto,
McGraw-Hili, 1970.
References
1 Lecture - Myasthenia Gravis by
Andrew Eifen, Postgraduate Course,
Montreal Neurological Institute, Apn122,
1975.
2 Ganong, William F. Medical
Physiology p. 166.
3 Ganong, William F. Medical
Physiology p. 204.
4 Goth, Andres, Medical
Pharmacology p. 73.
5 Gilroy, John et al. Medical
Neurology p. 170.
6 Musser, Ruth D., Pharmacology
and Th erapeutics p. 41 5.
7 Ganong, William F., Medical
Physiology p, 169.
8 Ganong, William F., Medical
Physiology p. 204.
9 Goth, Andres, Medical
Pharmacology, p. 73.
10 Ganong, William F., Medical
Physiology p, 202.
11 Root, Walter S., Physiological
Pharmacology p. 220.
The Canadian Nurlle Augusl1976
43
Nurses who wish to return to the profession after being
inactive for s'everal years will encounter a confusing
number of changes in new procedures as well as in the
professional attitudes of more recent graduates.
Historically, the returning nurse was hired and retrained
on the job. But current staffing patterns and health care
economics mean that this type of retraining is becoming
less feasible. In North America, refresher courses have
emerged to meet the demand of returning nurses to
"catch up" on new theory and skills, and remobilize their
nursing abilities. Available at various educational
institutions and health agencies throughout Canada,
these courses aim to update nurses in a v8:riety of topics
and give them clinical experience within a few months.
They enable the nurse to refamiliarize herself with basic
nursing skills and achieve confidence and competence
in nursing patients with common conditions. With this
background, they should be prepared to find
employment and continue learning within that setting.
Here, Bettie Scheffer shares some perspectives on
refresher courses, and outlines the one she is involved
in at British Columbia Institute of Technology. For a
different viewpoint we look at a diary that records
Heather Nelson's reflections while attending a refresher
course at Algonquin College in Ottawa. Her honest
appraisal of her reactions and thoughts will probably
strike a familiar chord with many nurses
f(
f/><fR
,
1111
11111
,
11111
Bettie Scheffer
In the last 15 years many significant
changes have taken place in nursing
practice and responsibilities. The nurse
who decides to return to the profession
after an absence of several years will find
changes in her relationship to patients
and to other members of the health team,
More and more frequently she will be
called upon to provide leadership and
direct the activities of auxiliary staff on t"e
health team. She will find, also, that the
"service" orientation of nursing has given
way to an emphasis on total patient care.
Spare time that may have been spent in
"busywork" previously, is now devoted to
therapeutic listening, patient teaching and
more complete psychological care. New
equipment. removal of sterilizers from the
utility room, disappearance of acute
cardiac patients from general wards and
the introduction of disposo.)le equipment
are only a few of the other changes that
will require adapting to and will claim the
returning nurse s energies.
Understanding new techniques.
remastering old skills and. in addition,
simply acknowledging the phenomenal
medication explosion are not small
accomplishments. As a means of
assisting the returning nurse to "catch up"
in her profession, refresher courses are
becoming more widely accepted. A
search through published data and a
survey of ongoing courses or studies
being carried out to establish guidelines
helps put this trend into perspective.
Cooper and Hornback have
published helpful information regarding
the basic methodology in setting up
refresher courses. based on several
years experience at the University of
Wisconsin Extension Divlsion. 1 A course
outline and summary of eight years of
programs at the Seth Israel Medical
Center was'described in an article in the
Þ,merican Journal of Nursing. 2 The Sritish
Columbia Institute of Technology, in
collaboration with the RNASC, has
conducted 24 refresher courses since
1972. Three hundred and forty-four
nurses have completed this program.
Some data describing these courses is
presented on page 44. A committee
of the RNASC recently carned out an
extensive survey to establish expected
competencies of refresher graduates as
perceived by practicing nurses in staff and
supervisory positions Results of this
survey will be used in the process of
setting out guidelines for courses in the
44
The Canadoan Nurse August 1976
BCIT Refresher Course Details
1
Description
Central objective: The nurse demonstrates confidence and compe-
tence in nursing medical-surgical patients with common condi-
tions.
Course length: 8 weeks full time; 10 weeks, 4-<!ay week
Enrollment: 12-15 students per course depending on clinical quota
Faculty-student ratio: 1 instructor and 1 assistant per class
2 Questionnaire
survey results
Average age of applicant: 42 years
Average years inactive: 16 years (range: 5 to 25 years)
Employed following course: 60/80 respondents
full lime: 29/60 acute care: 43/60
part time: 31/60 extended care: 31/60
relief: 10/60 other: 6160
3 Topics of
study
Stress and adaptation
Hazards of immobility
Inflammation and immunity
Normal aging process
Acid-base, flUid and electrolyte imbalance implications
Death and dying
The nursing process
Therapeutic communications
Common medical and surgical conditions and related nursing care
Drug therapy for conditions studied
Basic nursing skill practice
Metric system conversions
Administration of medications
Sensory deprivation awareness
Cardiopulmonary resuscitation
Intravenous, CVP management
Charting workshop - problem-onented records
Guest lectures: Contemporary pediatric, psychiatric and matemal-
child nursing: role of physiotherapist, social worker; X-ray and
radiological procedures; patient preparation
Clinical assignments: Medical; surgical; pediatric; extended care
units: PAR, OR, ICU observation and participation
Text used: Medical-surgical nursing: a psychologic approach by Joan
Luckmann and Karen Creason Sorenson. Toronto, Saunders,
1974.
4 Cost factors
$11,600 (96 students
7 courses)
Tuition paid by student: $290 (per 240-hr course)
Cost per student '75-'76: $846 (avg. over 1 yr)
Manpower contract (for 54 students): $561 (per student for 3
courses)
Cost per course '75-76:
The Canadian Nur... August 1976
45
province. In Manitoba, the Provincial
Department of College and University
Affairs has recently been funded to carry
out a Manpower Training Improvement
Project to survey refresher course
I practices in Canada and design
curriculum modules for independent
study. At present, only one Canadian
province, Saskatchewan, has a specific
reference to refresher course completion
In their Nurses' Act. Information about
variations in provincial regulations, and
roles and functions of nurses in Canada is
published in Contemporary Issues in
Canadian Law for Nurses by Good and
Kerr. 3
The establishment and scope of
retraining programs is limited by the
financial support available. Both of the
American programs cited above were
supported by federal funding, although no
cost factors were included in the
publications. Item 4 shows some very
real economic concerns related to the
BCIT refresher course programs; while
participants have receiv
d financial
support from Manpower and Immigration
in the past. current economic pressures
may restrict such funding.
Refresher Courses are usually
established in accordance with the health
needs of the community and the
orientation of the educators and
participants involved. Thus, the length,
content and objectives may vary
significantly from one course to another,
These differences may contribute to a
skeptical reception unless the proponents
of a course share their planning and
problems with nurses in the community
and the profession at large.
One common approach of many
refresher courses is an orientation
towards individual support To meet the
unique needs of a typical refresher course
student. presentation methods have been
geared towards overcoming her feelings
of Inadequacy and lack of
self-confidence. Out of 139 BCIT
refresher course participants, 129 rated
"close and encouraging Instructor
participation in the classroom and clinical
situation" as very valuable in a course
evaluation form. This is a rewarding but
costly method of instruction, and
alternatives such as Independent study
units or centralized teaching using
educational media need to be considered.
Shirley Adams describes a program
incorporating self-study units in the
education of returning nurses. 4
Programmed learning is already a
common feature of continuing education
and has proven useful in my experience
with refresher nurses. Theory
presentation is more amenable to
individual pursuit than development of
clinical skills and nursing responsibilities.
Choosing the type and amount of practice
oC'oortu"ities t"at w'll maximize the
nUl::;e s previous knowleoge and skill IS an
intriguing challenge. Comments like
those of Virginia Walker,s director of
nursing in an Ohio hospital, imply that
current methods have not been
completely successful in attaining high
levels of clinical performance. "I realized
that if I hired these nurses at the same
stah:Js and salary as other RNs and they
couldn'1 carry their load of ward activities
after a reasonable orientation period,
adverse criticism would develop." Her
solution was to place refresher graduates
under the gUidance of a staff instructor
and fi!mploy them at a practical nurse
salary. . Most of the returned RNs
required from 1 to 3 months to assume
routine staff nurse duties."
No systematic attempt has been
made to acquire feedback from
employers in B.C. hospitals, but none of
the 80 RNs who responded to the BCIT
questionn aire were employed as practical
nurses, and 54 percent were working in
acute care areas. This does not
necessarily contest the fact that refresher
nurses returning to employment
experience difficulties, but perhaps
reveals a difference in perspective.
Cooper states, "At best. a refresher course
is only the beginOlng step toward a return
to practice. No course ever replaces an
adequate orientation to a specific position
in nursing or supportive supervision
throughout the early employment
period. "61 have shared this viewpoint with
many nurses during courses and realize
that very few individuals perceive the
course as meeting all their leaming needs
to return to practice. Most express a firm
commitment to continued study, and
Intend to discuss their Current level of
competence with potential employers,
They anticipate continued growth and
increased competence as a natural
consequence of active practice.
Despite the fact that refresher
courses are gaining wider general
acceptance, they are still met with
reactions ranging from skepticism
(usually on the part of hiring agencies or
practicing nurses) to enthusiastic support
(from participants and promoters of
courses). As an educator involved in
planning and teaching refresher courses. I
am concemed with their reputation, and
as a member of the nursing profession, I
am eager to see this method of retraining
improved to satisfy the expectations of all
concerned. As long as the profession
attracts mainly women, and women
continue to combine the demanding roles
of wife and mother with their careers, the
need for retraining programs will continue
to exist at a relatively constant level.
Consequently, nurses as individuals \
should look at refresher courses with a
personal concern for the ways and means
of returning to practice should they
experience a need in the future.
As a practicing nurse. where do
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46
The Canadian NurBe Auguat 1976
scheme of things? Their teachers have
tned to provide them with learning
situations and on-the-job experience.
While few returning nurses expect to have
learned in a few short weeks all the new
material and situations they will meet,
they usually enter the profession with
basic skills and the incentive to continue
learning on the job. Their more
experienced colleagues can help further
refresher goals by providing educators
with input about contemporary role
requirements that seem to merit more
attention in refresher Courses.
At the same time "reality shock"7 is a
fact of life for refresher nurses as much as
for other graduates. In fact, in many cases
we are dealing with people who have
previously left their profession because of
disillusionment with nursing, While this
problem can, to some extent, be
counteracted by including those elements
which may contribute to "reality shock" in
refresher courses, employers and
colleagues of returning nurses must be
aware that' they often experience the
same conflicts that new graduates do.
Many facets of the refresher course
question still remain unanswered. Is there
a "pOInt of no return when the length of
absence from active practice makes it
unlikely that a nurse can attain
contemporary requirements for
employment? What are the magical
components of a course curriculum that
meets the needs of returning nurses? Will
the cost of retraining phase out refresher
courses as happened with "on-the-job"
methods?
Given the diversity in the education
and experience of individuals returmng to
nursing, it is relatively improbable that any
one formula for a refresher course can be
agreed upon. Whether the answer lies in
practical nurse status initially, longer
orientation programs, or more lengthy
and specialized refresher courses is yet to
be detern:uned.
Larousse International Dictionary
defines a refresher course as "a course of
study to bring one's knowledge of
something up-to-date." In nursing, we
must add tv tt;.::
, t"e complex task of
updating one's ability to perform utilizing
that knowledge. The means we use to
meet this challenge will reflect the viability
of reabsorbing inactive nurses into a
changing profession. I, for one, am
hopeful that the challenge can be met and
that it will be refreshinQ!
Bettie Scheffer (B.S.N., University of
Wisconsin, Madison, Wisconsin) is an
Assistant Master and Instructor of
Refresher Courses at the British
Columbia Institute of Technology in
Vancouver, B. C. She taught previously at
UBC School of Nursing and at Sf. Mary's
School of Nursing in Madison,
Wisconsin. ...
References
1 Cooper. Signe Skott. Continuing nursing
education, by... and May Shiga Hornback
Montreal, McGraw-Hili, 1973.
2 Hauer, Rose Muscattne. Coming of agt
of a refresher program, by... et al. Amer. J.
Nurs. 75:1:88-91, Jan. 1975.
3 Good, Shirley R. Contemporary issues ir
Canadian law for nurses, by no and Janet C
Kerr. Montreal, Holt, Rhinehart and Winston,
1973.
4 Adams, Shirley. A self study tool for
independent learning in nursing. J. Cont. Educ
Nurs 2:3:27-31, May/Jun. 1971.
5 Beaumont, Estelle ed. Innovations in
nursing: inactive RNs return to nursing withou
fears, ed. by _.. and Shirley Claypool.
Nursing'75 5:8:39, Aug. 1975.
6 Cooper, op.cit., p. 155.
7 Kramer, Marlene. Reality shock; why
nurses leave nursing. St. Louis, Mosby,1974.
./
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The Canadian Nurse Auguat 1976
47
"
1'1 (
I
II "I
Heather Nelson
II [ 1 "1
II , II
IIJJ!
of a Retread
In November 1975, aher seven years
away from nursing and with a great deal
of apprehension, I undertook a 6-week
intensive nursing refresher course at
Algonquin Community College. At the
initial orientation, the instructors
emphasized their interest in receiving
feedback from students about the
course, I kept a diary throughout the six
weeks, usually jotting down my reactions
last thing at night, and finally submitted it
as part of my course evaluation. These
are excerpts from the dIary.
1 st week
Monday
Didn't sleep a wink, of course. Too
nervous. Swung between thinking "it's
been too long and why am I doing this?"
and "if you could cope at 17, you ought to
be able to manage at 35."
Introduction by S. She seems
genuinely concerned with our learning
experience - obviously trying to
encourage us to test ourselves -can she
keep that up with us old-timers?
Neoplasm pretest and explanation of
Dacums. They look like one heck of a pile
of work. No way to absorb each one in one
week - good for continual study and
reference, I would imagine.
Home early, thank goodness Head
swimming. Stomach in knots.
Tuesday
To hospital in a.m. - surgery first -
OK. Postop always seemed more
common-sense oriented - if not too
many procedures are radically different, I
should be alright (I keep telling myself.)
Explored floor - fortunately it's small.
Nursing staff seem comfortable with our
dumb questions.
Picked a patient fo tomorrow - such
a production - wa Ie, , 'tween finding
an easy one and skat,ng through and
learn
ng nothing, or trying a toughie and
maybe not dOing a good enough job. B.
helpful and supportive. Doesn't push.
Encouraging 1 picked an old postop -
should leave ole free to watch the
interesting procedures I m not confident
enough to do myself yet. Or am I just
chicken ??
Feeling lonely for my kids today.
Miriam finds the p.m. at the sitter's long.
Could I do this indefinitely? No time for
Butch either - just beat at night. And this
is nnlv thø c:øf"nnrl rl"" t,
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lost 2 pounds! Not that that's bad. But
basically a let-down feeling today.
Wednesday
Wasn't so bad after all! My patient
had the good sense to be discharged
before I could get my hands on him, so I
asked B. if I could float. She countered
with a suggestion that I follow the team
leader around, A little whirlwind from
Kingston - practically a classmate. She
was into everything, so it was a really
good deal. Good nurse too- combines a
sort of offhand insouciance with a concern
for the patient and a surprising knowledge
of the whys and wherefores,
Team conference in p.m. was
interesting -I was supposed to be "team
leader" for our group and ask pointed
questions re care, etc. Nothing
stupendous, but didn't make a fool of
myself. Funny to see the ideals of
classroom nursing tempered by the
realities of doctors' quirks, hospital
procedures etc., like the man undergoing
multiple tests for possible carcinoma of
the lung and getting progressively more
scared, and nobody telling him what was
suspected because the almighty MD
hadn't decided to yet. Still, the doctors do
have a point. Somebody must take
ultimate responsibility. Maybe the ideal
would be a stable enough staff that the
doctors and nurses could trust each other!
Dreamer.
Scheduled lecture from
pharmacologist. Bright young man telling
us all about unit dose system,
Tremendously efficient, but couldn't get
over the pollution caused by all those
disposable items, and the unreclaimable
energy used in producing what gets
disposed of! I raised the question and got
patted on the head. Unreal. Doesn't
whoever plans these monumental
switch-overs realize we can't keep on
doing this? Glass and foil containers used
once and that's it. The boom will be
lowered in the not-so-distant future and
hospitals will be up the creek. Wonder
what kind of a budget all this stuff
requires?
Thursday
Day of classes - mostly with S. That
lady knows her stuff, I don't think I'll ever
get to that point. Did neoplasm test and
trauma pretest. Are we really finished
neoplasms? What I don't know is
monumental. Thank heaven for Brunner.
Saw a Trainex film. Great idea for
individual study.
Friday
Library onentatlon. Wow - great
place. Spent the day there and got a lot
done. Love librari
s,
2nd week
Monday
Hard to reconcile the feets of kids and
house and husband with STUDY. But the
family's great, bless them. On the
weekend, caught Mike saying proudly to
his buddy, "My Mom's studying." Made
my day.
Today went over neoplasm tests and
trauma pretest with S., and orthopedic
splints as well. I really like those tests.
Makes me feel less inadequate, because
basically J can do them with few mistakes
- but enough discussion comes out of
them to flesh out my basic knowledge.
Enjoy the round table participation. Also
am beginning to appreciate my fellow
students now that they are emerging as
people with names, families, aod
difficulties much like my own. Nice group.
In p.m., to hospital to pick out patients
- feel a little more confident this time.
Nursing care plans still a mystery to me.
Are they just a busy-work deal or do they
really help in communication between
nursing shifts and promotion of better
patient care? Most of the other women
feel much the same way - wait and see.
Tuesday
First real day of patient care and do
my feet hurt! A real problem coming home
at the end of a working day and having to
be giving and bright with my kids.
Beginning to empathize with my husband
more - but I'll bet his feet don't get as
sore as mine!
Did a suture removal and two
compresses today. Incredibly nervous.
B, supportive. Patient kept asking, "You
have done this before??" in a quavering
voice. Poor man, I spent some time with
him afterwards to let him know I
appreciated his letting me do my stuff.
Main difficulty is tension of having
nothing come naturally - all the floor
procedures are done differently from what
I remembered - charts, meds, CSS
equipment, IV etc. The whole works need
to be thought out before action taken.
Exhausting. And can only improve with
time. I think that's what's so enervatina
4t
The Canadian Nurse August 1976
r.
1111"
Wednesday
Last day on surgery. Was fun to be
able to answer Mrs. G.'s questions re her
operation from first-hand knowledge. She
enjoyed it too, and got a bang out of my
fainting nonsense. Complimented m
,
besides, believe it or not: "You'll get aJot
- you're a great nurse.': Wonder if I car
use patient testimonials on my rounds 0
pounding on doors of hospital personnel
offices??
Hard to move on to the next area -
we're all a bit nervous again. Having been
used to B.'s "supportive nitpicking," what
will D. belike? Funny-the other group is
feeling the same about B! We're busily
reassuring each other like a gang of
first-graders. No matter how secure we
are in our own lives, new roads are always
a bit scary. Though some manage to
camouflage it more than others.
So much of nursing is reflex. common
sense and rationale - the first is
impossible at the moment, and the third
I'm struggling to broaden. Thank
goodness I have enough common sense
to get by, or I'd give up.
I'
Wednesday
Felt quite good today - not as
jumpy. I find myself admiring the other
women in the group - lots of concern and
honest caring for the patient, and still that
irrepressible hilarity that surfaces so
easily and that I remember so well from
former days. It's not all nervous relief
either - though that does playa part -
there is real enjoyment of life here.
Had a clinic on IV therapy - wow. A
far cry from what we were allowed to do at
school. No IV team here. But I still feel that
a lot of the mystique around taking blood
is just that - mystique. Seems quite
straightforward - as long as the veins are
good! Maybe I'll try sometime during the
course if I find a likely candidate for
experimentation. But my feeling is that an
IV team must cut down on the number of
phlebitis problems. Can't tell me that
every nurse is equally conscientious
about technique.
Overall personal feelings good
today.
Thursday
Class day. Did shock rationale: a
d
cardiac and respiratory resuscitation.
Doesn't terrify me once it gets going, but
the initial moments must be wild.
Saturday
Spent 4 hours at library - did
C.V.Dacum plus finishing up odds and
ends of neoplasms and trauma. C.V,
didn't seem so hard, really, maybe
because I've been attacking that
programmed fluid and electrolyte balance
book for the last few nights in bed. Some
bedside reading!
Sunday
Worked at home doing
pharmacology Dacum - really find
n
it
hard slogging because so much of It IS
straight memorization. No chance to put
common sense and accumulated
knowledge to work. Find that after a
couple of hours things begin to slide
together In my head and it's game over.
3rd week
Monday
S. tackled fluid and electrolyte
balance this a.m. Tackled is the word too
- poor woman went at it like a charging
lion. Maybe like the rest of us mortals she
finds it tough going, though it's hard to find
a chink in her theoretical armour - one
smart cookie.
In p.m. to hospital again to pick
patients for tomorrow. This is my last stint
of clinical days on surgery, so tried a
patient who will have surgery tomorrow-
removal of a ganglion from wrist. Wanted
abdominal surgery, since that's the kind I
remember best and should upset me
least, but this was my next best bet
Talked with Mrs. G. (patient) about the
operation, anesthetic, feelings etc. and
really found it rewarding. Obviously she
needed somebody to talk to and that's the
one thing I really feel adequate about in
this whole enterprise - being able to
draw out someone's basic feelings in
order to help her deal with them. Think I
did a good job. Now if I can cope with the
OR!
Tuesday
Where to start? Made a fool of myself
by coming within an inch of keeling over
on the sterile field. Didn't even do that as a
student! Don't really know what set me off
- maybe all the poking and prodding
around in a small area full of tendons and
nerves and so forth. Gradually got dizzy
and uncomfortable; walked out of the
room just in case and lay on a bench.
Craziness - I was lying there with my
head hanging over one end of this dumb
bench and my feet over the other thinking
through the haze "Oh yes - symptoms of
shock: dizziness, vertigo, diaphoresis,
.rapid pulse.. It's all here... too bad I dOn't
have a BP cuff." Maybe some of the
lectures are soaking in after all!
Fortunately I felt better soon enough to go
back in, help get Mrs. G. onto a stretcher
and off to the recovery room. Now there's
an interesting place. Action, movement,
need for theoretical knowledge, patient
reassurance, the whole bit. And the whole
thing in one big room IS my kind of deal too
- instant accessibility to everything and
everyone J liked it. Great to be able to be
there with Mrs. G. as she woke up; took
her back to her room and did her reentry
stuff. Good feeling of accomplishment.
Thursday
Class day. Don't know what it was,
but we didn't swing as a group today.
Discussion seemed draggy. Not
stretching our minds as much. Did M.I.,
C.H.F. etc. Found myself personally
involved in the discussion because of
Butch's heart attack. Really two years
ago? We seem to have lived with that
forever - so lucky to have a crack at
restructuring lives, priorities etc. That's
something J have to share with my
patients and their families - a.w
y of
looking at a blow like that that Isn t
necessarily devastating. Those who
survive have a very special chance to
rethink their lives - in all dimensions. It's
not to be sneezed at as a growing
experience. . .
Had my mid-term discussion with B.
Fair shake, I think. Comforting to discover
that the area she thinks I need work in -
technical skills - is exactly where I think I
do - nice to have one's self-evaluation
reinforced. (Other areas - knowledge
and attitude - are OK.) Maybe this was a
good idea after all.
4th week
Monday
Did my thing at the library over the
weekend. That is getting to be quite a
comfortable routine now: shove the kids
out the door Friday a.m., be at Steinberg's
to do the grocery shopping at nine sharp,
out by 9;20 and sitting in the library by
9:40. Then I can get my list of books
prepared, and have about an hourto start
on the Dacum for next week before I have
to get home forthe kids'lunch. And things
are set for Sunday studying all p.m.
Unfortunately, Friday p.m. haS to be. I
reserved for making some headway Into
the week's accumulation of dirt in the
The Canadian Nurse Augusl1976
49
house. Butch is being a pet about doing
more than his share of the housework, but
I feel a bit guilty if I can t at least get things
started before the weekend. He says
that's silly, but I can't help it. Maybe I'm the
sexist in this family - no matter that we're
both loaded with out-of-house
responsibilities at the moment - I still
have that niggling feeling that basically
the house is my responsibility Dumb,
dumb.
Anyway, it was a quiet day at school
- mostly talking and watching films on
how to communicate with patients. Did a
few communication exercises, too. So
difficult to teach that sort of thing. I feel the
vital thing is to have an ability to very
quickly assess the patient's mood and
needs on first contact and then react
accordingly. No point in soft answers to
the man who wants a good argument in
order to clear the air before he gets his
real feelings out. Equally no point in
coming in all breezy and cheerful to a
patient who is shy and/or depressed and
needs a quiet, gentle approach with a
minimum of bustling about Maybe that s
one advantage that comes with the curse
of being shy - an ability to gauge
vibrations pretty accurately. Could be an
advantage for all of us because of our
ages - more time and life experience
: I under our belts.
In the p.m. we met in the hospital
lobby again to head off with D. to our new
ward which is completely different - don't
know whether every ward is a law unto
itself or whether those were just chosen
as a deliberate attempt to expose us to
totally divergent areas. In any case, it's
weird. The nursing station has about half
the room behind it as the average rec
room bar and twice the number of people
around it. Charts everywhere but in the
cart; narcotic cupboard in a utility room;
med cupboard - unlocked - in a sort of
converted linen closet down one hall;
back rub materials in a closet clearly
marked "IV equipment" .. a strange place
entirely. Also a completely different aura
somehow - the nurses seem to be
mostly floats, so many students, Interns,
etc. that a feeling of oneness of purpose is
hard to grasp. My patient for tomorrow IS
an 87-year-old lady with seizures and
pneumonia, from a nursing home
somewhere. We II see how that goes.
Tuesday
Well, I made It. But barely. It was
rather fun doing little Mrs. K. - she's tiny
and determined and wanders in and out of
reality like a kid in a revolving door, but I
must admit I didn't really feel as if I learned
a heck of a lot. I was so worried she'd zing
out of her bed onto the floor and cream
herself that I couldn't concentrate on
exploring the ward, reading charts,
procedures or whatever. A good day of
patient care, since I did do a good day's
work for her, but nothing really learned.
In the p.m. we had a lecture on
various kinds of 02 therapy equipment.
That brings up another interesting point of
hospital priorities. 02 therapists
(inhalation therapists, really) are on 24
hours a day, which would mean a
substantial staff, I presume, and nurses
are not required to do anything really,
except see that the patient has the mask
or cannula or whatever on. The therapists
do the whole shot - set up the liter flow,
fill bubblers and so forth. And yet. every
nurse is required to learn to start I. V.s,
take blood etc. No LV. team - too
expensive But which actually costs more,
and which really needs the expert and
conscientious care of a select group??
Seems to me the average patient would
be in a whole lot more danger from
procedures involving the blood stream
than from procedures involving 02. We're
all taught how to administer 02 and it Isn't
that involved - just a matter of becoming
accustomed to the different equipment.
Maybe 111 see the hospital logic as I
become more accustomed to the work,
but at first exposure, I'm really confused.
Not a good day altogether, and my back is
beginning to bother me again,
Wednesday
Second day on medicine and a bit
better. I removed a FOley catheter from
my lady - D. supervised - and managed
to wander about a bit more on my own.
Helped bandage the stump of an
amputated leg and watched the
physiotherapist do ultraheat and
ultrasound treatments on decubiti.
Interesting. Will keep an eye on the sores
over the next 2 weeks and see how they
react. (Hey, only 2 more weeks!!!) Also
learned to take my books into Mrs, K's
room so I could study and keep an eye on
her at the same time.
In the evening, a bonus for me. A
seminar at our church on death and dying
- how to explore our own feelings in
order to help others. We filled out a
ACTIFED*
Tablets/Syrup
Trit; 'olidine HCI/Pseudoephedrlne HCI f--
Anti hi sta m i ne/ Decongesta nt
Indications: The prophylaxIs and
treatment of symptoms associated with
the common cold. acute and subacute
sinusitis. acute eustachian salpingitiS.
serous otitis media with eustachian tube
congestion. aerotitiS media, croup and
similar lower respiratory trod diseases;
in allergic conditions which respond to
antihistamines Including hay fever,
pollenosIs, allergic and vasomotor
rhinitis allergic asthma
Precautions: Use with cauhon In
hypertenSive potlents and in potlents
receiving MAO Inhibitors. Patients should
be cautioned not to operate vehicles or
hazordous machinery until their response
10 the drug has been determined Since
the depressant effects of antihistamines
are addItive to those 01 other drugs
affectmg the central nervous system,
potients should be coutloned ogainst
drinking alcoholic beverages or laking
hypnotics, sedatives, psychotherapeutic
agents or other drugs with CNS
depressant effects durang antihlstamlmc
theropy. Rorely. prolonged therapy with
antihistamines can produce blood
dyscrasias.
Adverse Effects: None serious. Some
patients may exhibit mild sedation or
mild stimulation.
Dosage: Adults 8. children over 6 years
2 teaspoonfuls of syrup or 1 toblet 3 times
doily. Children 4 months to 6 years.
1/2 adult dose. Infants up to 4 months.
1 2 teaspoonful of syrup 3 times clolly.
Supplied: Syrup. Tablets: Each white,
biconvex tablet 74 mm in diameter with
code number WELLCOME M2A on same
side as diagonal score mark or each
10 ml of clear lemon-yellow syrup
contains traprolidine HCI 2.5 mg and
pseudoephedrine HCI 60 mg.
The syrup 15 available In 115 225 and
2250 ml bottles; tablets are available In
pockoges of 12 and 24, and battles of
100 and 500
I Burroughs Wellcome Ltd.
:Ill LaSalle. Que.
"Trade Mork
W40S1
T
50
The Canadian Nurse
Aug us, 1976
questionnaire on how we feel about our
own death, or the death of someone else,
and discussed quite freely - it was a
good experience. A common feeling was
that one would want to know oneself
about a terminal illness, but would
hesitate to tell the family because then
there is the added pressure of having to
deal with the other person's sorrow as
well. It is essential to be honest, in my
book - when there is only a limited time
left, who wants to play games? A good
seminar.
Thursday
SNOWSTORM. Wow. Today, M.
gave us a test on stress and we discussed
liver problems and a bit on peptic ulcers
though everyone was anxious to get
home and deal with snow and tires and
kids boots and piled-high walks and so
forth. I guess liver pathology - or even
normal physiology - is something that
most of us haven't really studied very
much-or been exposed to in patient
care. Certainly III have to do a lot of
brushup in that area. I find it hard to get a
handle on M. - not sure why. She's
certainly competent and concerned - but
presents such an even surface that it's
difficult to feel where she is at personally.
Funny how I find myself analyzing the
teachers - unfair too - although they're
likely doing the same thing to me! But
interesting that I'd bother to try -I can't
remember thinking ternbly deeply about
teachers in my student days. They were
either good or not so good: fair or biased:
able to see beyond the masks or not. I
don't remember caring one way or
another what kind of persons they were.
And I do now. Maybe it's a function of
growing up - or maybe having
discovered that teaching is never
'value-free' - nothing is value-free
There's always the person doing the
teaching coming through
5th week
Monday
Someone in to talk about respiratory
problems. Knows his stuff but, today at
least, had a bad time getting It across. In
p.m. it was back to wards. I asked D. to
assign me to someone who didn't have to
be physically lugged around and she did,
bless her. Mr. F., a recovering M.1.
Fell into bed at night, back screaming.
Rotten day.
Tuesday
My patient was light work, physically,
since he can be up, so I ended up
making beds and bathing and helping with
other patients. Still have the "service"
orientation in me - I could have studied
my patient's problem and not assisted
with the ward work, but really can't do that.
And I don't feel I should, either. Nursing is
such an odd mixture - educated we may
be, but our first duty is service, and I hope
it stays that way.
Worked on nursing care plan. Am
gradually coming to terms with those
things. Still feel they're a bit padded with
stuff that could remain unsaid and
understood, but maybe it helps to put
things down in black and white. Who
knows?
Wednesday
Spent much of the day talking with
Mr. F. about diet, exercise, health care at
home and so forth. Felt I did a good job
too. He was very cooperative - wanted
so much to know how to keep from gettif1g
sick again - and I think I helped a fair bit. I
told him what to notify the doctor about
without unduly panicking him, I think, and
feel I did a good job. Nice feeling to have.
Thursday
End of our 5th week. Can't believe it.
And still don't feel at home on the medical
floor. Is it a slump or what?
CI
ss day again. Respiratory guy
back with a much better presentation.
This time got personally involved with his
subject and swung a lot better. Interesting
views on I.P.P,B. that we were all so in
awe of! A much better time and I'm
beginning at last to see the end of the
tunnel re acid-base balance. Hallelujah!
After work, went over to new hospital
to update my application and try for the
geriatric ward, opening in January.
Friday
Last Dacum - diabetes. And as I
suspected, my worst pretest to date. I
really have to spend the whole weekend
sorting out diabetes.
Sunday
Did up diabetes Dacum reasonably
quickly on weekend - more came back
as I studied than I'd anticipated. Guess it
is because diabetes is rather an entity in
itself.
6th week
Monday
Went over diabetes pretest. Covered
a good deal of ground. Two members of
the
rouJ? have both done a lot of nursing
of diabetics and had lots of helpful hints
for the rest of us. I continue to be amazed
and delighted at the depth and breadth of
the personal and professional experience
of the class - particularly in the eight I've
worked with more closely. The insights
they have are quite remarkable in any
group of women.
Tuesday and Wednesday
Doctor said I should spend some
time on my back to rest it - apparently it's
a disc problem. Asked D. if I could skip
Tuesday's ward day and see If 24 hours in
bed would help. Hated to do it, but
seemed the best idea. Called back to say
both she and B. felt I could and should
stay home Wednesday too - apparently
the evaluations are already made out. Am
going to try to make it for Thursday, to
finish up the diabetes theory and get in on
the general course evaluation. Dying to
hear what some of the other women feel
about the course in general, how they
would improve it; and also how S. felt
about our general performance. If I can
crawl, 111 make it!
Thursday
Fast summary - it's been worth it!
I've grown a lot, I've learned a lot. I have a
generally good opinion of my nursing
colleagues. I feel the instruction has been
excellent and the study approach
fantastic. Family has survived basically
well. Husband has been supportive
beyond hopes. Now- to get a job!
Heather Nelson (R.N., Kingston General
Hospital) is now employed at the
Neonatal Intensive Care Unit at the
Children's Hospital of Eastern Ontario in
Ottawa. She was a staff nurse at the
Neonatal Intensive Care Unit at Kingston
General Hospital until 1968, when she left
to raise her two children. After seven
years, she decided to go back to nursing.
She says of her decision to take the
refresher course: "I entered it because I
thought, with the tight labor market, I'd
never get a job otherwise after being
away for seven years .. but as I
progressed I found the benefits much
more far-reaching than merely job
preparation. It was great to study again,
to test myself in new situations and to find
my self-confidence increasing almost
daily. I am better prepared for work now
and, of equal importance, am also
prepared for further personal
development." ..
The Canadian Nurse August 1976
51
DilEMMA
In the past five years, 577 families have undergone amniocentesis through the
Prenatal Genetic Clinic in Toronto to test for genetic disorders of their unborn child
Of these families, five percent have been confronted with selective abortion as a
result of prenatal genetic testing. There is no precedent to help them cope with the
dilemma they must face....
Prenatal genetic testing of a developing baby dUring
the first half of pregnancy is a relatively new
approach in dealing with serious genetic disorders.
Given the diagnostic procedures to determine
genetic disorders and chromosome abnormalities
before bi rth, the health team and prospective parents
alike are confronted with new questions and
responsibilities.
Since 1971 , a testing service has been available
in Toronto to evaluate and support couples when the
risk of having a deformed child is evident. A team
comprised of a geneticist. an obstetriCIan, a
radiologist. a biochemist. a cytogeneticist, and a
nurse are involved in the care of each couple. Similar
genetic counseling facilities are found in most large
university centers in Canada.'
Figure 1
Factors Indicating Prenatal Genetic
Testing
Prenatal Diagnosis
At present, certain chromosome disorders,
biochemical diseases, X-linked conditions, and open
neural tube defects are being detected through
prenatal testing. It has been determined that some
couples have a greater risk of bearing a child with
such disorders. Factors indicating that tests for these
diseases In the fetus should be considered are listed
in Figure 1 .
If couples have had a previous stillbirth, a child
with multiple malformations, spina bifida, Down s
syndrome (mongolism), mental retardation, or a
biochemical defect, they should receIve genetic
counselling before another pregnancy to discuss the
risks of recurrence of such defects and the value of
prenatal testing if another pregnancy is being
considered. Many types of birth defects cannot be
diagnosed by the available prenatal testing
techniques and the families involved must then
accept the risk of recurring defects with out the aid of
prenatal testing.
Evaluation of the fetus in the first half of
pregnancy can be done through amniocentesis and
ultrasonography. Fetoscopy is in the developmental
stage as a prenatal diagnostic device. (These tests
are examined in Table 1).
1. Chromosome Disease
a) Maternal age - The risk of Down's syndrome increases
from 1 :2000 live births at maternal age 20 to 1 :300 at 35 and
1:100 at age 40.
b) Parental chromosome abnormality -If one parent has
been identified (through family studies or the birth of an
abnormal baby) to be a carrier of a chromosome
rearrangement, all subsequent pregnancies should be
monitored by amniocentesis.
c) Previous trisomy - If a previous pregnancy had
terminated in a conceptus with trisomy (Down s syndrome)
- whether livebirth, stillbirth, or spontaneous abortion, -
subsequent pregnancies should be mOnitored.
d) Anxiety - If the parents are unduly anxious concerning
the possibility of abnormality of the child, this is not
necessarily an indicallon for testing. In this case, each
couple is treated individually.
2. Biochemical Disease
Generally, parents are proven carriers of biochemical
disease as an indication for testing. There are now 80
different inborn errors of metabohsm that can be tested In
utero by showing enzyme deficiency in cultured amniotic
fluid cells.
3. X-linked Conditions Not Detectable in Utero
Certain inherited diseases affect the male child of a known
female carrier. In cases where the condition Itself cannot be
determined, sex determination through amniocentesis is
valuable ego Duchenne muscular dystrophy affects 50
percent of the male offspring of a known female carrier
The Nurse and the Patient
The role of the nurse as a prenatal genetic team
member has evolved as the clinic has developed.
Information gained through close contact with
couples over a period of time has brought the unique
needs of these couples to light. and has helped the
health team to deal with their needs more effectively
than was initially possible.
The nurse has the opportunity to assess the
needs of the patient as they are expressed at the
clinic, to support the patient and help to alleviate
mdptv
nrf to rommlJnicate t e oatient's ne ds as
4. Open Neural Tube Defects
Previous birth of a child with an open neural tube defect
indicates a five percent risk of recurring disease.
Amniocentesis is done for determination of
alphafetoprotein levels (an elevation in alphafetoproteln
indicates the presence of an open neural tube defect).
. These indications for prenatal testing are extracted frof!!
the Canadian guidelines for antenatal diagnosis of genetic
disease as published in 1974.
. A list of medical genetic centers In Canada IS available on
rea est from the C .A. Ubrarv
52
The Canadian Nurse August 1976
she sees them to other team members, so that
support can be given in an aware and consistent
way.
Couples are referred to prenatal clinic by their
own doctors. At the clinic, they are interviewed by a
geneticist who discusses with them their risk of
having a child with a genetic defect and explains to
them the limitations of prenatal diagnosis. Each
patient is also examined and interviewed by an
obstetrician in order to set the dates for testing. He
also discusses the risk of abortion caused by
amniocentesis, a risk of less than one percent It is
after these interviews that the nurse first meets the
patient.
Many patients express their confusion to the
nurse when they first visit the prenatal clinic. Their
questions imply uneasiness in a situation that they
have not faced before. Initially, the patient may ask
questions about the clinic itself, about the number of
health personnel that they are required to see, the
necessity for a number of visits, or the role of their
own doctor in their care.
The nurse may find it helpful at this time to
explain the consulting nature of the team - that the
team works together in the patient's interest. She lets
the patient know that her family doctor will be kept
informed by the team and will continue her care after
testing is completed. The nurse conveys her
personal interest in the patient and asks if she may
telephone the patient as she progresses through her
pregnancy.
One of the main concerns expressed by the
patient during the initial interview with the nurse
involves the procedure of amniocentesis itself. Fears
of what will happen to them or to the baby during the
test can sometimes be alleviated by a thorough and
understanding explanation of the procedure and its
preparatory routines. It is often helpful for the nurse
to relate the reactions of other patients to the test,
and if further support seems necessary. women who
have previously undergone amniocentesis may be
called upon to reinforce the nurse's supportive
explanations. Several women who have had this test
have volunteered to talk to anxious patients.
Another early concern of the patient is with the
risk of abortion as a result of testing. Such a risk has
been pointed out to the patient by both the geneticist
and the obstetrician in the first meeting. Women may
wonder if such a risk factor makes testing advisable
although they are also concerned about having an
abnormal child. Questions that the patient may raise
are a good indication of her understanding of what
she has been told by members of the team and of her
emotional needs. If the patient misunderstands
genetic risk factors, such information may be
communicated to the geneticist or obstetrician so
that the team can work together in clarifying her
questions.
The initial nurse-patient interview allows the
nurse to assess the patient's psychological needs
and her understanding of genetic disease and
prenatal diagnostic testing. It also serves as the
beginning of a relationship to continue throughout
the woman's visits to the clinic.
to watch. Others are disappointed because they
slept through the test.
Perhaps the greatest worry expressed by the
patient at this time concerns the chance of aborting
as a result of the testing. She may ask what she is to
expect if she aborts, whether she should moderate
her activity, or how long the risk of spontaneous
abortion will be present. It is explained that "abortion
dangers" are considered to extend to two weeks
following the testing, and that the patient should
contact her family doctor if she does have any
physical concerns.
Patients must wait a minimum of three weeks for
the results of the tests and the wait may be an
anxious one. Women may feel very hesitant about
their ability to make the decision to abort a defective
fetus. Some hint at this time that they haven't told
anyone about their pregnancy and don't plan to until
they receive test results. Others state more directly
that they'll need help if they receive test results
indicating that an abortion should be considered.
Questions about where the abortion would be done
provide other hints about this concern. The nurse
ought to be aware of the worried implications of these
questions and statements. She tells the patient that
both she and her family doctor will be notified as soon
as the test results are known, and that any steps
necessitated by the results will be taken with the full
support of the team.
Women mayor may not wish to be told of the sex
of their child. The geneticist of the team is kept
informed of the patient's wishes.
The patient at this time may be able to express
some of her feelings to the nurse. Her concerns
about having a handicapped child, or her reactions
and those of her family to her pregnancy may be
voiced as her relationship with the nurse proceeds,
She may feel she has to explain why she came for
the testing, and it is important for her to have
someone to talk to about her feelings concerning the
whole experience.
Testing is performed on an out-patient basis.
Several days after the procedure, the nurse phones
the patient to see how she is feeling. This call
enables the patient once again to express her
feelings and any anxieties she may have over the
three week waiting period. The nurse reminds the
patient to call her own doctor if she has any unusual
symptoms. The patient is also given the nurse's
phone number so that she may call if test results
have not been reported to her in three weeks. If test
results are normal, the last contact the nurse has with
the patient is after the birth of her baby.
The Waiting Period
Following ultrasound and amniocentesis, the
nurse visits the patient for a second time. Many
patients express relief that the testing is over, and
most confess that it wasn't as bad as they had
anticipated. Some find the ultrasound "fascinating"
Implications of Prenatal Testing
Amniocentesis for prenatal diagnosis of genetic
disease has recently become an accepted approach
for families who face a high risk of bearing a child with
a serious genetic disorder. In the past five years, 577
families have had an amniocentesis for genetic
indications through the Prenatal Genetic Clinic in
Toronto. The majority of these couples received
good results and assurance that their baby was free
of the genetic disorder in question, but some did not.
Twenty-seven women decided to terminate their
pregnancy prior to 20 weeks gestation as a result of
information received through prenatal genetic
testing. Very little has been written to date about the
new dilemmas we are creating for such couples. Our
close contact with these 27 couples has given us
insight into the unique needs created by a difficult
The CanadIan Nura8 Augual1976
53
Table I
Test Time Method Analysis Results
1. &I') - 16th week of pregnancy
'iij - local anesthesia - cells in amniotic fluid cultured - indication of biochemical or
(1) when - needle puncture through for chromosome and chromosomal abnormality
...
c: i- fundus above pelvic brim abdominal wall biochemical analysis
ii- fetal cells present in - 10 to 15 ccs of amniotic fluid - cell-free fluid analyzed for - elevation in alphafetoprotein
0 amniotic fluid aspirated by needle from the alphafetoprotein (a protein indicates the probability of an
c:
E amniotic sac manufactured in the fetal liver) open neural tube defect (spina
<{ biflda, anacephaly) in the fetus
2. > - just prior to amniocentesis - sound waves used to generate - picture indicates: - allows for increase in
.s.: picture (like the use of sonar to i- localization of the placenta knowledge of normal fetal
Q,
co detect underwater objects) ii- presence of twins development
... iii- configuration and growth - guides needle placement for
C)
0 rate of the fetal head amniocentesis by showing
c:
0 iv - ventricular system of the position of the placenta
ell brain - allows for evaluation of the fetal
co
... v- fetal kidneys skull and spine (open neural
.:!::
::> vi - the emptying and filling of tube defect)
the fetal bladder
3. > - not yet done routinely - still in - local anesthesia - allows direct visualization of - potential (not yet fully
Q,
0 developmental stage as a - scope inserted through anterior the fetus (total fetal established) to diagnose a
(.) diagnostic device abdominal wall to scan the visualization not always number of anomalies
&I')
0 fetus and sample tissues or guaranleed)
...
(1) blood - abortion rate unknown at
U. present
Ultrasound photos and line drawings: Fetus at 25 weeks
A
lONGITUDINAL
!o.
... ..
\
..
SPINE
B
TRANSVERSE
,
f
\
SPINE
54
The Canadian Nurs. August 1976
--- Case Study -------:::o:;es-w:o:::c:::;,a
d::'::O:d-'
talk to them if they thought it would help.
The next day, Jane phoned and told me that she
and her husband had decided to terminate the
pregnancy. She asked that it be done as soon as
possible. I made an appointment for her with the
obstetrician on the team, who would reexamine her
before she came into the hospital and explain the
procedure to her. I told Jane the date and time of her
admission to hospital, and said I'd visit her soon after
her arrival.
Then I spoke to the head nurse in charge of the
floor to which Jane would be admitted, discussing
with her the circumstances of Jane's abortion, This
let the staff know that Jane was being cared for by the
amniocentesis team, and that she would have need
of their support.
Soon after Jane's admission I went to see her. I
found her sitting on the edge of the bed with her back
to the patient next to her. I thought that she wanted
privacy, so I suggested that we go for a walk. Jane
immediately expressed how difficult it had been for
herself and her husband to make the choice and said
she felt "nke a murderer." I told her that the way she
felt had been expressed by others with the same
concern, and encouraged her to talk about her
feelings. Together we discussed her choice, and
Jane described in detail how she and John had
reached their decision. The abortion had been
booked for the following day, and I told her that I'd
see her beforehand.
Jane looked frightened and somewhat tearful
when I saw her early the next morning, and said she
was really "anxious to get it over with." I went with
her to the floor where she was to receive the saline
injection. After the injection, I spent the afternoon
sitting with Jane at her bedside until her husband
arrived. We talked about everything from politics to
religion. Now and then she would ask when I thought
the labor pains would start. That evening I phoned
Jane from my home.
The next morning when I went to see Jane, she
was up walking in the halls. She appeared to be
relatively relaxed. She told me that she had aborted
at about four in the morning, and compared the
physical experience to that of giving birth, saying it
was more intense but took a shorter time than her
other deliveries had taken. Jane was anxious to go
home, and talked of "getting out ... as soon as the
doctor comes in."
I visited Jane in her home three weeks after the
abortion. She saId that the whole experience already
seemed slightly unreal. but that she was troubled
by recurring dreams about it. She seemed relieved to
know that other women had reported such dreams,
but that the dreams had been only temporary in
nature. Jane also said that she felt closer to herthree
children than she had before the abortion.
I still keep in touch with Jane periodically - she
tells me that time has helped her to see the
experience in a different perspective and to
incorporate it into her life.
.
In her sixteenth week of pregnancy, 40 year old
Jane D. was tested through amniocentesis for the
presence of genetIc disease in her unborn child.
Three weeks later, test results indicated that Jane
was carrying a child with Down's syndrome or
mongolism. She and her husband John were
contacted by their family doctor, who broke the news
to them. He also told the couple that the
amniocentesis team would be available on the
following day to discuss the alternatives available to
them.
We were seated in lounge chairs in the hospital
conference room - the geneticist, Mr. and Mrs. D"
and myself, the amniocentesis nurse. Jane D. and I
smiled at each other in recognition - we had talked
together at antenatal clinic, and on the day of her
amniocentesis. She looked fairly composed, and I
wondered how she managed after what must have
been an anxious and sleepless night.
Jane was the first to speak and break the silence
- '" really can't believe this is happening to us. Our
doctor says something's wrong with our baby.
Couldn't there be a mistake somewhere? How do we
know that the test results are right?" The shock and
denial in her voice was something I'd seen in others
who had received similar news.
The geneticist patiently explained the careful
labeling procedure for amniotic fluid specimens,
assuring Jane and her husband that the test results
were accurate and indicated mongolism in their
unborn child. The couple were then told about
Down's syndrome - "I can't really tell you how your
baby will develop, but his mental development will
reach the level of a six or seven year old at best." The
geneticist also discussed with them the varying
degrees of physical disability associated with
mongolism. He let them know that some mongoloid
children die young as a result of cardiac or other
serious anomalies, while others, physically healthy
can be expected to live a normal life span of sixty or
seventy years.
Jane and her husband listened quietly and
intently to the doctor. I felt that any doubts they had
had about 'mistakes' in the diagnosIs had been
dispelled. Given a realistic picture of Down's
syndrome, I felt they would be able to evaluate the
impact the birth of a mongoloid child would have on
them as a family.
John D. finally spoke, softly, and with some
difficulty: "If we decide to abort our baby, how safe
will it be for my wife?" I talked to them about the
details of terminating a pregnancy, and told them
how long Jane would be in hospital.
There were no other questions. John stood up,
and said they would talk overtheir decision and let us
know what they had decided the next day. I walked
them to the elevator and said I understood that they
had a difficult decision to make. I told them that they
could call me anytime, at home or at work, and gave
them both telephone numbers. I also mentioned that
I
------------------------------------------------
..--
choice. Because prenatal diagnosis is a relatively
new approach with implications for future
management of genetic disease, we wish to share
this insight.
Abortion
It is during the initial interview in the Prenatal
Genetic Clinic (before testing) that the issue of
abortion is raised by the doctor to give the couple a
chance to express their feelings and air their
differences. Some couples express practical
concerns and are able to evaluate their situation
realistically and positively. They may state: "We just
couldn't afford to have another child with Down's
syndrome."
Many couples however, do not see abortion as
the inevitable outcome of test results that indicate an
abnormality, and they need to wor\< out their feelings
to determine if such a route is justified. This
ambivalenæ may be seen in 'selfless' comments,
like "I could handle it but my husband couldn't," "It
wouldn't be fair to our other children," or '" wouldn't
want to inflict such a hard life on the child,"
All these feelings and attitudes should be
explored and documented in an interview before
testing in the event that test results should prove
abnormal. If a decision is to be made in favor of
abortion, it must be made within a short time after the
results are known, so it is important that the couple
understand their feelings and have the time to
consider their decision. It is also helpful to health
personnel to understand how the couple feels, so
that they can better support them in their decision,
When an affected fetus is diagnosed, the
patients are told of results of tests by the
doctor best acquainted with their needs, perhaps by
their family physician. They may also require a
pre-admission interview with the geneticist and
nurse to discuss the implications of the test results
and the method of termination of the pregnancy.
Women admitted to hospital for an abortion of
an abnormal fetus may express many conflicting
feelings about the unbom child and about the
decision they have made to abort. At this stage of
pregnancy, they are able to feel the movement of
their baby, and this may compound their feelings of
guilt and confusion. "I can feel the baby kicking - it
would be easier to terminate if J hadn't felt life."
Questions about the abortion procedure itself, or
about what will happen to the baby are common.
Many patients relate the difficulties they have
had in dealing with another handicapped child in the
family. Others with healthy children may tell about
their family's happy activities and of their concern
about allowing this happiness to be interrupted by
the bi rth of an abnormal baby. They attemptto justify
their decision and to communicate their need for
understanding. Often they cry when they talk of their
families or their other children,
Concern about 'what others will think' is also
evident. A number of patients have not yet told
anyone of their pregnancy, and will tell the nurse of
excuses they have given family and friends for their
hospitalization. Those who have shared their
pregnancy with others may feel a great deal of social
pressure when they decide to terminate. Acceptance
by hospital staff is most important and helps to
alleviate the painful effects of an unhappy decision
on the part of the patient. A number of patients have
been visibly upset by comments from nurses whose
1!),...Lr nf Ilnn.o.rct!1nr4inn hrnllnht nlløc;,tinnc::;, likp lI[)ici I'>
The Canadian Nur.. Auguat 1976
55
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56
The Canadian Nuraa Augusl1976
your contraception fail?"
Women admitted for abortion are often
concerned that the results of the test may have been
wrong. Often they ask how sped mens are identified
and results reported.
The abortion itself is done either by
prostaglandin infusion or intra-amniotic saline
termination. In spite of fetal maceration through
these procedures, we have been able to confirm the
diagnosis in all fetuses. Hysterotomies are only
performed when tubal ligation is being carried out.
We feel strongly that a hysterotomy is not in the
patient's best interest merely to allow us a better
chance to confirm the diagnosis.
been through the expenence. and a nurse who has
been with them throughout the expenence. In this
way, we may lessen the long-term psychological
complications of this new sociological dilemma
which scientific advance has created. ...
Noreen L. Rudd, (MD., F.R.C.P.(C)) is a graduate
of the University of British Columbia. She is
presently a Staff Geneticist and Pediatrician at the
Genetics Department, Hospital for Sick Children,
Toronto. She is also an Assistant Professor of the
Departments of Medical Genetics and Pediatrics at
the University of Toronto.
Follow-up
When the Clinic began, many women raised
issues during the immediate recovery period, which
we were not prepared to deal with. We now make a
point of discussing such issues with families before
the abortion if they are not initiated by the patient.
They raised such questions as, "Can I see the
baby?". "Where will it go after you have done your
studies?", "Can we arrange a burial?", "Willi know
the results of your studies?". How these questions
are answered varies with each patient. If studies
prove valuable for management of a future
pregnancy, then the family should be informed. This
decision is reached before the abortion so everyone
knows how to handle the family'
questions.
One woman has reported recurrent nightmares
about the baby after two years post-termination.
Another woman, also in the advanced maternal age
group, had vivid dreams about her baby at the
expected date of confinement after the abortion.
Although all the women who chose to have an
abortion insisted that they had no regrets about that
decision, many were still having difficulty dealing
with the fact that they had produced an abnormal
baby. One woman, when asked if we could have
made things easier for her stated that she wished
she had never looked at the ultrasound photo
because seeing the fetal head made the baby more
real to her and created difficulties for her when she
decided to have an abortion.
After the initial follow-up care by telephone or
home visiting from our amniocentesis nurse, several
families required a visit from the geneticist to help
answer some of their questions about the baby. At
this interview, results of post mortem studies were
given (if they were previously decided upon) and the
implications of these studies for other family
members or themselves were discussed. Our
impression was that these interviews were regarded
by the family as a completion of an unhappy event.
After the interview they felt better prepared to put the
event in perspective.
In summary we feel that the unlucky five
percent of families who face selective abortion as a
result of genetic amniocentesis are a unique group of
people in our society. There is no precedent to help
them cope with the ordeal they must face. They
require a fair amount of professional time before,
during, and after the therapeutic abortion to help
them work through many of the conflicts, questions,
and anxieties which arise. Those of us who generate
these anxietilc's should assume the responsibility of
spending the necessary time with these families and
ensuring that adequate support is available for
couples. In addition, support can be forthcoming
through their family, church, other couples who have
Betty M Youson, (R.N., B.N.) is a graduate of the
Hospital for Sick Children in Toronto and McGill
University in Montreal. She has had previous
experience in public health nursing, nursing
education and as a research assistant. Youson is
presently on staff at the Genetics Department,
Hospital for Sick Children, Toronto.
References
1 Doran, TA The antenatal diagnosis of genetic
disease, by... et al. Amer. J. Obstet. Gynecol.
118:314-321, Feb. 1974.
2 Miskin, M. Use of ultrasound for placental
localization in genetic amniocentesis, by... et al.
Obstet. Gynecol. 43:872-877, Jun. 1974.
3 Benzie, R.J. Fetoscopy. Mod. Med. Can.
30;9:780-783, Sep. 1975.
4 Canadian guidelines for antenatal diagnosis of
genetic disease; a joint statement. Canad. Med.J.
111 :2;180, 183, Jul. 20, 1974.
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Keeps
him drier
Instead of holding
moisture, Pampers
hydrophobic top sheet
allows it to pass
through and get
"trapped" in the
absorbent wadding
underneath. The inner
sheet stays drier, and
baby's bottom stays
drier than it would in
cloth diapers.
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helps prevent moisture
from soaking through
and soiJing linens. As a
result of this superior
containment, shirts,
sheets, blankets and
hed pads don't have to
be changed as often
as they would with
conventional cloth
diapers. And when less
time is spent changing
linens, those who take
care of bahies have
more time to spend on
other tasls.
"
"
PROCTER. GAMBLE CAR 3:!l
58
The Canadian Nurse August 1976
Nttllles
i\11(( Faces
The University of New Brunswick
acclaimed Margaret G. McPhedran
(R.N., Charlotte E. Englehart
Hospital, Petrolia, Ontario; B.A..
University of Toronto; M.A., Columbia
University, New York), by making her
honorary professor emerita at
Encaenia exercises in Fredericton, on
May 13, 1976.
..
\
-
\
Professor McPhedran has been
associated with the University of New
Brunswick's nursing faculty from its
beginning in 1959 until her retirement
in 1974. She served as acting director
of the school in 1962 and was
appointed dean when it was made a
faculty in 1968.
Professor McPhedran's career
has included 16 years' service to UNB
as teacher and administrator and
previous positions as instructor of
nursing at the Metropolitan School of
Nursing, Windsor, and assistant
professor of the School of Nursing,
University of Toronto.
Janet Cha"erson (R.N., St. Giles
Hospital, London, England and
Toronto East General Hospital;
B.Sc.N.. University of Windsor) has
been appointed National Coordinator
of Health and Community Services of
the Canadian Red Cross Society.
On joining the Canadian Red
Cross Society in 1973, she was
Assistant National Director of Family
Health and served as Acting National
Director prior to her present
appointment.
She has previously taught at the
Toronto East General Hospital School
of Nursing and was a Canadian Red
Cross Observer in the Guatemalan
earthquake zone.
Nessa Leckie, (R.N.. St. Paul's
Hospital, Saskatoon, Sask.; B.N.,
McGill University, Montreal, Quebec)
director of nursing, Douglas Hospital,
Verdun, Quebec, retired on April 30
after seven years in the post. Formerly
assistant director in charge of nursing
education, Leckie joined the hospital
staff in 1958 as an instructor.
Leckie has been involved in
nursing education programs in three
large mental hospitals. She did clinical
post-graduate work at the Alberta
Provincial Mental Hospital at Ponoka.
While at Douglas Hospital, she was
chosen a member of the Canadian
government external aid mental
health advisory team, and was sent to
the Caribbean in 1966 for a year.
There she helped reorganize the
nursing education at St. Ann's
Hospital, Port-of-Spain, Trinidad.
Hélène Berthelot replaces Leckie as
the director of nursing at Douglas
Hospital. Berthelot received her basIc
nursing education at L'höpital
Saint-Sacrement in Quebec; her
post-graduate training in child
psychiatry at L'höpital Sainte Justine;
and her M.A. in nursing at the
University of Montreal. She has been
at Douglas Hospital since 1972.
Carolyn Marie Pereyma of Sedley,
Saskatchewan has been awarded the
Kathleen Ellis Prize for the most
distinguished graduate in the College
of Nursing at the -University of
Saskatchewan's 65th annual spring
convocation on May 20, 1976.
",
'-
Max Hugel (R.N., Brockville
Psychiatric Hospital School of
Nursing; B.Sc.N., University of
Ottawa) has been appointed Director
of Nursing at Brockville Psychiatric
Hospital, Brockville, Ontario. Hugel's
psychiatric nursing experience
includes general staff nursing, area
supervisor, nursing coordinator and
acting assistant director of nursing at
Brockville Psychiatric Hospital. He
has been involved in the hospital's
Planning Committee and is also the
author of a Psychiatric Nursing
Program which ls to be implemented
in the hospital's Psychiatric Unit. The
program focuses on an intense
ongoing nurse-patient relationship
which will allow the patient input into
his/her type of care.
The following are new appointments
to Lakeshore Psychiatric Hospital,
Toronto:
Vahe Kehyayan (B.Sc.N.,
American University of Beirut,
Lebanon; M.Sc.N., University of
Toronto), Clinical Nurse Specialist in
Community Health Nursing.
Joan V. Abbo" (B.Sc.N.,
Memorial University of Newfoundland;
M.Sc.N., University of Toronto),
Clinical Nurse Specialist in mental
health and psychiatric nursing.
Grace Darling (B.Sc.N.,
D.P.H.N., University of Western
Ontario, D.P.H.N.A., (M.H.) and B.A.,
M.Sc.N., University of Toronto),
Clinical Nurse Specialist in mental
health and psychiatric nursing
"
Nora I, Parker, (Ph. D., University of
Toronto, Faculty of Nursing) has
received a grant from the Ontario
Ministry of Health for the development
of credit examinations for diploma
graduates entering a baccalaureate
nursing program. This project is to
develop methods of determining the
extent to which applicants have
mastered the competencies peculiar
to baccalaureate education.
Examinations will be based on
assumptions regarding differences in
baccalaureate and diploma education,
and the further assumption that
competencies to be tested may have
been acquired by means other than
formal education.
......
"'-
-.
Eva M. Wideman (R.N., B.A.) has
recently returned to Canada after é
2-year tour of duty at the Jordan
University Hospital in Amman, Jordé
with MEDICO, a service of CARE.
Wideman previously nursed al
the Royal Alexandra in Edmonton ar
at St. Paul's in Vancouver before
going to the new 220-bed Jordan
University Hospital where, as
Education Supervisor, she
established the In-Service Educati(
Department. Her duties included tt
teaching of medical English and hI
to write medical charts not only to
Jordanian nurses but multinational
as well.
This was the first hospital in
Jordan to establish an In-Service
Education Department which is bei
keenly observed by other hospital
Dorothy Wylie recently joined the
RNAO staff as director of its newl}
organized division on nursing. She
leaves her position as Director,
Patient Care Services, Sunnybrool
Hospital in Toronto.
Eunice Coles (R.N., Hospital for SI
Children, Toronto) recently retired
Senior Assistant Director of Nursing
the Hospital for Sick Children,
Toronto. after 32 years of service.
In 1944, Coles returned to wo
because of a nursing shortage,
worked in the Emergency departme
and in the surgical clinic before takil
a position in the Nursing Office, whe
she remained until retirement.
She has been described by hI
colleagues as a great humanltarial
and a concerned professional abol
patient care.
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12 ABITIBI PLACE BONAVENTURE
MONTREAL. QUEBEC
60
The CanadIan Nurse Augusl1976
Resumés are based on studies placed
by the authors in the CNA Library
Repository Collection of Nursing
Studies.
Jiese1il-cll
. Amputation in Children
AdJustive and Affective
Responses of School-aged
Children to a Leg Amputation.
Pittsburgh, Penn., 1975. Thesis
(Ph. D. in Pediatric Nursing)
University of Pittsburgh by Judith
Anne Ritchie.
The purpose of this study was to
examine the adjustive and affective
responses of children undergoing a
leg amputation. Five children ranging
in age from ten to fourteen years were
studied for two to six days
preoperatively and six to nine days
postoperatively.
The data were collected through
unstructured observations and
interviews conducted during periods
in which the investigator was providing
the children's nursing care. The data
collection sessions were chosen to
coincide with events which were likely
to be crises or which would tocus the
child's attention on the amputation.
\"\.
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The children's hospital
experiences were examined in four
time phases: the preoperative phase,
and the early, middle and late
postoperative phases. The behavior
protocols were divided into Units of
behavior measurement and were
categorized according to the
dimension of the "self as amputee"
and the behavioral responses to each
of these dimensions. The dimensions
of the "self as amputee" include
condition of the self, physical
characteristics, and social aspects.
The behavioral responses include
both adjustive and affective
responses.
""'"
The children's predominant
response to the aspects of the "self as
amputee" was adjustive behavior
through which they began to
understand the reality of changes
within themselves. Adjustive
responses were most freq uently in the
form of verbal and non-verbal
behaviors seeking information which
identified the self as an amputee. The
children limited information to
manageable amounts through
behaviors which restricted the amounl
and type of information received.
Limitation behaviors decreased
during the later postoperative phases.
Alteration behRviors, wishes,
fantasies, and dreams, which
attempted to change the reality of
becoming an amputee, occurred prior
to the amputation and then decreased
sharply. The children's adaptive
responses, behaviors indicating a
beginning accommodation to the
changes in the "self as amputee"
increased with the beginning of
mobility training, an event which
appeared to represent a degree of
restitution.
Affective responses to the "self
as amputee" occurred less frequently
than adjustive responses. The
occurrence of all affective responses
except hope or pride remained
constant over the four time phases.
The most frequent affective response
was depression through which the
children expressed their sadness and
grief about being an amputee. Fearful
responses, occurring almost as
frequently as depression, were
expressed in relation to treatments or
other threats involved in being ill,
beginning mobility, and the reactions
of others to them as amputees.
Rejection, expressed through anger
or aversion, occurred in response to
being an amputee and in response to
the appearance of the stump and
temporary and permanent artificial
limbs. Expressions of hope or pride
were few in number and were almost
exclusively in relation to their
functional capacity or recovery from
illness.
The dimensions of the "self as
amputee" to which the children
referred shifted in relation to the time
phases of the hospital experience.
The condition of the "self as
amputee," including being ill and
being an amputee, was the major
focus of the children's response
throughout the study. However, the
proportion of referenæs to the
condition of the self decreased with
increasing mobility. The responses to
the physical characteristics were
mostly in relation to appearance
during the early and later
postoperative phases, whereas
functional capacity was the focus in
the preoperative and middle
postoperative phases. Reference to
the social aspects of the self occurred
least frequently but were observed
most often in the middle and later
postoperative phases when the
children increased contacts in the
hospital and prepared for discharge.
In summary, the children were
able to begin to adapt to their
amputation during the first nine
postoperative days. The process of
grieving the loss of a body part
seemed to Occur simultaneously with
the striving to establish realistic
information about the "self as
amputee." The patterns of response
to amputation seemed to represent a
struggle toward mastery.
. Leadership
The Problem of Leadership in
French Canadian Nursing.
Detroit, Mich., 1975. Dissertation
(Ph. D.) Wayne State University,
by Georgette Desjean
This study is a survey of the
opinions and perceptions of a selected
group of French-Canadian
professional nurses concerning the
actual state of nursing and of
leadership in French-Canadian
nursing.
A set of cnteria for leadership was
developed, and a questionnaire
constructed to inquire into four areas
considered especially important.
conflict and change, roles and
functions in nursing, leadership in
French-Canadian nursing, and, finally,
the university and leadership in
nursing.
The final return of the
questionnaire came from 62% of the
total population: the faculty and
students of Laval University and of the
University of Montreal.
The findings of the study
corroborate the hypothesis that the
present situation of French-Canadia
nursing offers a picture of poor
definition, confusion of roles, apath
resistance to change, social lags. a
marked lack of leadership, and low
influence.
. Acupuncture
The Effects of Different
Techniques of Acupuncture or
Knee Pain. Winnipeg, Manitobé
1976. Thesis (M.A.), U. of
Manitoba. by Janice Ramsey.
//
.....
The purpose of the present
Investigation was to determine whit
of three lechniques of acupuncture
(distal, local, or combined distal-loCé
had analgesic effects on knee pain
The three techniques of acupunctu
were determined by location of needl
insertion relative to the area of
treatment. These techniques were
compared with similar placebo
techniques where needles were
inserted one centimeter away from tt
correct acupuncture point. To
determine change in pain, subjects
rated their knee pain twice before ar
five times after treatment.
The results indicated that therE
was a significant reduction in pain
following treatment and that this
analgesia was the same for all grou
and techniques. Because there wa,
no difference in degree of analgesi
between placebo and acupuncture
subjects, il was concluded that a
placebo effect was responsible for II
pain reduction in this study.
61
Patient- Oriented Nursing Texts
I
PATIENT STUDIES
IN
PHARMACOLOGY:
A Guidebook
FALCONER
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Falconer: Patient Studies in Pharmacology: A
Guidebook
Forty selected disease case studies provide a thought-provoking
review of the clinical use of all major drugs and drug groups.
Information about the patient. the disease in question and the
progress of treatment is interspersed with questions on the implica-
tions of diagnostic tests and the drugs prescribed. Explanations that
might be given in response to a patient's questions are also included.
Written by the author of the popular Current Drug Handbook, this
new book underscores the nurse's vital role in teaching patients
about the medications they are taking. Case studies cover the
pharmacologic care of patients with hypertension. depression,
bums. angina pectoris, leukemia. asthma. menopausal syndrome,
glaucoma, parkinsonism, venereal disease, arthritis, hyper- and
hypothyroidism, diabetes mellitus. epilepsy, peptic ulcers, and much
more.
A valuable adjunct to any nursing pharmacology textbook, the guide
also serves as a useful review for practidng nurses. Answer blanks
are provided right on the page; correct answers appear in the
accompanying Instructor's Manual. Along with a general bibliog-
raphy at the beginning of the book, references pertaining directly to
the subject being discussed are listed in each chapter.
By Mary W. Falconer. RN, MA, formerly, Instructor of Pharmacol-
ogy, O'Connor Hospital School of Nursing, San Jose, California.
147 pp. Soft cover. June 1976. $515 Order #3545-8.
Other Valuable References.
Falconer. Patterson & Gustafson: Current
Drug Handbook 1976-1978. 279 pp. Soft
cover. March 1976. $6.70. Order #3567-9,
Luckmann & Sorensen: Medical Surgical
Nursing: A Psychophysiologic Approach.
1634 pp. 422111 Sept 1974. $21.35.
Order #5805-9,
Miller & Keane: Encyclopedia and Dictio'1-
ary of Medicine and Nursing. 1089 pp. 122 ill
March 1972 $1365. Order #6355-9.
Gillies & Alyn: Patient Assessment and
Management by the Nurse Practitioner, 236
pp. IJIustd ApriJ 1976 $980 Order #4133-4,
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 responsibilities
0/ the pro/essional nurse, the legal aspects 0/
practice, ways to improve communication and
understanding, the administrative and manage-
rial responsibilities 0/ nurses, methods 0/ work
improvement. and leadership skills. Particular
attention is paid to defining the role of each
member of the nursing team.
By Thora Kron. RN. BS. 247 pp. Dlustd Soft cover.
Apnl1976. $5.15. Ot-der #552S-9.
Simmons: The Nurse-CHent
Relationship in Mental Health
Nursing: Workbook Guides to
Understanding and Management. New
2nd Edition
This practical workbook shows you how to
establish a therapeutic relationship with the
client under stress This revised edition includes
new guides on observation o/anxiety, assessing
the milieu, theoretical approach crisis interven-
tion. descriptive data, assessment 0/ the client's
leaming, and evaluation 0/ the nurse's leammg
By Janet A. Simmons. RN, MS. M Ed. 248 pp. Soft
cover. Apnl1976. $670. Ot-der #8286-3.
5
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62
The Canadian Nurse Augusl1976
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. Science
DNA
The invariable likeness of an
offspring to its parents, whatever the
species, has been traced to a unique
molecule that controls the production
of proteins and transmits
characteristics. This genetic material.
dioxyribonucleic acid, or DNA - the
hereditary material of life - is
described and illustrated in this film by
color animation. Mutations are also
discussed. This 1 O-minute color film is
available in 16 mm or 35 mm from
regional offices of the National Film
Board.
. Medicine
Preventing Pressure Sores
This is a slide presentation written
for nursing and rehabilitation
personnel, health educators, and
nursing and vocational school
students. The program of 49 color
slides and narrative on audiocassette
is sold by the Sister Kenny Institute.
Included with each set of slides is
a printed sheet containing a list of
basic facts about pressure sores, a
sample turning schedule, and 4
diagrams showing the bony
prominences that are most
susceptible to skin breakdown,
Additional information about the
slide-audiocassette program on
preventing pressure sores, and other
educational audiovisuals and
publications developed and
distributed by Sister Kenny Institute,
may be obtained by writing to:
Publications - AN Department,
Sister Kenny Institute, 1800 Chicago
Ave., Minneapolis, MN 55404, U.S.A.
Chronic Bronchitis
and Pulmonary Emphysema
This is a 53 minute film in two
parts_ Part I (29 minutes) reviews the
pathology and physiology of bronchitis
and emphysema and demonstrates
eqUipment and diagnostictechniques.
Part II (24 minutes) shows the results
of a study of the actual treatment and
rehabilitation procedures in a well
controlled program. This is compared
to the results when no planned
program is followed. These films may
be obtained from your local TB and
Respiratory Disease Association.
Management of Chronic
Respiratory Insufficiency
This is a 24 minute black and
white film that reviews the
rehabilitation program for chronic
respiratory patients as set up at the
D.A. Stewart Center, Winnipeg. This
film may be obtained from your local
TB and Respiratory Disease
Association.
. Health Promotion
A Matter of Fat
This is a 98-minute color film
available in 16 mm and 35 mm that
shows how one man shed nearly half
his body weight -140 pounds - by
complete starvation, under hospital
observation. What brought him to so
desperate a course, and how he
managed to cope with it, is told with
candor and humor by the fat man
himself. Lorne Green narrates the
rest. Between times, the film leaves
Gilles Lorrain and his lonely struggle to
examine what other overweight
people are doing, singly or in groups,
to reduce to more normal proportions.
It visits body-contouring parlors,
weight-watchers clubs and summer
camps. Medical authorities comment
on some misconceptions and
malpractices of the slimming industry.
Available from any regional office of
the National Film Board.
. Health Promotion
Diet Sheets
Diet sheets incorporating the
different foods used by ethnic groups
are available in 5 languages from the
Ontario Hospital Association, 150
Ferrand Drive, Don Mills, Ontario M3C
1H6.
These diet sheets are offered in
Portuguese, Greek, Italian,
Hungarian, and German. They will be
useful for the non-English speaking
patient who must adhere to a special
diet. -
Currently in translation are:
gastric III, restricted residue, low fat,
and restricted sodium. The sheets
cost 5 cents each, $5 per 100 and
$4.50 per 100 if ordered in quantities
over 1,000.
Food and Fitness
This is a 96-page booklet that
discusses the important issues in the
relationship between nutrition and
physical activity. It is available free to
Ontario residents from: Ontario Blue
Cross, 150 Ferrand Drive, Don Mills,
Ontario, M3C 1 H6.
Nutrition
The dietetic services department
of the Ontario Hospital Association
has published a 1975 edition of Film
and Textbook References, a
comprehensive guide to audiovisual
and written materials in general
distribution on the subjects of food
services. diet, and nutrition.
The guide contains over 400
listings of films, slide shows, and
educational literature. It is available, at
$2. per copy, from: Dietetic Services,
Ontario Hospital Association, 150
Ferrand Drive, Don Mills, Ont.. M3C
1H6.
A Global Approach
Poster, maps and charts.
monographs, and books on
population, food production, United
Nations organizational activities, and
technological development are
available from the Canadian Hunger
Foundation, 75 Sparks Street, Ottawa,
Ont. K 1 P 5A5. Write to the Foundation
for a list of publications available, with
prices.
Health and
Welfare Canada Pamphlets
"Antacids," "Cough Remedies,"
and "The Laxative Habit" are three
recent additions to informative heal
pamphlets published by the authon
of the Minister of National Health ar
Welfare. They are available from
Educational Services, Health
Protection Branch, Health and
Welfare Canada, Ottawa.
. Miscellaneous
Brochures
Information Canada publishes
eight brochures that describe some
the services offered by the federal
government. The following brochurE
are available: Citizenship; Federal
Services Employment; Health and
Social Security; Youth, Arts, and
Recreation; Senior Citizens; Farmir
and Fishing; and Housing.
These brochures are available
free from any Information Canada
center, or write Information Canadé
Mail Order Service, 171 Slater Stree
Ottawa, Ontario, K1A OS9.
Psychology Film Catalog
16 mm films on psychology ar,
listed in a 32-page brochure prepare
by the International Film Bureau,
Chicago. Topics covered include t
developmental psychology of
childhood, adolescence, and aging
mental retardation; clinical
psychology. family counseling; anc
psychology in business and indu
tr
Canadian rental and sale pnc
are available from Educational Filr
Distributors Ltd. 285 Lesmill Road
Don Mills, Ontario M3B 2V1.
Film Index
The Canadian Film Institute Fil
Title Index is a 300 page documen
listing over 6,500 titles available to
you. Titles only have been include<
complete with alternative titles, seri
title references, and the current
catalogue listing each film title. Thl
CFI will continue to update this
document on an annual basis. Cost
members - $20. and to
non-members - $25. For your col
write to the Information Officer,
Canadian Film Institute, 303
Richmond Road. Ottawa.
I"
The CanadIan Nur.. AuguIII1976
63
Books
Nursing Administration;
Theory for Practice with a
Systems Approach, by Clara
Arndt and Louise M. Huckabay,
Mosby, 292 pages, 1975.
Reviewed by Karen George,
Instructor, Staff Education and
Development, VIctoria Hospital,
London, Ontario.
Based on the premise that
:idministrative theory improves
administrative action, the authors
attempt to provide practising nursing
administrators and students of nursing
administration with a theoretical
. framework for use as a guide to
. dministrative action. While many
authors of administrative texts view
dministrative process as consisting
of a set of specific techniques, Arndt
and Huckabay portray administrative
theory within the systems frame of
reference and consider the
administrative process as a complex
. of vanable factors.
In the preface, four critical
.. requirements for the solution of most
important nursing service problems
are outlined - models, concepts,
analytical process and data. These
become the predommant themes of
the remainder of the work.
While the basic functions of the
nursing service administrator are not
viewed as having altered, the authors
proposethatthe manner in which they
are used has changed. For the reader
ho has found other descriptions of
c he systems frame of reference
onfusing, Arndt and Huckabay
rovide an orderly explanation of the
ystems approach as it relates to
ursing administration. Summarily,
he model describes the two concepts
of administrative process and the
pen system.
One chapter is devoted to
evaluation and measurement. A very
. complex topic is managed briefly but is
, sufficiently detailed for the purposes
outlined.
Two chapters are outstanding in
. describing other concepts needed by
a nursing administrator and the
" necessary qualities and specific role
expectations required. Chapter 7
. discusses change emphasizing
systematic analysis of all facets of a
proposed change program. It is
viewed as a management function to
recognize, anticipate and shape
changes according to certain criteria.
A model for planned change with
appropriate diagrams is proposed in
some detail with stress on the method
of change.
The qualifications and
educational preparation of the nursing
administrator is discussed in Chapter
11. Her qualifications are divided into
three broad categories -
(1) intellectual, (2) skills in leadership,
operation and communication and (3)
personal charactenstics, both
physical and psychological. The
authors perceive the nursing
administrator of today situated in a
network of mutually dependent
relationships, where she must
successfully coafign personnel or
become obsolete. One of the key
words used to describe the nursing
administrator is vitality - a tenn
connoting fortitude and personal
attractiveness in an individual. It is
recognized that a leadership position
is often a lonely one, eased somewhat
through working with others and
satisfying staff needs.
Regarding educational
qualifications, the authors maintain
that schools of nursing should retain
the ultimate responsibility for
educating nursing administrators
through an interdisciplinary approach.
A logical rationale for curriculum
development is presented
accompanied by direction for
decisions concerning how to teach in
such a program.
Although many of the factors
described in Chapter 13, "A Look Into
The Future," are specific to the
American nursing scene, resolution of
our health care problems in Canada
will require the same type of shared
leadership that Arndt and Huckabay
promote.
The illustrations, formulae and
diagrams throughout the book are
helpful. Reference sources cited at the
end of each chapter serve as
comprehensive guides to additional
reading.
If nurses in leadership positions
believe that the future for nursing
service administration looks bright,
this text is a valuable addition to the
body of administrative knowledge
concerned with implementing our
existing knowledge in a manner that
methodically analyzes all facets of the
system.
The Common Symptom Guide
by John Wasson, B. Timothy
Walsh, Richard Tompkins, and
Harold Sox, Jr., 353 pages,
McGraw-Hili Book Company,
New York. 1975.
Reviewed by Nettie Peters,
Assistant Professor, SChool of
Nursing, University of Manitoba.
Wmnipeg, Manitoba
This book, written by a group of
physicians, is a gUide to the evaluation
of 100 common adult and pediatric
symptoms. The Common Symptom
Guide outlines the relevant historical
data and physical examinations
reqUired to assess a patient's
symptoms. It includes diagnostic
considerations for each symptom
presented.
The book contains a helpful
glossary, and a cross index to enable
the user of the guide to find the page
best describing the patient's
complaint. Thus, for the patient
complaining of "weight gain:' the
health practitioner may find
Depression, Obesity, Swelling, listed
adjacent to "weight gain" in the index.
A medication section, which
indudes the names and physical
descriptions of some of the common
drugs prescribed for a patient's
complaint, may also be useful to
identify drugs the patient is taking. In
addition, a list of common descriptions
for symptoms is included in the front
and back cover page for easy and
quick reference.
Although the book has definite
merits as a reference for use by
nurses who are involved In primary
care activities, certain precautions in
its use should be noted. The focus of
the 100 symptoms is mainly physical.
Little consideration is given to the
emotional components of a patient's
health status. The GUIde is by its very
nature illness oriented and assists the
health practitioner in diagnosing and
treating illness. If nurses are
interested in using health indices to
detennme a person's level of wellness
in order to further promote health, then
this book has limited usefulness.
However, for the purpose of
further investigation of common
physical symptoms of adults and
children, this guide serves as a
convenient and compact reference.
Sexual Options for Paraplegics
and Quadriplegics, by Thomas
O.Mooney, Theodore M. Cole,
and Richard A Chilgren. 111
pages. Little, Brown and Co.,
Boston. 1975.
Reviewed by Diane Pechiulis,
Assistant Professor, Faculty of
Nursing, University of Calgary.
At last a comprehensive and
well-illustrated handbook on sexuality
and sexual techniques for disabled
persons has been written . . .
Sexuality and sexual expression
of the disabled has too often been
ignored as a teaching responsibility by
unenlightened health team members
because of their own inhibitions or
ignorance of basic physiological and
psychological facts. Thanks to these
three auth(){s, the handicapped now
have a sex manual of their own to
assist them in deriving satisfaction
and enjoyment of a basic
physiological and psychological need
Divided into five chapters and a
glossary oftenns, this book deals with
sexuality generally and sexuality as
perceived by the disabled.
Preparatory and arousal techniques,
oral-genital and manual stimulation,
and copulation positions are
discussed.
The book is written in easily
understood language, and presented
frankly with photographs of disabled
persons engaging in sex. It would
seem to be a useful manual for those
who face a sexual adJustment of their
own or their partner.
Although the book is presented
primarily for the disabled, there is
much useful information for the health
team member to assist the disabled
person with a sensitive area of
rehabilitation.
64
The Canadian Nurse August 1976
II(.(.I
H
This book should be part of every
rehabilitation unit library, for use in
Activities of Daily Living education.
The authors, one of whom is
disabled, are to be commended for
writing a long-needed book on a topic
of sensitive concern.
Special Care Units in
Hospitals, Health and Welfare
Canada, 159 pages, 1976.
RevIewed by Liz Scaife,
Teacher, Grace General
Hospital, School of Nursing,
Winnipeg, Manitoba.
Due to the rapid increase in
special care hospital facilities and
programs throughout Canada, the
need for guidelines and standards for
the planning, organization, and
operation of these special care
facilities has become apparent. This
book is the report of the Working Party
on Special Care Units in Hospitals,
appointed by the Federal-Provincial
Committee on Health Insurance to
provide these guidelines.
The standards developed in this
report are based on information and
experience available during the period
from 1973 to 1975. It is hoped that use
of these guidelines will improve both
the quality and the amount of health
care, while reduCing the costs of care.
Fourteen special care areas are
covered, from intensive care and burn
units to units for nuclear medicine and
the treatment of narcotic addiction.
Each special care area is covered in a
chapter, which gives the purpose of
the unit. the optimum patient load, bed
requirements, and criteria for
admission to the unit. Administrative
policy and procedures, staff
requirements in terms of numbers and
of qualifications, required equipment,
space, and supporting departments,
and the recommended distribution of
such units, are also outlined. An
up-to-date reference list completes
each chapter.
The information is presented in a
logical a'1d ;,;tl3.ightforward manner.
ThE' rletaJled table of contents makes it
easy to find information on any of the
special care units covered, and the
reference lists provide the reader with
additional sources of information for
areas covered by the book.
Although the report is not
particularly useful to many nurses, it
would be a valuable resource for those
involved in setting up or managing one
of these special care units.
Ambulatory Pediatrics for
Nurses by Marie Scott Brown
and Mary Alexander Murphy, 468
pages. Toronto, McGraw-Hili
Book Company.
Reviewed by Margaret T. Olsiak,
Assistant Professor, The
University of Ottawa School of
Nursing, Ottawa, Ontario.
The authors stipulate that the
book is a synthesis of information
dealing in preventive pediatrics which
today is an evolving focus of child
care. Therefore, the approach is
oriented to the child in his non-hospital
milieu.
The topic of history-taking
concisely delineates the practitioner's
specific role as a health team member
capable of documenting very
meaningful data that pertains to the
child's specific health-illness status.
The focus is on the individual child's
needs, as well as those of his family.
The most outstanding feature of
this text is the presentation of valuable
reference data in schemata and tablæ
that facilitate a busy practitioner's
functioning. Tables such as
calculations of homemade formulae,
skeletal measures, etc. are
outstanding in the areas of both data
compilation and reference value. The
topic of development and related
theories should also have been
structured in similar schemata to
which the practitioner could refer more
easily. The authors needlessly
present the fundamenlal methods of
body temperature and pulse rate
assessment. Rather, they should
hav presented the body temperature
range and pulse rates for given age
groups. The authors do not
emphasize that the apical beat is
considered the most accurate pulse
measurement in infants and is the
most commonly used clinically for
accuracy.
There are some areas of
incompleteness, e.g., the assessor's
interpretation of the D.D.S.T. with
repeats within a two-week period, and
indications of pathological conditions
of the resulting extremes of laboratory
results. Inclusion of such pathological
data would be beneficial to any
practitioner to facilitate a complete
collection of data and a complete
assessment of each client.
Each chapter is documented with
bibliographies and nonprofessional
sources are used. The use of these
sources serves as a very overt
reminder to the practitioner that these
child care sources are those
predominately used by parents, and
hence critical awareness as to their
value and data accuracy is essential.
The appendices are a source of
further resources that would facilitate
any practitioner's effectiveness. Such
shared data usually takes years for -
any practicing professional to glean.
Understanding Research in the
Social Sciences by Curtis
Hardyck and Lewis F.
Petrinovich. 224 pages.
Philadelphia a, W.B. Saunders
Co., 1975.
Reviewed by Pat Hayes,
University of Alberta, School of
Nursing, Edmonton, Alberta.
Unlike many publications in the
area of research and statistics this
book is not directly intended for the
use of researchers, rather the readers
are intended to be consumers of
research. The authors' objective is to
develop intelligent and critical readers
by providing them with the knowledge
necessary to comprehend and
evaluate differing research
approaches and methods of handling
data.
I
I
The style of presentation takes I
much of the mystique out of the
knowledge required for
comprehending research publicatior
Headings are clear and content area: I
organized in respect to major
concepts in research and statistics.
These are defined, discussed, and
illustrated in such a way that even thE
novice at reading research should b!
able to identify their application in 1
studies within their own discipline. Thl
six complete research publications
included in the text are used both tc
identify concepts and to evaluate
strengths and weaknesses.
The process of evaluation I
permeates the whole book, focusinçl
on the concepts of research design ir
the first six chapters and statistical I
concepts in the last five chapters.
The last chapter introduces the
reader to multivariate statistical
methods that include the use of
computer programs and printouts.
Light printing makes the printouts
difficult to read and the complexity 0
the concepts may be beyond Ihe
comprehension ofthosewithoutsorTlf
background in statistics.
Nevertheless, the authors' rationale
for including these complex method
(i.e., .....multivariate analysis will
predominate in the future"),
demonstrates their philosophy that
research is a dynamic process.
This book crosses disciplinary
boundaries and is pertinent to anyon l
functioning in the fields of social ant
behavioral sciences. It is not intended
however, to replace basic texts in
research methodology or statistics,
although it could be a companion
book. For those who feel they are rust
in the area and have no readily
available texts, it could be a reference
As a self-leaming text, the concepts
are well within the intellectual domail
of every nurse. I would certainly
recommend this book to those who
are novices in the area of research.
The Canadian Nurse AugU8t 1976
115
Lil)(-a.ilU lTI)(la:ltt>>
I fhe following publicallons, received
I ecently by the Canadian Nurses'
I\ssociation Library, may be borrowed
rom the Library by C.NA members,
;chools of nursing, and other
nstitutions. Publications marked R
owever, include reference and
:lrchlVe material and are not available
'or loan. Theses, also marked R are on
eserve, and are loaned on an
nterlibrary basis only.
I Loans from the C.NA library
llay be requested by a letter stating
he title of the publication, the author's
lame, and the item number specified
I, the following list, or by a standard
nterlibrary Loan form. Three
)ublications may be borrowed at one
ime. Borrowers are requested to
;over mailing charges for sending and
eceiving loaned publications.
If you wish to purchase a book,
;ontact your local bookstore or the
)ublisher.
Books and documents
11. Amencan Nurses' Association.
I!\NA clinical sessions, 1974, San
ICrancisco. New York,
I\ppleton-Century-Crofts, c1975.
417p.
2. Anthony, Catherine Parker.
Structure and function of the body,
by , . . and Irene B. Alyn. 5ed. St.
ouis, Mosby, 1976. 202p.
3. Arnow, L Earle. Introduction to
aboratory chemistry. ged. Saint
Louis, Mosby, 1976. 101p.
4. - Introduction to physiological
<Jnd pathological chemistry. ged.
Saint Louis, Mosby. 1976. 191p.
5. Association canadienne
d'Éducation. Repertoire canadien sur
'éducation, 1975. v. 11, no. 4.
Toronto, 1976. 107p. R
6. Bannerman, Gary. Cruise ships;
he inside story. Sidney, B.C.,
Saltaire, 1976. 270p.
7. Barritt, Evelyn R. Florence
Nightingale: her wit and wisdom. New
York, Peter Pauper Press, c1975.
61p.
8. Benson, Harold J, Anatomy and
ohysiology laboratory textbook,
by. . . and Stanley E. Gunstream.
2ed. Dubuque, Iowa, Wm. C. Brown,
c1970, 1976. 440p.
9. American Cancer Society A
cancer book for nurses. New York,
c1975. 151 p.
10. Brownmiller, Susan. Against our
will; men, women and rape. New
York, Simon and Schuster, c1975.
472p.
11. Canadian Council for Research in
Education. Canadian education
index, v. 11, no. 4. Toronto, 1976.
107p. R
12. Cohen de Lara, A. Rhumatologie.
Orthopédie, par. . . S. Arti et M.J.
Fournier. Paris, Masson, 1976. 177p.
13. Les Comores. Documentation du
Service de santé. Moroni, 1976. R
14. Conseil International des
Infirmières. Manuel de politique
générale et de procédure. Genève,
1975. 1 v. (various pagings)
15. Human settlements: a
commonwealth approach. The
contribution of Ihe Joint Standing
Committee of Commonwealth
Associations to HABITAT - United
Nations Conference on Human
Settlements, Vancouver, 1976.
Edinburgh, 1976. 69p.
16. International Council of
Nurse. . . Policy and procedure
book. Geneva, 1975. 1v. (various
pagings) R
17. International Tele-Film
Enterprises. Film {video catalogue.
Toronto, 1975. 261p.
18. Jackson, Sheila M. Personal and
community health, by. . . and Susan
Lane. London, Baillière Tindall, 1975.
216p.
19. McKai b . Charlene.
Self-assessment of current
knowledge in child health nursing:
1300 multiple choice questions and
referenced answers, by .. Shirley
Steele and Marcia P. Sullivan. New
York, Med. Exam. Pub., c1975. 210p.
20 Meltzer, Lawrence E. Concepts
and practices of intensive care for
nurse specialists, edited by . . . and
Faye G. Abdellah and J. Rodenck
Kitchell. 2ed. Bowie, Md., Charles Pr.,
c1969, 1976. 565p.
21. Norton, Doreen An investigation
of geriatric nursing problems in
hospitals, by. . and Rhoda McLaren
and A.N. Exton-Smith. Edinburgh,
Churchill-Livingstone, 1975 238p.
22. Nurse-clienl interaction,
implementing the nursing process, by
Sandra J. Sundeen et al. St. Louis.
Mosby, 1976. 200p.
23. Parsons, Edgar. Audio-visual
communication for associatIons.
Washington, U.S. Chamber of
Commerce, c1974, 190p.
24. Portraits: Peterborough area
women; past and present. Woodview,
Ont., Portraits Group, c1975. 206p.
25. Pratte-Marchessault. Yvette. Pour
bebé: Ie sein ou Ie blberon. Montréal,
Edition de J'Homme, c1976 164p.
26. Pentup, Frank B. SkIpping the
rope for fun and frtness. Boulder,
Colorado, Pruett, c1963. 36p.
27 The prmciples and practice of
medicine, edited by A. McGehee et al
1ged. New York.
Appleton-Century-Crofts, c1976.
1892p.
28. Registered Nurses Association of
Bntlsh Columbia. Committee on
Safely to Practice. A dIscussIon paper
on competence in nursing practice.
Vancouver, 1975. 80p.
29. -. Library catalogue books,
periodicals, audio-tapes, May 1976.
Vancouver, 1976. 115p.
Meet summer head-on
with
·
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m
EQ
N
" Tablets/REPETABS* /Syruprrlnjectable
. ) " full prescribing InfOTmatton.avaliabie
J 0 on request from
Schering CorPoration Limttect
Po;nte Cla.re, Quebec, H9R 184
if , -... *Aeg.TM ·
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:, ' · · \
8: ·
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.
.
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.
.
.
66
The Canadian Nuree August 1976
l..4il))et1I e 'J l'1' 1 )(I.lt(-
30. Registered Nurses' Association of
Ontario. Folio of reports, annual
meeting 1976. Toronto, 1976, 64p.
31. Robert, Henry Martyn.
Parliamentary practice; an
introduction to parliamentary law.
New York, Irvington, c1975. 203p.
32. Roberts, Keith D. Paediatric
intensive care; a manual for resIdent
medical officers and senior nurses,
by. . and Jennifer M. Edwards. 2ed.
Oxford, Blackwell, c1975. 307p.
33. SChrameck, E. L'infirm,ére en
urologie Paris, Expansion
scientifique française, 1976. 110p.
34. Selye, Hans. Stress in health and
disease. Boston, Butterworths,
c1976. 1256p.
35. Tega, Vasile. Flexible working
hours and the compressed work
week; techmcal and practical
aspects, implications. Montreal,
Guérin, c1975. 217p.
36. -. Les horaires f1exibles et la
semaine réduite de travail; aspects
théoriques et pratlques, implications.
Montréal, Guérin, c1975. 217p.
37. Toronto. Home Care Program for
Metropolitan Toronto. Eleventh
annual report, April 1, 1974 to March
31,1975. Toronto, 1975? 21p.
38. World Health Organization.
Multinational study of the international
migratIon of physicians and nurses;
analytical review of the literature.
Geneva, 1975. 99p.
UNIFORMS
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Pamphlets
39. Association of Nurses of Prince
Edward Island. Folios of reports,
Fifty-fifth annual meeting, 1976.
Charlottetown, 1976. 18p.
40. Canadian Teachers Federation.
Bibliographies in education, no. 55
Teacher education programs for
native people. Ottawa, 1975. 16p.
41. Canadian University Nursing
Students Association. Conference,
Queen's University, Feb. 6-8, 1976.
Report. Kingston, 1976, 1 v,
42. College of Nurses of Ontario.
Annual report of the director, 1975
Toronto, 1975. 17p.
43. -. Serving the public and the
profession. Toronto. 1975. 7p.
44. Dartnell Corporation. What a
supervisor should know
about. . . accident prevention.
Chicago, 1965. 24p.
45. -. What a supervisor should
know about. . . building morale.
Chicago, c1959. 23p.
46. Jersch, Charles E. Observations
on funding ,and grantsmanship or
manna from heaven. Ottawa, Youth
Science Foundation, 1975. 15p.
47. McMinn, Alex. Training of medical
laboratory technicians: a handbook
for tutors, by. . and Graham J.
Russell. Geneva, World Health
Organization, 1975. 83p. (WHO Offset
Pub. no. 21)
48. National League for Nursing.
Policies and procedures of
accreditation for programs in nursing
education; assocIate degree
programs, baccalaureate and higher
degree programs, diploma
programs, practical nursing
programs. New York, c1972, 1976.
28p. (NLN Pub. no. 14-1473)
49. Nursing involvement in health
care planning. Annotated
bibliography. Vancouver, Registered
Nurses' Association of British
Columbia. 1976. 7p.
50. Ontario Hospital Association.
Hospital career information, 1976.
Toronto, 1976.
51. Saskatchewan Registered
Nurses' Association. Annual report,
1976. Regina, 1976. 36p.
Government documents
British Columbia
52. Department of Health. Bureau of
Special Health Services. Project
report of the par-q validation study
and health evaluation program (HEP).
Part II. Victoria, 1975. 3v. in 1. (various
pagings)
Canada
53. Council of Ministers of EducallOn
Metric style guide. Toronto, c1975.
1v. (unpaged)
54. Health and Welfare Canada. The
fit-kit. Ottawa, Information Canada,
1975.
55. -. Progress report: preparation
of nurses for an expanded role in
Canadian health services, by Bevel1y
M. Du Gas and R.M.A. Sametz.
Ottawa, 1975. 12p. (Health manpower
report no. 4-75)
56. -. Community Health
Directorate. Health Programs Branch.
Annotated guide to venereal disease;
instructional materials available in
Canada. Ottawa, 1975. 38p.
57. -. Fitness and Amateur Sport
Branch. Fitness trails. Ottawa, 1976.
36p.
58. Labour Canada. Labour
organizations in Canada, 1974-75.
Ottawa, Information Canada, 1975.
148p.
59. Labour Canada. Economics and
Research Branch. Union growth in
Canada in the sixties, by J.K. Eaton.
Ottawa, 1976. 202p.
60. Law Reform Commission. Family
law; enforcement of maintenance
orders. Ottawa, Information Canada,
1976. 47p.
61. Laws, Statutes, etc. An act to
provide for the restraint of profit
margins, prices, dividends and
compensation in Canada. S.C.
1974-75. Bill C-73. 34p.
62. Lois, statuts, etc. Loi ayant pour
objet de limiter les marges
bénéficiaires, les prix, les dividendes
et les rémunérations au Canada. S.C.
1974-75. Bill C-73. 34p.
63. Manpower and Immigration.
Immigration Division. ImmIgration
statistics, 1974. Ottawa, Information
Canada, 1975. 46p.
64, Metric Commission. Second
report. Ottawa, 1975. 1 v.
65. Post Office. Report 1975. Ottawa,
Information Canada, 1975. 30p.
Tha CanadIan Nurse Auguel1976
67
,6. Postes canadiennes. Rapport
::J75. Ottawa, Information Canada,
'975. 30p.
7. Travail Canada. Organisations de
avallleurs au Canada 1974-75.
,Ittawa, Information Canada, 1975.
48p.
8.-. Direction de I'économique et
es recherches. Croissance du
'1ndicalisme canadien dans les
nnées soixante par J.K. Eaton.
Ittawa, 1976. 202p.
9. Ministry of State for Urban Affairs.
anadian settlements -
erspectives, edited by C.1. Jackson.
Ittawa, Information Canada, 1975.
26p.
J. Parlement. Comité mixte spécial
ur la politique de !'immigration.
apport, troisiéme. Premiére session
é la trentiéme législature,
974-1975. Ottawa, Imprimeur de la
ine, 1975, 142p.
,. Santé et Bien-être social Canada.
a physi-trousse. Ottawa, Information
anada, 1975. 6 pam.
2. -. Rapport préliminaire:
éparation des infirmiéres à un role
us é/aboré dans les services
anadiens de santé, par Beverly M.
Iu Gas et R.M.A. Sametz. Ottawa,
975. 12p. (Main-<!'oeLNre sanitaire
3ppOrt no. 4-75)
3. Statistics Canada Canada year
ook 1974. Information Canada,
974. 914p. R
4. -. Mental health statistics;
atient movement, 1975. Ottawa,
976. 4p.
'5.-. PensIon plans in
;anada, 1974. Ottawa, 1976. 135p.
6. Slatistique Canada. Annuaire du
'anada 1974. Ottawa, Information
'anada, 1974. 1017p. R
7. -. Régimes de pensions au
'anada, 1974. Ottawa, 1976. 135p.
8. -. Statistique de I'hygiéne
,entale, mouvement des mala des,
975 Ottawa, 1976. 4p.
ntario
9. Council of Health. District health
ouncils. Toronto. 1975. 43p.
O. -. Evaluation of primary health
are services. Toronto, 1976. 100p.
1. -. Genetic services. Toronto,
976. 79p.
nited States
2. Department of Health, Education,
nd Welfare. Public Health Service
enter for Disease Control
Tuberculosis statistics 1974: states
and cities. Atlanta, 1975. 15p. (DH EW
Pub No. (CDC) 76-8249)
83. National Institutes of Health.
Annual report of international
activities, fiscal year 1975. Prepared
by John E. Fogarty, International
Center for Advanced Study in the
Health Sciences. Bethesda, Md., U.S.
Department of Health, Education, and
Welfare, Public Health Service, 1976.
131p. (DHEW Pub. No. (NIH) 76-62)
84. NallOnal Center for Health
Statistics. Development of the
national inventory of family planning
services, United States. Rockville,
Md., 1976. 43p. (Its Vital and health
statistics. Series 1, no. 12.)
85. -. Family out-of-pocket health
expenses, United States - 1970.
Rockville, Md., 1975. 61p. (Its Vital
and health statistics. Series 10, no.
103
86. -. Inpatient utilization of
short-stay hospitals by diagnosis,
United States - 1972. Rockville, Md.,
1975. 66p. (Its Vital and health
statistics. Series 13. no. 20,)
87. -. Persons injured and disability
days by detailed type and class of
accident, United States -
1971-1972. Rockville, Md., 1976. (Its
Vital and health statistics. Series 10,
no. 105.) (DHEW Pub. No. (HRA)
76-1532)
88. National Institutes of Health.
Teaching of chronic illness and aging.
A conference sponsored by The John
E Fogarty International Center for
Advanced Study in the Health
Sciences and the Association of
Teachers of Preventive Medicine,
National Institutes of Health,
Bethesda, Md., Dec. 6-7, 1973. Ed.
by Duncan W. Clark and T. Franklin
Williams. Bethesda, Md., 1975. 132p.
Studies deposited in CNA
Repository Coltection
89. Association des infirmières
enregistrées du Nouveau-Brunswick
Une étude comparative de deux
modéles de personnel dans une umté
de nursing dans un hopital.
Frédericton, 1975. 205p. R
90. Cöté, Gemma, Soeur. Etude des
divers aspects du probléme de la
veillesse. Nicolet, P.Q., 1975. 131 p. R
91. Maranda, Josette. Problem is that
the respiratory patients are deprived
of adequate nursing care thus
hindering or prolonging their
recovery. Los Angeles, 1975. 21 p. R
92. Morgan, Madeleine.Analysedela
situation du syndicalisme chez les
infirmier(e)s (Québec '73). Montréal,
1974. 15p. R
93. -. Situation analysis: labour
unions and Quebec nurses (1974)
Montreal, 1974. 12p. R
94. New Brunswick Association of
Registered Nurses. A comparative
study of two patterns of staffing a
hospital nursing unit. Fredericton,
1976. 199p. R
95. Phillips, Margaret. Patients
perceptions of selected feelings of
nurses related to seff-disclosure of
nurses, by. . and Lettie Turner.
Toronto, University of Toronto, 1976.
76p. R
96. Ramsay, Janice. The effects of
different techmques of acupuncture
on knee pam. Winnipeg, 1976. 105p.
(Thesis (M.A.) - Manitoba) R
97. Thibaudeau, Marie-France.
Comportements des méres aprés la
consultatIon dans trois services de
sante de premIere ligne (CLSC,
urgence, cabinet privé), par. Mary
Reidy et Jean-Pierre Bélanger.
Montréal, Université de Montréal,
Faculté de Nursing, 1976. 255p. R
98. Thind, Gurpal K. Contact
interviewing in venereal disease'
contact tracing. London, 1972. 63p.
(Thesis (M.N.) - Western Ontario) R
Director of Nursing
Service
The Victoria General Hospital, Halifax, Nova Scotia, is a
large teaching general Hospital owned and operated by
the Province of Nova Scotia. The Hospital provides
services in all of the clinical specialties with the
exception of pediatrics and obstetrics.
The Hospital is seeking a Director of Nursing Service,
which is a senior management position reporting to the
Executive Director. The duties include participation in
the general management of the Hospital and
responsibility for the total nursing service program.
Accordingly, applications will be welcomed from
individuals with a strong background in Nursing who
also have the academic qualifications necessary to
participate at a senior level in the teaching programmes
of the Schools of Nursing at Dalhousie University and
the Victoria General Hospital.
The appointment offers excellent compensation and
fringe benefits. Applications should be directed to the
Executive Director, Victoria General Hospital, Halifax,
Nova Scotia.
68
The Canadian Nurse
('I.lssi 11.-(1
.i. \.1 ,-.-.-e is(-,)).-,) es
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
.
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 applicants should
apply to the:
Director of Nursing
Montreal Children's Hospital
2300 Tupper Street
Montreal, Quebec, H3H 1P3.
+
+
British Columbia
Operating Room Nurse wanted for active modem acute hospital.
Four Certified Surgeons on anending staff. Expenence of training
desirable Must be eligible for B.C. Registration. Nurses residence
a.adable Salary according to RNABC Contract. Apply to: Director of
Nursing. Mills Memonal Hospital, 2711 Tetrault St. Terrace. Bntlsh
Columbia. V8G 2W7
General Duty Nurses required for an 87-bed acute care hospllal In
Northern B C Residence accommodations available RNASC poli-
cies In effect. Apply to Director of Nursing. Mills Memonal Hospital.
2711 Tetrault St. Terrace, Bntlsh Columboa, V8G 2W7
General Duty Nurses for modern 41-bed hospItal located on the
Alaska Highway. Salary and personnel policies in accordance with
RNABC Accommodahon available In residence Apply. Duector of
Nursing. Fort Nelson General Hospl1al; Fort Nelson. Bnllst' Columbia
Ontario
RegIstered Nurses for 34-bed General HospItal. Salary $945 00 to
$1.145 00 per month. plus expenence allowance. Excellent personnel
policies Apply 10 Director of Nursing Englehart & District Hospllal
Inc.. Englehart. Onlano, POJ 1 HO.
August 1976
Registered Nurses
Southern California
An excItIng and rewarding career awaIts the
CanadIan educated regIstered nurse at SaInt
John s 551 bed acute-care hosp
al In sunny
Southern California. ChallengIng posItIons are
offered to those who wIsh to utIlize theIr
knowledge and nursIng skIlls in the followIng
areas: Intensive care. Coronary & Post Coronary
care, Medical-Surgical, Orthopedic,
Hemodialysis, Obstetrics, Gynecology,
PedIatrics, Labor and Delivery, Nursery,
OperatIng and Recovery room and Mental
Health Care.
Located wIthIn sight of the beautIful Santa
Monica Beaches, Saint John.s HospItal IS in the
center of Southern CalifornIa s many diverse
recreational, educatoonal and cull ural areas
Such activitIes as skIing, boating, swimmIng, goll
and tennIs are excellent year-round This
together wIth the numerous colleges and
unIversIties located wIthin mInutes of Saint
John.s enhances the already aftractive
employment opportunitIes. You may even meet
"Marcus Welby" as our hospital IS often used as
the set for the TV senes.
An outstandIng fnnge benelit package IS
supported by an equally impressive salary
schedule. General starting salary gUldelones are
as followS
R.N..s one year experience
R N.'s B.S degree
R.N. s B.S. degree & one
year's expenence $1139/mo USA
A 10% shift differentIal IS paId for everting and
nIght shift. Please don't heSItate' Send resume
today together with any questions regardIng
CalifornIa licensure. vIsa reqUirements.
Employment Office
$1084/mo USA
$1084/mo USA
SAINT JOHN'S HOSPITAL
& HEALTH CENTER
[qual Opportumty Employer M F
-t?
<9
'J.
'(f Sf
., Santa
o
Ç)
C,/>o
Mot\\C'3,
Quebec
Business for Sale - Paramedical Service operating In the provinc
01 Quebec wIth the head of
ce sItuated In Montreal. Good opportun
to expand allover Canada. Fantastic opportunity for licensed nurSe"
FOrtnlormatlon: MedIc Mobile Inc., 8415 Sf. Oems, Montreal, Oueb..
H2P 2H1 Telephone: (514) 381-8876-77
United States
Texas wants you! If you are an RN, expenenced or a rt:1c.en
graduate, come to Corpus Chns',. Sparl<ling City by the Sea . . . a c;t
bUilding for a benerfuture. where your opportunrtles for recreation a""
studies are limitless. Memonal Medical Center, 500-bed. genera.
teaching hospital encourages career advancement and provide
Inser\'lce onentation. Salary lrom $802 53 to $1,069.46 per month
commensurate with education and experience Differential fo
eventng ShiftS, available Benefits Include h01idays, sick leave
vacations. paid hospitalization. health, hfe Insurance, penSIOI
program. Become a vital part of a modem. up-to-date hospital. write 0
can John W. Gover, Jr., DIrector of Personnel, Memorial Medica
Center. P.O Box 5280, Corpus Chnstl, Texas. 78405.
The Canadian Nurse August 1976
69
:\
CENE
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is
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1tAæ'
The Executive
Nurse
A THREE DAY SEMINAR
for
DIRECTORS, ASSISTANT
DIRECTORS, SUPERVISORS,
HEAD NURSES
and
TEAM LEADERS:
Sept. 29, 30.
Oct. 1
Oct. 6, 7. 8
Quebec's Health Services are progressive!
Oct. 27. 28, 29
OTTAWA
Holiday Inn
TORONTO
Royal York Hotel
MONTREAL
Holiday Inn -
Sherbrooke
So
. .
IS nursing
The Educator-
Manager
at
A THREE-DAY WORKSHOP
for
STAFF DEVELOPMENT &
INSERVICE EDUCATION
CO-ORDINATORS:
The Montreal General Hospital
Oct. 20, 21, 22 TORONTO
Royal York Hotel
a feaching hospital of McGill University
The Manage-
ment Of
Motivation
Come and nurse i" exciting Montreal
A TWO-DAY WORKSHOP
for
ALL HEALTH CARE
PROFESSIONALS:
Oct. 18 & 19
TORONTO
Royal York Hotel
!1iß\
\U
The Montreal General Hospital
1650 Cedor Avenue, Montreal, Quebec H3G IA4
All courses are available on an
in-hospital basis.
Please tell me obout hospital nursing under Quebec's new concept of Social and
Preventive Medicine.
for more informatIOn write or call:
Name
Address
R.M. BROWN CONSULTANTS
1701 Kilborn Ave., Suite 1115
Ottawa, Ontario K 1 H 6M8
telephone: (613) 731-0978
L_______________________________J
70
AUSTRALIA
THE ROYAL MELBOURNE
HOSPITAL, in VICTORIA, AUS-
TRALIA, is a Premier Teaching
Hospital with 680 Beds, providing
a complete range of Medical and
Surgical Services.
Applications
re invited from -
Qualified Nurse Educators:
Trained Nurses:
for -
Intensive Care Unit
Coronary Care Unit
Renal Unit
Emergency Department
General Duties
Medical or Surgical
Salary - Dependent on experience
Accommodation - provided
Applications to be addressed to:-
The Director of Nursing,
Royal fnclboulnc
HO/pltal
Post Office,
The Royal Melbourne Hospital,
Victoria. 3050, Australia.
3300....,j
+
Once a Nurse. . .
Always a Nurse
Whether you're a practiCing R.N. or just
taking time out to raise a family, you can
serve your community by teaching lay
persons the simple nursing skills needed
to care for a sick member of the family at
home.
Red Cross Branches need
Volunteer Instructors
to teach Red Cross Health
in the Home courses.
Volunteer now as a Red
Cross Instructor in your
Community
For further information, contact:
National Coordinator
Department of Health
and Community Services
The Canadian
Red Cross Society
95 Wellesley Street East
Toronto, Ontario, M4Y 1H6.
The Canadian Nurse
Instructors
Work Overseas
The Government of Ghana has embarked on
an ambitious programme to expand training
facilities to meet the needs of an increasing
number of hospitals, health posts, and mobile
clinics. Assistance is required in the staffing
of these institutions.
Tutors are needed to teach General Nursing
and Psychiatry.
Conditions of Service: Two year contract,
Local, not Canadian, salary. CUSO pays
return transportation, Life Insurance, medical
and dental coverage.
Detailed information about these CUSO
assignments are available through:
CUSO - Health - 10
151 Slater Street
Ottawa, Ontario
K1P 5H5
Two Head Nurses
Two Head Nurses with preparation
and lor demonstrated competence In
Psychiatric Nursing and
Management functions.
One to be responsible for
participation in the organization,
initiation, and the management of a
New Psychiatric In-Patient Unit.
The other to be responsible for
participation, organization and
management of an existing
Psychiatric Day Care Unit.
Forward complete resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
I N5A 2Y6
The General Hospital
St. John's, Newfoundland
Associate Director of
Nursing
Applications are invited for the position of
Associate Director of Nursing at The General
Hospital in St. John's, Newfoundland. The
General Hospital is the major teaching
hospital in Newfoundland, and will be moving
to a new Health Sciences Complex in early
1977.
Applicants will have creative and innovative
leadership qualities, with the ability to
anticipate and plan for the indicated changes
developing in the fields of Health and Hospital
care.
The applicant will preferably be a Registered
Nurse with post graduate training in nursing
or health care administration.
Position available Immediately.
Please direct all correspondence in
confidence to:
The Director of Nursing
The General Hospital Forest Road
St. John's, Newfoundland A1A 1E5
August 1976
Director of Nursing
Director of Nursing required for new
acute care 25-bed hospital, duties to
commence October 1, 1976.
Preference given to applicant with
previous experience as D.O.N"
Head Nurse, or Supervisor.
Salary in accordance with
R.N.A.B.C. policies
Application to:
Administrator
Princeton General Hospital
Box 610
Princeton, British Columbia
VOX 1WO
Port Saunders
Community Health Centre
requires
Registered Nurses
Applicants must be registered or eligible
for registration with the Association of
Registered Nurses of Newfoundland.
Salary is on the scale $9,963. - $12,282.
Living-in accommodation available for
single applicants.
Applications should be addressed to:
Mrs. Madge Pike
Director of Nursing
Community Health Centre
Port Saunders, Newfoundland
AOK 4HO
General Hospital
Corporation
Positions available immediately for
Nursing Instructors for a three year
Nursing Programme.
Qualifications:
Baccalaureate Degree in Nursing.
Preference will be given to applicants with
experience in nursing and teaching
Applications in writing stating
qualifications and experience should
be addressed to:
Director of Nursing Education
General Hospital School of Nursing
St. John's,
Newfoundland
A1A 1E5
PUBLIC HEALTH NURSE
CHETICAMP
The Department of Public Health. Province of Nova Scotia,
invites applications for the posillOn of Public Health Nurse in
Cheticamp, Nova Scotia.
Qualifications:
Graduate of an approved School of Nursing plus a Diploma In
Public Health Nursing. Candidates should be registered or
eligible for registration in the Province of Nova Scotia.
Candidates must be bilingual (French and English).
Duties:
To provide general public health nursing duties including
nursing care to persons in the Cheticamp area. Extensive
travel is required in the area.
Salary:
Commensurate with qualifications and experience.
Full Nova Scotia Civil Service Benefits.
Competition is open to both men and women.
Please quote competition number 76-519.
Application forms may be obtained from the Nova Scotia
Civil Service Commission, J.W. Johnston Building, P.O.
Box 943, Halifax, Nova Scotia, B3J 2V9, and from the
Provincial Building, Sydney, Nova Scotia, B1P 51.. 1.
1JJco m f, k thE--
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Apply 10=
Diredor of Nursing Ongoing staff education
Monlreal Neurological Hospilal
3801 Univenjly Sf.
Monlreal. P.O. H3A 284
Individual orientation
The Canadian Nurse August 1976
71
Clinical Co-ordinator
Cardiovascular Surgery
Responsible to the Assistant Director of
Nursing for planning, co-ordinating and
supervising patient care.
Must be a Registered Nurse in the Province
of Ontario with nursing service experience at
the Head Nurse level and post-basic
preparation in nursing service
administration,
Toronto
Ge n eral Hospital
O n i vers i ty
Teaching Hospital
. located in heart of downtown Toronto
. within walking distance of accommodation
. subway stop adjacent to Hospital
. excellent benefits and recreational facilities
8pply fo Per,onnel OffIce
TORONTO GENERAL HOSPITAL
67 COLLEGE STREET, TORONTO, ONTARIO. MSG 1 L7
Assistant Administrator
Patient Care Services
Applications are invited forthe above newly created position at
the Holy Cross Hospital, a 500-bed fully accredited active
treatment hospital in Calgary, Alberta.
The Position:
Reporting to the Administrator, the incumbent will be directly
responsible for the co-ordination of Patient Care Services for
the hospital including the Department of Nursing,
Occupational Therapy, Physiotherapy, Social Service,
Admitting and the Central Supply Room.
The Applicant:
Advanced preparation in nursing administration with a
Master's Degree in Nursing or a Master's Degree in Health
Service Administration. Considerable experience IS essential
with the most recent experience being in a senior
administrative position.
Please submit a confidential resume stating
qualifications, experience, date available and salary
expected to:
Director of Personnel
Hospital District No. 93
940-8th Avenue S. W.
Calgary, Alberta
T2S OK1
Telephone: 1-(403)-264-9880
72
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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 career I
I opportunities In this serVice I
I Name: I
I Address: I
City: Prov: _
_______________J
The Canadian Nurse August 1976
Index to
Advertisers
August 1976
Abbott Laboratories
Burroughs Wellcome Limited
--
The Clinic Shoemakers
Equity Medical Supply Company
Hampton Manufacturing (1966) Limited
Hollister Limited
House of Appel Fur Company Limited
ICN Canada Limited
Image Uniforms Inc.
L'eggs Products International Limited
J.B, Lippln <: ott Company of Canada Limited
Procter & Gamble
Reeves Company
W.B. Saunders Company Canada Limited
Schering Corporation Limited
Uniform Specialty
U niforms Registered
White Sister Uniform Inc.
Cover 4
1,49
2
55
18
5
8
17
6 6
9
36, 37
57
15
61
65
Cover 3
59
7, 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.
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9 76 The Canadian Nurse
ES1502861935 F 10 1.
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9 76
Input
News
Calendar
Names
Books
Library Update
The Canadian Nurse
The official journal of the Canadian
Nurses' Association published
monlhly in French and English
editions.
6
10
12
14
56
56
Volume 72, Number 9
Focus on Prevention
Anatomic and Physiologic
Dynamics
Head to Toe
Childhood Cardiac Anomalies:
A Review
Quick Change Quiz
A New Look at Cardiac
Catheterization Equipment
Clinical Wordsearch # 2
Enforced Proximity to Stress
in the Client Environment
Mary Berglund:
Backwoods Nurse
Tell Me About Your Picture
Betty Oka
17
Penny Jessop
Lynda Ford
22
26
J Hendry and J Mitton
Penny Jessop
28
33
Sandra LeFort
Mary Bawden
34
39
Mary L.S, Vachon
40
Ingrid Bergstrom
Beverley McCann
44
50
\.'
"
"
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Changes - The "ever-whirling wheel
of change" spins for everyone. even
the little girl on the cover. Her photo is
supplied by Health and Welfare
Canada who also provided the photos
for the collage on pages 20 and 21 of
this issue.
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. Manuscnpts should
be typed double-space. Send original
and carbon. All articles must be
submitted for the exclusive use of The
Canadian Nurse. A biographical
statement and return address should
accompany all manuscripts.
Canadian Nurses' Association,
50 The Driveway, Ottawa, 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!
territorial nurses' association where
applicable. Not responsible for
journals lost in mail due to errors in
address.
Postage paid in cash at third class rate
Montreal, P.Q. Permit No. 10,001.
Canadian Nurses. Association
1976.
'>>(>>1-81)(>>(-t i
e
All too often, for reasons that are
not as yet fully understood, it is the
heart that proves to be the weakest
vital link in what Dr. Hans Selye has
termed "the biologic chain that holds
our vital parts together."
More than 2,500.000 Canadians
of all ages suffer from some form of
cardiovascular ailment. More than half
of the deaths that occur annually in
this country are caused by heart and
circulatory diseases.
As nurses, we are all too well
aware of what happens when the
demands plaæd upon the
cardiovascular system are beyond the
capacity of the individual to withstand
them. What we tend to forget are the
enormous medical advances that
have taken place reæntly in the
research, diagnosis, treatment and
control of heart disease.
The Canadian Heart Foundation
reminds us that today:
. most people who have heart
attacks recover.
. high blood pressure
(hypertension) can be controlled.
. recurrent attacks of rheumatic
fever, which damage the heart, can be
prevented.
. most heart defects can be
repaired.
. medical science can do a great
deal for people with circulatory
disorders.
The nurse in the intensive care
unit, coronary care unit, emergency or
other hospital setting, has an obvious
and important role to play in helping
cardiovascular patients learn to live
and work productively. Less obvious
but equally or even more important, is
the crucial part that the nursing
profession can play in stimulating,
developing and implementing primary
preventiO:1 programs.
More and more evidenæ is being
accumulated to indicate that, for most
of ils victims, heart disease is a
"disease of choice." There are simple
steps that anyone - at any age - can
take to help protect the health of his
heart and nurses are in an ideal
position to impress this lifesaving
knowledge on the people around
them. What we have to say is
important - even critical- but it is not
new. Thomas Chandler Haliburton
said it more than 100 years ago when
he wrote:
"The mechanism of the human heart,
when you thoroughly understand it, is,
like all other works of nature, very
beautiful, very wonderful, but very
simple. When it does not work well,
the fault is not in the machinery, but in
the management."
M.A. H.
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It seems appropriate that the theme
we finally settled on for this series on
the dynamics of the cardiovascular
system should be "Changes."
Hopefully, the title will serve as a
reminder of the infinite adaptability of
the human heart over the span of a
human lifetime. The series in its
entirety could not have happened
without the cooperation of several
very concerned and knowledgeable
nurses. We thank the authors whose
articles appear in this issue and look
forward to more of the same high
calibre contributions in October and
November.
Credit must also go to one
particular nurse who was the
whirlwind force behind the
brainstorming session that was
needed to get the series off the
ground. She is Penny Jessop, director
Editor
M. Anne Hanna
Assistant Editors
Lynda Ford
Sandra LeFort
Production Assistant
Mary Lou Downes
Circulation Manager
Beryl Darling
Advertising Manager
Georgina Clarke
CNA Executive Director
Helen K. Mussallem
of public education for the Ontario
Heart Foundation for the past three
years and author of "Anatomic and
Physiologic Dynamics," in this issue
This issue is also significant
because it marks the first time that the
work of the Journal's newest staff
members - assistant editors Sandra
LeFort and Lynda Ford - has
appeared under their own byline. By
coincidence, both are graduates ofthe
Atkinson School of Nursing, Toronto
Western Hospital. Their travels before
joining the staff included expenenæ in
general surgery, general medicine,
intensive care and critical care at
hospitals in Toronto, Belleville, Ottawé
and Vancouver.
I think that you will like what the
can contribute to your Journal and all
of us hope that you will find this series
one to remember.
Next month. . . "Hypertension: A
Major Health Concern", a look at
techniques for measuring blood
pressure and the story of one
successful screening program. In
addition, to help you understand you
MI patient better, a first-person
account of what it's like to suffer a
heart attack, as well as numerous
other articles in the continuation of thi!
series.
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The Canadian Nurse September 1976
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.
111))u1
Recognizing reality
Having read Jo Logan's
article, "The Handmaiden is NOT
dead," in the May issue of The
Canadian Nurse, I feel compelled to
respond.
I agree that in practice one still
finds nurses who act as handmaidens
to doctors, but I wonder if perhaps they
do so because they feel a comforting
sense of safety in a dependency
relationship, and perhaps doctors find
it flattering. But whose goals are being
met? To what end?
I cannot agree that "nurses need
physicians," at least, not unless they
are ill. Nor can I accept the concept
that "nursing educators must retain
handmaiden skills in the curriculum:'
nor that these skills are "urgently
required." A curriculum is only valid
when it is based on a philosophy of
nursing. Those who would teach
"handmaiden skills" must believe that
the nurse IS a handmaiden of the
physician.
It seems to me that Logan's thesis
IS based on false assumptions. To
begin with the key is the patient. Both
doctors and nurses serve the patient,
and it is the patient who is in the
dependency relationship, not the
doctor or the nurse, theirs is an
INTERDEPENDENT relationship.
Many nurses, and some leaders
in nursing, believe that of the seven
identified functions of the nurse, one is
a dependent function, that of "fulfilling
the doctor's orders." It seems to me
that this is not only an anachronism,
but a contradiction in terms. It implies
that the doctor is responsible for one
aspect of nursing, even though
doctors are not nurses.
When prescribing medications
and treatments, the doctor is
practicing medicine and the patient
depends on him to make effective
medical judgements. But when the
nurse gives the medication or
treatment she is nursing, and in failing
to carry out these prescriptions she
fails the patient, not the doctor.
Conversely, if in her professional,
independent judgement, she fulfils the
medical prescription believing it to be
detrimental to the patient, again she
fails the patient who is depending on
her to serve his best Interests.
Furthermore, in those situations
where the doctor needs assistance
while treating patients, it is the nurse's
independent function to render
assistance, not because the doctor
needs it. but because the patient does.
Is this a "handmaiden" role?
It seems to me that nurses must
place all these relationships in the
proper perspective. Common
courtesy between nurses and doctors
is required not only because of the
professional roles and
responsibilities, but because they are
people.
If we teach students
"handmaiden skills," we perpetuate
the past. In order to teach for the
future, their future, it would seem more
valid to help them understand the
meaning of human behavior, their own
and others'. Teach them that the
interpersonal skills and
understandings they learn in schools
of nursing, must be used with
sensitivity in all relationships, with
patients, medical and nursing
colleagues, visitors, and others. Let
them learn how to ask the right
questions, and what the professional
roles and respo.lsibilities of the nurse
entail. So armed, the novice will be
better prepared to cope with the
situation as she finds it, and be able to
function with a minimum of stress in
the changing world of nursing. She
may then become a n agent of change.
According to the Oxford
Dictionary the word "handmaiden"
means "a female servant." I find it
difficult to believe that Logan intended
we should teach our students how to
be skillful servants, but I sympathize
with the conærns which prompted her
to write the article. She is not alone in
recognizing the realities faæd by
noviæs in the "doctor-nurse game:'
but we should trust them to
demonstrate a new, more effective,
colleague role, for "Life goes not
backward, nor tarries with yesterday:'
(Kahlil Gibran. The Prophet.)
- Joyce Nevitt, St. John's, Ntld.
Did you know?
Sex Education for Disabled Persons is
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teachers' roles, sex education in the
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Cost: 35 cents from Public Affairs
Committee, 381 Park Ave., New York,
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Reality - the spice of life
The conflict situation between
hospital "realities" and training
"ideals" is vividly described by
Jocelyn Harper in "Coming Out: A
Confrontation With Reality" (July).
This would, in particular, apply to
those non-hospital based teaching
programs where clinical experience
comes late (and then, only briefly) in
the training period. However, such a
conflict is a rather general problem,
and is not restricted to the nursing field
alone. It is a prevalent trend in modern
education to sacrifice comprehensive
knowledge and high standards to
provide "job-oriented" training (where
professional idealism becomes a
token matter).
It seems to rr,e, that in order to
deviate, i.e. take "short-cuts", from tho I
professed "ideal!;" of nursing, in
situations where staff and time are
wanting, the nurse must be aware c
what is, in fact, the "ideal" nursing
standard. Instant recognition is mOr!
likely to follow a training period whel'f
these proven guidelines are
emphasized, and "peppered lightly"
with reality.
So let us "spice" our teaching
programs with that inevitable "reality
of the hospital situation, but let us nc
compromise high ideals in order to
provide efficiency at all costs.
- Audrey Moeller-Wiegmann R.N.,
St. Martha's School of Nursing,
Antigonish, N.S.; B.N. Student,
McGill University, Montreal, Que.
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Mail to: The Canadian Nurse, 50 The Drivewav. Ottawa K2P 1 E2
The Canadian Nursa September 1976
7
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Available Styles and Sizes 3 pairs 6 pairs for 12 pairs for TOTAL
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L' eggs - Queensize $ 4.77 $ 7.95 $15_90
Sheer Energy' -SizeA $11 97 $19.95 $39_90
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Ontario residents add 7'10 sales lax SALES TAX
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NAME
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CITY
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-----------------------------------------------
8
The Canadian Nurse September 1970
'.11)1..
A welcome note
A brief note to say how much I
enjoy the "new" Canadian Nurse. May
I congratulate the staff on their fine
editorial work.
- Ann Parsons, Burnaby, B. C.
"Sunny-side-up"
In r
ply to Jocelyu Harper's
article: "Coming Out: A Confrontation
with Reality," I would say to her:
1. Don't give up your professional
ideals.
2. Talk to the head nurse on your unit.
She will welcome your contribution to
and initiation of patient care plans.
3. Have ward conferences (even if
only for 20 minutes) with as many R Ns
and PNs as is feasible to formulate
individual patient care plans. You will
be surprised how much they will
contribute to care.
4. Be patient with hospital
administration. Things can be
changed by going through the proper
channels. Consult with your head
nurse about this. She is receptive to
change and innovation.
5. By maintaining your own high
standards, you will set an excellent
example for the rest of the staff.
- Evelyn Mosher, R.N., Vancouver,
B.C.
Occupational hazard?
I was very pleased to see an
article on Occupational Health
Nursing in your July issue, particularly
as it covered an aspect often
neglected or misunderstood, "the
Nurse's role in the work environment."
Anything whict1 helps to dispel the
image of Occupational Health nurses
as "Knitters and Stickers" is to be
welcomed and Hayman's article
covers a very broad area succinctly
and well ...
Your readers may like to know
that the Occupational Health Nursing
Course offered by Grant McEwan
Community College is 300 hours in
length and is being offered as evening
classes at present. The first nurses
graduated and were awarded
Occupational Health Nursing
Certificates this year and are to be
congratulated on the hours of hard
work needed to achieve this in
addition to their full time jobs.
Anyone requiring more
information should write to Ms, Rhea
Arcand, Grant McEwan Community
College, 7319 -29 Avenue, Mill
Woods, Edmonton, Alberta
- Elizabeth M. Butler, RN, OHNC,
Dip. Nursing (London), Occupational
Health Nurse Consultant, Medical
Services Branch, Albert(J. Dept. of
Labour.
Brain teaser
I just thought I would take this
opportunity to write and tell you how
much I enjoyed the Clinical
Word search No. 1 in the last
Canadian Nurse. I found it a very
interesting way to get me thinking!
Hope the No. 1 means there will be
many more to follow.
Congratulations on a much
improved magazine. I enjoy the
articles and look forward to each
issue.
- Healt1er Ducharme, R.N.,
Brandon, Manitoba.
An independent view
I'm just one of those nursing
students that aJt nurses have been at
one time in their lives, and, as yet,
have never assisted in an abortion
proædure. I have never had to
account for myself in this type of
situation, in the ca
city of a nurse.
However, I'm thankful that somebody
out there spoke out about Ihe article
entitled, 'What Are the Bonds
Between the Fetus and the Uterus.'
I couldn't agree more with Bettie
Scheffer's 'Input' in last May's issue. I,
too, was astonished at the lack of
objectivity and unbiased facts in the
article. As I read it,l found it difficult to
believe that I was rea,ding a magazine
that supposedly promotes
professionalism and open, intelligent
thinking for Canadian nurses.
The author of the article, V.
Adamkiewicz, appeared to judge any
nurse who assisted in abortions as
callous and uncaring, and attempted
to inflict guilt on those nurses who
agree with abortion.
We need articles with unbiased
facts lt1at can be used to formulate our
own, independent opinions, not harsh
(and sometimes unwarranted)
criticism!
- Carolyn Czartorski. Ottawa,
Ontario.
Our readers say....
I would like to answer Charles W.
Lindsay whose letter appeared in
Input, May, 1976.1 feel thatthisor any
other would be an inopportune time to
suggest a combined English/French
edition of The Canadian Nurse. Don't
deny the English-speaking Canadian
his right to a publication in English.
Please don't change.
- Patricia Black, R.N.. Flin Flon,
Manitoba.
... don't want to miss any issues.
Really like your new format. The
Journal has improved immensely!
- Robin M._ Scobie, Kasco, B.C.
....I'd like to tell you I think I've got more
information and enjoyment out of the
last SIX issues of The Canadian Nurse
than all the five previou previous years
I've reæived it altogether.
Congratulations on a terrific job!
- Faye Denys, Saskatoon, Sask..
Last year's model?
With regard to the article
"Storyboarding: A Teaching Tool"
June, 1976, I agree that
communication tends to be more
successful when both sight and sound
are used to reinforce the basic
message. However, one of the basic
rules of using pictures or films in
teaching is that they should be
up-to-date. The pictures in this article
distracted me from the article itself
since the use of a common can of
cotton balls and pick up forceps in an
open-ended container certainly isn't
up-to-date when considering Infection
Control in hospitals.
- D. Pequegnat, Infection Control
Officer, Ottawa CNic Hospital.
Huntington Society formed
The purpose of this letter is to
announce the formation of the
Huntington Society. For many years
Huntington's Chorea, a hereditary
illness, has been hidden by affected
families. It is our wish to bring it out into
the open and to reach not only
affected individuals and families, but
also those who offer care and
professional service to those affected
by the disease.
The Hunllngton Society of
Canada was recently established t,
aid in the battle against Huntingtor
Chorea, a hereditary degenerative
disorder of the nervous system. Tt
illness is characterized by the
association of abnormal involunt
"jerky" movements and a progressi'
mental illness. It is a disease
determined by a so-called dominar
gene, and therefore will be passed (
from generation to generation, witt'
every new child having a 50 perce
probability of eventually developin
the disease if either parent is affecte.
Unfortunately the signs of the disord,
usually appear after the age of 30,
when most persons have already
married and had children. The gen
although relatively rare, is still prese
in 1/10,000 persons.
The goals of the Society are
Research, Education, and Family
Assistance. Available on request is
family booklet in English or French
and a Handbook for Health
Professionals. Already Chapters 01
the Society have been established
several provinces. This non-profit,
voluntary organization is registered i
a Charity by the Federal Governmer
For further information please
contact: Huntington Society of
Canada, Box 333, Cambridge (Gal
Ontario, N1R 5T8.
- Ralph Walker, president.
Did you know?
Do you or your patients suffer
from migrwnes? The Migraine
Foundation has a pamphlet, availab
to the public. which gives simple
directions and suggestions indicatir
how migraine sufferers can help
themselves before and during an
attack.
The Migraine Foundation is al
attempting to conduct a survey of
known migrainers in Canada and ha'
questionnaires which they will glad
send to industries, organizations 01
individuals.
To receive the pamphlet or
questionnaire, contact: The Migraine
Foundation, 390 Brunswick Ave.,
Toronto, Ontario, M5R 2Z4.
GENEROUS NEW GROUP DISCOUNTS on all
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MRS. R. f. JOHNSON
SUPERVISOR
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II. 1.
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CHARLENE HAYNES
....
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10
The Canadian Nurse Saplember 1976
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Six Canadian nurses were among
participants in the thtrd International
Nurses' Seminar sponsored by King's
Fund College and held in London,
England in late July.
The conference theme was
"leadership" and discussion topics
included the nature of leadership,
definition of the role and responsibility
of nurses for leadership in a health
care delivery system, emergence of
leaders and evaluation of leadership.
Pictured with King's Fund
College Director Frank Reeves,
during the seminar, are: front row,
-1<-
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fill'
";>'Ç,.
-
,/" -
. ,
.
It -.
f
(left) Shirley Stinson, professor,
school of nursing and Division of
Health Services Administration,
Edmonton, Alta.; and Huguette
Labelle, principal nursing officer,
Health and Weffare Canada; back
row (left to right) Helen Mussallem,
CNA executive director; Ada
McEwen, national director, Victorian
Order of Nurses: Dorothy Kergin,
Associate Dean of Health Sciences
(Nursing) McMaster Health Sciences
Centre. Hamilton; Lorine Besel,
director of nursing, Royal Victoria
Hospital, Montreal.
Special loan fund for
1976 grads in Ontario
A limited number of loans will be
granted by the RNAO to 1976
graduates of basic nursing programs
in Ontario. The maximum amount of
the loan is $250. and IS available to
those nurses who wish to pursue
post-diploma or post:degree nursing
education programs: For further
information and/or application form,
write to: Executive Director,
Registered Nurses' Association of
Ontario, 33 Price St., Toronto,
Ontario, M4W 1Z2.
Hospital allows
Parents in OR
McMaster University Medical Centre
in Hamilton, Ontario is apparently the
first hospital in North America to allow
parents into the operating room during
induction of anesthesia in their
children. They are also in the recovery
room when the child regains
consciousness. After a sucessful pilot
study, the pediatric outpatient clinic
program (POPS) is now being
extended to different types of pediatric
surgery.
NB. nurses discuss resolutions
on soc and ec benefits and conditions
Negotiations and employment proved
the key issues di scussed by members
of the New Brunswick Association of
Registered Nurses at their annual
meeting in June, The resolutions
voted on are as follows:
. A resolution calling for NBARN's
full support of the provincial Collective
Bargaining Councils in their efforts to
improve salaries and working
conditions for New Brunswick nurses
received unanimous approval.
The resolution pointed out that
many nurses are receiving a lower
wage than the hospital workers they
supervise. An unsatisfactory
settlement from current negotiations
will widen the di sparity, it added, which
could lower standards by loss of
nurses from the profession and the
province.
. Nurses at the meeting supported
the broadening of the "Employment
Practices Guidelines" to assist the
2200 New Brunswick nurses not in a
bargaining unit 10 obtain adequate
social and economic benefits.
. A resolution was accepted
discouraging immigration of
out-of-country nurses when there are
sufficient nurses to meet employment
needs.
The resolution also pointed out
that some N.B. nurses are presentty
having difficulty finding employment in
their own province. Association
registrar Eva O'Connor presented
statistics on nurses coming into New
Brunswick which indicated a
significant rise in the number of
non-New Brunswick nurses registered
in the province in the first six months of
1976 over the previous year.
The Registrar advised members
that a letter explaining the
employment situation in New
Brunswick and the other provinces
has been sent to the Canadian
Embassy in the Philippines, where
many requests for registration
originate. The situation has also been
discussed with the Department of
Immigration, and a form letter has
been sent to out-of-country applicants
providing employment information
and advising them to be assured of a
position before completing plans to
immigrate.
. Nurses defeated a resolution
calling for the Association to do all ir
its power to prevent an
over-abundance of nurses.
The concern expressed here wa
that cutbacks in nursing school
enrolments could cause a future
shortage of nurses in New Brunswicl
. A resolution calling for NBARN t
limit its budget increase for next yea
to 10% was defeated,
. A resolution proposing that the
fee increase be split over a two-yeé
period was over-ruled by the previou
vote in favor of the $65 fee hike.
. A resolution was accepted callin,
for an increase in the non-practicin
membership fee from five to eight
dollars next year and from eight to te
dollars the year after.
. Members resolved that the
Association reiterate its anti-smokin
stand and actively support this
posillon.
This resolution referred to a 197
Canadian Public Health Associatior
study which illustrates that over 44'
of New-Brunswick nurses who belon
to that organization are current
smokers. ThiS compares with the 26 0
national average and is the highest (
all provinces. The resolution also
pointed out that public health nurse
serve in an exemplary role.
. Resolutions referring to
registered nursing assistants were
accepted which oppose the
employment of RNAs in the public
health field and call for an increase
the ratio of RN's to RNAs and for th
RNA to remain under the direction (
the RN in the practice setting.
Did you know?
The five most prevalent pathogens
occurring in American hospital
patients during 1975 were E. coli
(20.1%), Staphylococcus Aureus
(12.0%), Proteus (8.0%), Klebsiella
(7.7%) and Pseudomonas (7.5%)
according to a study done by
Bac-Data Medical Information
Systems Inc., Clifton, New Jersey.
Among all isolates,
gram-negative organisms
represented 57%; gram-positive,
43%.
The CanadIan Nurse September 1976
11
-iespiratory interest
roup formed
.A. Dutche[, President of the New
13rtJnswick Tuberculosis and
espiratory Disease As-sociatlon, has
Innounced the formation of a
espiratory Interesl'Group in
=redericton. Th
interdisciplinary
oducational resource 9rouP is an
tffili
te of the N.B. TB and Respiratory
)isease Association (the Chnstmas
.eal People) and the.second of its
.ind to be formed in Canada. The first
uch group is in Winnipeg.
The Respiratory Interest Group
cludes representatives from all
lealth. care disciplines: nurses,
)hysicians, respiratory technologists.
md other Interested professionals
md non-professionals from a variety
)f community health care institutions
md agencies.
Chairperson of the Group is
tAargaret Irwin, physiotherapist at
lictoria Public Hospital,
/1ce.chairperson is Louise Smith,
'IIurse Clinician In Oromocto, formerly
volved in Winnipeg's Respiratory
nterest Group..
The objective of the Respiratory
nterest Group is to improve the
revention and management of
espiratory diseases by encouraging
In inter-disciplinary approach,
romoting interprofessional and
Jublic communications, providing a
neans for professional development
.hiough continuing education, and
erving as a stimulus forthe formation
non-professional interest groups.
Interested nurses may contact
Ima Leclerc, RN, Program Director,
ew Brunswick Tuberculosis and
espiratory Disease Association,
.0. Box 1345, Fredencton.
Why not?
he results of a nation-wide
government survey on attitudes
owards the status of women indicated
a 20 per cent shift in the attitudes of
both sexes towards women's equality
between December 1974 and
December 1975.The results of the
survey were released in July by the
Mimster Responsible for the Status of
Women, the Honorable Marc Lalonde.
The survey was designed to show
current attitudes on women's roles
and potential abilities and to measure
any changes in attitude that occurred
dUring 1975, International Women's
Year. Attitudes on such topics as
equal employment opportunity, child
care, marital property division,
custody of children, and women
working in the home were
investigated.
In releasing the survey results,
the Mimster noted that this was the
fi rst comparative evaluation survey on
attitudes conducted by the
government and this fact indicated the
high priority the government placed on
status of women concerns.
The survey indicated that 86 per
cent of the population was aware that
1975 was Inlernational Women's
Year, and that 74 per cent of the
population recalled the "Why not'"
advertising for the year.
Nu rses will be heard
As a guest speaker of the New
Brunswick Association of Registered
Nurses' Annual Meeting held in
Fredencton in June, Mary Kay
Harrison spoke out in favor of a more
positive attitude among nurses and
delivered a hard-hitting critique of the
"doctor-nurse game".
Harrison, of the University of
Toronto s Faculty of Nursing:
delivered the keynçte address entitled
'Today's Nurse - A Dynamic
Professional", as well as conducting a
workshop "Nurses'Wili Be Heard!".
In her workshop, Harrison
stressed the complementary rather
than subservient role of nurses in their
relationship with doctors. She said
that although nurses have a different
role than doctors in the care of
patients, it is in no 'way to be
considered a less important role.
Harrison suggested
consciousness-raising -groups and
tlurrian relations workshops as the
means to making nurses more
comfortable with themselves, and
thus more assertive and responsible
in their professional role. She
concluded the workshop with a
warning to nurses: "If you act like a
doormat, you'll get treated like a
doormat."
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The Nursing Sisters Association of
Canada held its 25th biennial meeting
in Halifax during the CNA annual
meeting. Approximately 100 nurses
who served in two World Wars
attended. Two former Matrons of
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Photo by Wamboldt,Waler1lllld
Canadian units, Blanche Herman
(center R), and Nancy Kennedy ReId
(R), are pictured with the
association's honorary president,
Evelyn Pepper (L), and national
president, Agnes Butler (center L)
AARN supports university education
for all Alberta nurses by 1990
The Alberta Association of Registered
Nurses has endorsed the suggestion
of the Alberta Task Force on Nursing
Education that all professional nurses
graduating after 1990 in the province
should have a university degree.
Support for the proposal was
contained in a Response to the Report
of the Task Force submitted by the
AARN to the province's Minister of
Advanced Education and Manpower,
Dr. Bert Hohol, in mid-July.
In endorsing the recommendation
the AARN agreed that the
professional nurse of the future will
need a broader educational base to
meet the changing health care needs
of Albertans. The Association
supports the view of the Federal
Ministry of Health that within the health
delivery system more emphasis must
be placed on promotion and
maintenance of health as well as the
curative and rehabilitative aspects of
illness.
The 1wO routes of attaining a
university degree in nursing outlined in
the Task Force Report ( a university
based program and a joint program
be1ween college or hospital and a
university setting) were also agreed to
by the Association.
In the response the AARN
recognizes that a university degree for
nurses by 1990 will only become a
reality if priority commitment is
received from both government and
the concerned professionals.
Upgrading of the educational
preparation of nursing Instructors
must occur. The Association urges the
establishment 10 Alberta of more
nursIng programs at the Master's
level. Sufficient financial assistance
must also be available to support
nurses who wish to advance their
education.
The Association rejected the
Task Force's recommendation
regarding monitoring of nursing
education and advocated that an
organization outside government be
given the responsibility and authonty
for establishing and monitoring
standards of nursing education. The
AARN endorses the statement i.... the
1972 report to the Alberta
Government of the Commission on
Educational Planning that the
Professional Association is the most
appropriate body to perform the
monitoring task.
12
The Canadian Nur&e September 1976
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A Canadian Association of University
Schools of Nursing (CAUSN)
Committee on Accreditation
concerned with the development of a
tool for the evaluation of university
faculties/schools of nursing in
Canada, has been awarded financial
support by the Canadian Nurses
Foundation. The support, In the form
of a $5000 grant from the CNF, wi/1
enable CAUSN to continue work on
the proJect.
CNF secretary-treasurer, Helen
Mussallem, (center) made the official
presentation of the cheque to CA USN
representatives, Sue Finch (left)
chairman of the Committee on
Accreditation and Ruth McClure,
CAUSN president, during the recent
annual conference of CAUSN held in
conjunction with the Learned
Societies in Quebec City.
Neuro nurses meet
The Seventh Annual Meeting of the
Canadian Association of Neurological
and Neurosurgical Nurses was held in
Winnipeg this past June. Despite the
air strike which was in full swing, 84
nurses from Canada and the United
States attended the conference.
The conference included a day of
workshops, a day of scientific
presentations, and a half day of
special presentations. all of which
were of excellent quality. Dr. B.
Jeannett, Professor of Neurosurgery
from Glasgow, Scotland and special
guest of the 1976 Congress of
Neurological Sciences spoke to the
delegates on "Head Injuries".
CNA issues statement
on fiscal constraints
CNA Director5, meeting in Halifax
following the Association's annual
meeting and convention in June,
approved an official CNA Position
Statement on a subject of national
concern - fiscal constraints in health
care services. The text of the
statement reads as follows: "The
Association has repeatedly requested
that governments put forth plans to
re-focus the Canadian system of
health care in order to expand
services in the directions of health
education, health promotion and
pnmary care. Groups of nurses across
the country urge the provision of
realistic alternatives to our present
over-reliance on costly, acute care
facilities.
The Association supports the
Federal Government in its steps to
broaden the cost sharing
arrangements with provincial
governments in order to encompass
not only acute care facilities and
services but all health facilities. This
organization will work in concert with
government and voluntary agencies to
achieve that end.
The Association also strongly
urges greater emphasis on home care
programs, occupational, industrial
and school health programs. At the
same time, the Association is firm in its
commitment to promote an approach
to health care that achieves cost
effectiveness which IS compatible with
an optimal level of health for all
Canadians."
N.S. negotiations
reach stalemate
After three months of negotiations,
contract talks between the New
Brunswick Nurses Provincial
Collective Bargaining Council (PCBC)
and the Province's Treasury Board
broke down'i'n late June.
In Ii'ne.with 'the steps laid down by
the Public Sé-rvice Labour Relations
Act jn the "event of a breakdown in
negotiations,- PCBC has applied for
and been granted a cOQciliation board.
This three-member board will rule on
the contract dispute after hearing
evidence from both sides.
One member of the conciliation
board is nominated by the nurses and
another by Treasury Board. These two
members then nominate the third
board member who serves as
chairman.
The contract for New Brunswick s
2300 public hospital nurses expired
March 31, 1976. According to Glenna
Rowsell, spokesman for the
Bargaining Council, 17 of the 52 items
In the contract were unsettled,
including the wage issue. The nurses'
last wage proposal called for an
increase from the basic $721 per
month to $945 (31%) in one year.
Treasury Board's last offer called for
two $74 per month pay hikes bringing
the basic salary level to $869 per
month October 1, Rowsell said.
One of PCBC's major concerns is
the present discrepancy between the
salary of the RN and that of the RNA
whom she supervises. The historical
wage relationship between the two
groups was lost when the RNAs
signed their last contract. PCBC is
seeking to have the historical
relationship restored.
RNAs presently earn a basic
yearly salary of $8715 which will go up
to $9599 in October. The basic RN
salary amounts to $8652, the rate
currently in effect under the expired
contract. In addition, the RNA contract
comes up for negotiation at the end of
this year.
Nurses have traditionally earned
25-30% more than RNAs to reflect
their lengthier training, responsibility
for total patient care, as well as
responsibility for the supervision of
RNAs and others involved in patient
care.
Did you know?
The Department of National
Health and Welfare has awarded 26
grants totalling $25,000 as part of the
final phase of the department's
International Women's Year funding
program.
The Canadian Indian Nurses
Committee based in Winnipeg,
Manitoba received a $400. grant to
reprint 1,000 copies of their IWY
Project Report consisting of material
presented at and arising from "The
Rrst Assembly of Registered Nurses
of Indian Ancestry."
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September
10 Year Reunion at the School of
Nursing of Memorial University 0
Newfoundland for all graduates of
the school. To be held from Sept. :1
- 26, 1976. For information, comac
The School of Nursing, Memorial
University of Newfoundland, Sf.
John's, Newfoundland.
October
Ischemic Heart Disease - An
Inaugural Symposium to be held I
the Talisman Motor Inn, Ottawa on
Oct. 1 and 2, 1976. The Symposium i:
sponsored by the University of Ottaw
Cardiac Unit, Ottawa Civic Hospital
and the Canadian Heart Foundatior
and is open to all interested personnE
in the cardiac field. Registration fee
$50. For further information contact
Mrs. E Masson, University of OttaWé
Cardiac Unit, Ottawa Civic Hospita
1053 Carling Ave., Ottawa, Ontario
K1Y 4E9.
Workshop in Psychodrama to be
held at the Faculty of Nursing,
University of Toronto on Oct. 1 - 2,
1976 and Dec. 3 - 4, 1976.
Fee:$50.oo. For further information,
contact: Mrs. Dorothy Brooks,
Chairman, Continuing Education
Programme, Faculty of Nursing.
University of Toronto, Ont., M5S 1 A 1
Annual Rehabilitation Nursing
Course for Registered Nurses and
Registered Psychiatric Nurses at
Wascana Hospital, a division of the
South Saskatchewan Hospital Centrl
Regina, Saskatchewan to be held
from Oct. 18 - Nov. 5, 1976. For
information, contact: Mrs. Audrey
Balon, Co-ordinator of 1976
Rehabilitation Nursing Course,
Wascana Hospital, 23rd Avenue an
Avenue "G", Regina, Saskatchewal
S4S OA3.
Annual Conference of Ontario
Occupational Health Nurses
Association to be held at the Park
Hotel, Niagara Falls, Ontario, Oct.
26 - 29, 1976. Information from: Ann.
L O'Brien, Publicity Chairman.
OCHNA, 320 Queenston Rd.,
St. Catharines, Ontario.
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14
The Canadian Nurse September 1976
r
I
NaJlleS
8]1() FIlees
In recognition of her distinguished
service to the nursing profession,
Margaret M. Street (B.A., U. of
Manitoba; R.N., Royal Victoria
Hospital, Montreal; M.S., Boston
University, Boston, Mass.) was
presented with an "Honorary
Membership" in the Alberta
Association of Registered Nurses.
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Street is past president of the
AARN and a former Associate
Director of Nursing at the Calgary'
General Hospital. In 1972, she retired
as an Associate Professor Emerita
from the University of British Columbia
School of Nursing. She has been an
extremely active member of both the
AARN and RNABC as well as having
served on committees with the CNA.
Her best-known publication is
"Watch-fires on the mountains: the life
and writings of Ethel Johns."
Margaret (Peggy) Mitchell was
honored with the 1976 "Nurse of the
Year" award, presented by the Alberta
Association of Registered Nurses'
Annual Convention. Mitchell has been
the Special Project's Coordinator at
the Alberta Children's Hospital,
Calgary, where her main focus has
been on the importance of people as
individuals and excellence in nursing
care. She has been involved in many
community projects including the
organizing and supervision of a teen
drop-in center.
The "Nurse of the Year Award,"
initiated in 1965, is presented annually
in memory of the late Abe Miller, Legal
Advisor to the AARN. It is designed to
honor those who participate in
community affairs.
Karon Croll of Moncton has been
named incoming Executive Secretary
of New Brunswick Association of
Registered Nurses. Croll's
appointment was announced by the
President, Simone Cormier, during
the Association's annual meeting in
June.
A native of Yarmouth, Nova
Scotia, the new Executive Secretary
has spent most of her nursing years in
Moncton both as a staff nurse and a
nurse teacher. She graduated from
the Moncton Hospital School of
Nursing (1965), and holds degrees in
nursing and education from Université
de Moncton. Croll is presently
completing requirements for a
master's degree In adult education at
the University of Maine in Orono.
A graduate of the University of
Montreal Faculty of Nursing, Francine
Gratton.Jacob is the recipient of the
1975 Warner-Lambert Canada
Limited Nursing Fellowship award
made annually by the company's
Warner-Chilcott Laboratories
Division.
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Warner-Lambert makes the $ 750
cash award available each year to a
promising nursing graduate to assist
the nurse in furthering her knowledge
and experience in the field of nursing.
Gratton-Jacob is seen receiving
the award from Yves Bordeleau, left,
Field Sales Manager for Quebec and
the Maritimes. Jeanne Reynolds,
Dean of the Faculty of Nursing,
U. of M. is on the right.
Dr. Rae Mcintyre Chittick was
recently awarded an honorary Doctor
of Science degree at the Health
Sciences Convention at McGill
University. Chittick received her
formal education at Johns Hopkins
School of Nursing, Columbia
University and Stanford University in
nursing and education, and received a
Master of Public Health from Harvard
University in 1951.
She has held the position of
Director of the School for Graduate
Nurses at McGill and was instrumental
in the developmeñt of the Bachelor of
Science in Nursing and of Master of
Science (Applied) programs at McGill.
She is past-president of the CNA,
AARN, and past vice-president of the
ONQ and as such her influence has
spanned local, national.and
intemationallevels. She also served
with WHO establishing university
nursing programs in Ghana, Jamaica
and New Zealand.
At the convocation, Joan
Gilchrist, newly elected president of
CNA, described Rae Chittick as a
great Canadian, nurse and teacher
who truly epitomizes a dedication to
equality, cultural integrity and human
value.
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Carol Whiting (R.N., The Wellesley
Hospital school of nursing, Toronto;
B.Sc.N., M.Sc.N., University of
Western Ontario, London) has been
appointed director of nursing services,
The Wellesley Hospital, Toronto. She
had been associated with Wellesley
throughout her nursing career until
she joined the staff of the Ryerson
Poly1echnicallnstitutein 1973, when it
assumed responsibility for the
Wellesley school of nursing.
Whiting has been a Canadian
Nurses Foundation scholar.
A. Joyce Bailey (R.N., The Wellesley
Hospital school of nursing; B.Sc.N.,
University of Toronto; M.Sc.N.,
Western Reserve College, Cleveland,
Ohio) has been named assistant
administrator, patient services, The
Wellesley Hospilal, Toronto. Formerly
director of nursing service, she has
held several positions during her
association with Wellesley, with time
out for educational leave. She has
been a Canadian Nurses Foundation
scholar.
Jean Livingstone nurse in charge é
the Fort Providence nursing station i
the recipient of the Judy Hill Memorié
Scholarship. She has been awarded.
$3,500 grant to study midwifery in
Edinburgh, Scotland.
After graduating from St. Frana
Xavier University, Livingstone
practised general duty nursing in
Antigonish, N.S., and Victoria, B.C.,
and was Assistant Di rector of Nursinc
at North Battleford Indian Hospital an;
also served at the Charles Camsell
Hospital in Edmonton. For the past
two and a half years, she has been
employed by the Northwest T erritorie:
Region of Medical Services and has
worked in many nursing stations in the
north.
The Judy Hill Memorial Fund wa.
established to commemorate the
memory of Judy Hill who died while
accompanying patients on a mercy
flight in 1972. These scholarships arE
awarded annually to enable nurses tc
improve their education for service ir
the Canadian Arctic.
't
The Canadian Medical Association
has announced the appointment of Dr
Bob Wilson, Vancouver, B.C. as
Secretary General. Dr. Wilson,
currently an assistant professor at
U.B.C. and coordinator of the FamilJ
Practice Unit assumed his
responsibilities at CMA House in
Ottawa on Sept. 1, 1976.
Dr. Wilson has extensive
experience in organized medicine in
Canada having served as Medical
Economics and Execulive Secretary
of the B. C. Medical Association for 1
years.
The CanadIan Nurse September 1976
15
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The Canadian Nur. September 1976
17
;ardiovascular disease in Canada is estimated to cost over $1.2 billion each
'ear. 1 Advances made in the treatment of cardiovascular diseases have
lecreased the mortality rate associated with them, but the incidence of such
liseases may nonetheless be termed epidemic. Leading epidemiologists
uggest that control of this epidemic can only be attained through primary
.revention...
;zsaUß SA
RE11BF1SJZr8F1
Betty Oka.
p
There is nothing new about coronary heart disease
- evidence points to its existence in ancient Greek
and Roman times. 2 But the twentieth century has
seen the disease rise to epidemic proportions,
particularly in western and industrialized countnes
Fifty per cent of the deaths recorded in Canada in
1971 were related to cardiovascular disease -
"heart attack", the rÍlajor cause, leading other _
cardiovascular diseases. Although death rates
related to cardiovascular disease other than "heart
attack" have decreased significantly since 1950,
there has been only a ten per cent decline in deaths
resulting from "heart attack".J
The decrease in mortality rates associated with
cardiovascular diseases is primarily due to the
tremendous advances in diagnosis and treatment of
the acute attack. There can be no dispute over the
impact of the coronary care unit and increased
nursing knowledge and skill on the recovery of those
suffering an acute myocardial infarction. But many
persons continue to develop this disease and a great
number die before they reach a hospital.
Along with the mounting incidence of coronary
heart disease and its devastating physiological.
psychological and sociological effects, soaring
economic costs for treatment are of paramount
concern. Cardiovascular disease in Canada is
estimated to cost over $1.2 billion each year.
Leading epidemiologists suggest that control of
this epidemic can only be achieved through primary
prevention. Concerted effort must be exerted to
reduce the initial development of atherosclerosis.
Contrary to popular belief, atherosclerosis is not a
natural result of growing older, but is, in fact, a
disease, often having its origin at a very early age,
and showing itself clinically in the third and fourth
decades of life - the prime productive years. Health
professionals must now emphasize the prevention of
this disease to curtail both the loss of productive
years and the soaring costs involved in its treatment.
Epidemiological research has identified many
causative factors influencing the development of
coronary heart disease. Although such factors as
heredity, sex and age are not subject to change,
most of these predisposing factors can be linked to
the life style associated with advanced industrial and
western nations, Stamler states: "Without a doubt,
the 'easy' life is killing us from the inside ouf'.4 The
main risk factors inherent in our life style seem to be
associated with a rich diet. obesity, high blood
pressure, smoking, stress, and lack of physical
exercise. The relative importance of causative
factors related to the development of cardiovascular
disease is a subject of debate among researchers.
There is agreement however, to the fact that such
factors do increase the risk of disease, and that they
can be prevented.
18
The Canadian Nurse September 1976
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pressure may be lowered through exercise,
triglyceride levels decrease, there is improvee
handling of carbohydrates by the body, and II
catecholamine is excreted in response to stres
. It has been shown that there is a significant
decrease in the resting heart rate associated w
the maintenance of regular physical exercise
. It is also believed that the improved cardiac
contractility results in an increased stroke volur
and decreased cardiac wor1< load.
. It appears that there is a relationship betweer
lowered heart rate and mortality, Stamler has
shown a significant increase in the death ratE
men 40 to 59 years of age with resting heart ra
greater that 80 beats per minute, as comparee
those with heart rates below 60 beats per minutl
. The exact mechanism by which exercise
enhances health of the heart muscle has not be
determined, but positive findings indicate that
exercise has a place in the prevention of
cardiovascular disease.
A multiplicity of environmental factors, along with
inherited tendencies contribute to coronary heart
disease. The following risk factors are amenable to
change. Through preventive programs and
teaching in these areas, we can hope to decrease
the incidence of cardiovascular disease, our
twentienth century epidemic.
Eating Style
. Dietary habits in Canada are similar to those in
other affluent countries - rich, and high in animal
fat.
. The intake of excessive calories along with high
cholesterol and saturated fat intake seems to play
a major role in causing hyperlipidemia, In Japan,
where people eat far less animal fat, they tend to
have much lower blood cholesterol levels, and
there is a significantly lower incidence of coronary
heart disease.
Cigarette Smoking
. Probably a major factor in the development of
coronary heart disease,
. Associated with the interference of oxygen intake,
effects on cardiac function, and a higher incidence
of hyperlipidemia.
. Among the younger age groups, the risk of dying
from coronary heart disease is two to three times
greater among cigarette smokers. s
Psycho-Social Stress
. The direct effect of personality traits and chrc
stress on the development of coronary heart
disease has been the cause of much controver
. Today's life styles - the tensions, pace and
turmoil of the urbanized society - may potenti
other risk factors.
. Physiological responses to stress do have a
negative effect on the cardiovascular system
. The aggressive, achieving, hurrying behavior
described by Friedman and Rosemann as 'T
A" behavior, may be a significant result of
contemporary society.
A Challenge for Nurses
The many aspects of heart disease offer a broë
range of nursing opportunities, but the key to
reduction in morbidity is through prevention. Th
'hows, wheres, and whens' of effective preventi
programs and methods of implementation of th
programs present a significant challenge to the
nursing profession. To discoverthe answers to thf
questions, input is needed from a variety of heë
disciplines as well as from those involved in the
behavioral and educational fields. Many new rol
for nurses will evolve to meet these challenges
involvement of nurses is needed from many areas
expertise. Where shall such preventive prograIT
begin... among the high risk group?.. among th
young? Where do we begin?
Programs need to create awareness about
need for changes In lifestyle in all age groups of t
population. At the same time, studies are requi red
determine the attitudes, beliefs and knowledge
related to cardiovascular disease risk factors
Different communities, different cultural and
Hypertension
. Now recognized as a main contributor in the
development of premature atherosclerosis.
. The ideal blood pressure has not been identified,
but findings indicate that at the arbitrary
hypertensive level of 150/90, there is a mar1<ed
increase in the risk of coronary heart disease
among both sexes aged 40 to 59, 6
. Of concern is the large proportion of the population
with hypertension that goes undetected,
untreated, or is inadequately treated.
Obesity
. Obesity related to diabetes or hypertension is
unquestionably a significant risk factor.
. Uncomplicated slight or moderate obesity in itself
may not be a crucial factor, but the type of food
eaten does increase susceptiblity to coronary
heart disease.
Physical Inactivity
. Research indicates the benefits of regular physical
exercise on cardiopulmonary fitness, and on
general well-being.
. Exercise not only affects cardiac fitness, but also
influences the control of other risk factors. Blood
The C...addm ....... s..........,t.", 117i
"
References
Canadla"l Heart Foundat )Tl ...,Dart Facr Foe
rev ad Ottawa Canadian Heart FoundatlOl" 1974
2 Dubas Rene Jules M"age or 'lea New Yor,
DOUDleda) 1959 145
3 Canadian Heart Foundatlor '7eart facts 1 focUIi rev
ed Ottawa Canad an Heal1 Foundation 1974
4 Stamler jeremiah Can e stop the coronary
eplderr1lc In Med, cal Commumcatlons Inc Coronary artery
dIsease a ne MEDCOM totallearnmg system Moms
Plams New Jersey, Warner Chilcott Laboratones 1972 P
65
5 Lough Jonr Cigarette smokmg coronary t- eart
disease and sudden death Canad Med Ass J
<13 <')919 Now 22 <975
SOCID-econOMIC groups re f1 er1 varying attl des
towards the disease, and programs should be
de..eloped acco r (' ng to t'1e findings of studies tra'
deterMine these an tudes
Ideally, changes In attrtudes and be"1aVIOf
should begin wltt1ln the nurSing and health
professions - higher level s of health In these groups
may lead to Increased awa eness and change tn
those we see to teact In cel1a"l health care
agenCies programs have already begun to crea'e -,
awa eness of IndIvidual fItness levels through the
use of \arIOUS methods of exerCise testing Some of
""lese prograrns are encouraging be-avlor change
and IndIVidual comml ments to become Invol ed In
personal f tness programs
Nursing must become Involvec In the
assessment of IndIvidual communities to de'ernlne
the basis upon whlcl"' prevertlve programs can be
de eloped This assessment can also be done .n the
work community by nurses In the occupa'ional realth
field Within thIS setting 1""\anagement can be made
aware of the e
nomlc :)eneflts of preventive
programs to the r orga-lZatlon In educating and
reduc ll 1g nsk factors among the r errtJlo ees
There are many approaches re!atød to t'ìe
prevention of cardIovascular disease which J""'ay be
.ncluded In occupational health prog ams Group
meetings to promote awareness of life style and nsk
factors 'f tness b øao<s dur ng work hours.
IndIVIdual assessments of emplo eesto Identify those
at fisk ndlvldual counse hng these are only a few
-he occupational "'ealth nurse may also become
IOvolved 10 secondary prever Ion and reh-
Ion
of those with cardiac disease among the wo
force
Change related to reduCing fiSK factors of an
erlVlronmental nature Involves alteration In behefs
att udes and learned pa-+erns - no sm task
Programs re a1ed to other health conce ns ha. e
expenenced hmlted success ratec- In fosLe-mg rea,
c'1ange n Ir'estyles EVidence to this fact IS tne recent
expression of the Addiction Researr-h Foundation of
Ontano that there IS an Increasing Inclde'\ce of
alcohohc probleons despite extensIve p eventlve
education There IS a cra enge to com"'1unrty
nursing to become Involved In t'";e exploration of
e"'ect,ve methOds for creating awareness and
change In behavior There IS a '\eej for nurses to
expa.,d their 51("15 and modify +heir role to provide
adersrup In community education ThIS rr,eans that
we need to become compe+e"1t In applYing pr nClples
re,a+ed to lear"llOg and change for ai, age groups We
need to teacn the IndrvldJal to take the In ßtlve to
make his own dlscove"es about his healtr and te
encourage groups to become 1vol ed In a ne
learning experience Our exper.fse In co"+e t IS not
enough to provide mea"'langfulleamll1g exper ences
and change be
,avlor toward mOre heaith' I lIVIng
T'1e re
e'1t concept of sc:: :;.' -2 e+"g May PfU\ ,::)e
6 Bruce Thomas A'1e r .JSclerD!: 5 :::0 ar
dIsease earn, g syst m Toronto Ph, t3S Elect Dn-""S
Industry Ltd Med,
I S)'C""ers DIVIS....
7 Zot nan Lenore Be d diet - exere. se your a
to 1ness and heart l)ealt h New York. Amencan Heal1
Assoc on and Preslderr Coun F ness and Spc
CPC InternatIonal Inc , 974 P 7
8 Starrier op p"'3
9 Lef'eld John 'leC ce;; ofsoc/a/marl<et Jg pa,Ær
presented a1 the SocIa Ma 1<.9tlng Forul'"" College of Fa,..,
and Cor-sumer
ud'es Un erslly of GLJelpr June ',,"'Ç
Unpublished
a frarnewo fort"'e assessrne
and deve opme'1' of
preventIve programs 9 Development of sLCh
programs wll, ta .E' tl-e and :::Ieserves tt-e a
e-+lOn of
nurses knowledgat e In ca dlovascular 'J rSlng at
the local provincial and natlonal1eve,s
P evermve programs related to card ovascular
dlseas.e are If1 an e. a .Jtlonary stage Nurses
II1volved In card'ulogy w\'1e:"'Ie- In pr'..,a'Y or
secondary healtr ser.-lCe5 "TIay touc"J ..... a
y current
comonunlty prog ams In an a!1eT"ì- to Integrate
prevel"!tlve teaching !rID the whole commu.,rty and to
Invol e all -ge groups SuCh progra.....s ;XOVlde aT"
opportunity for team worK among nurses and ot'""er
professionals In vanous areas Nursing II1put In
;>reventlve cardiology IS necessary In schools
parent groups ser.-lce groups church groups and
exercise programs
nese a e but a few oft e areas
for beginning awarel")ess
Formal programmtng, uSlOgf ""-s dialogue and
discuSSion, seer"1S to have an effect on awareness
and result In some modlf cation of estyles F ms
suc"J as Ce ebra" or or T Canac an orne F ess
Test are two exarnp es More struct red ;>'ogra
s
are In t'le developmental stages They are created to
reac\'1lOd,vlduals of specflc r.sk levels and are
designed for actl e partlClpa1lon and Info.....!atlonal
dissemination It IS too soon k> know tre resurs of
these types of programs but not too soon or r'}urses
to beCOlT'e Involved
-!øart disease has reached e;:)ldemlc
proportions In weste ,., SOCiety Recognition of 15
affect on the "earth and economy of the nation can
no longer go un"'eedec P'/On1les Ir "'eatt'1 ca 'e r- uS:
II1cluoe the study ana de elO;:Jment of programs to
eradicate thIS disease
here are ....ajor roles for
.,urses !r the stlmulatlor developPTJerrt a.,d
'"'1plementatlon of preventIve prog ams Are we
wil' ng to accept the cha enge ..
Bert OKa q N Vancou er Gere a Hasp al
School of N rslng B Sc N Un ers ty of
Wash ngtan M N Mo 'ana S.a e Un vers s a
c n CaJ spec - st n ca d,ovascu ar n rslng She IS
presently e,."plo ed as Nurs ng
Cons 1ta'1t-SuperY sor wlttJ me TV ë:;a a Fe; ,j"1a
-e- . rt -
'Jo _ J OntarIO
20
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The Canadian Nurse September 1976
Gtlgn
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development of the cardiovascular series on the cardiovascular system in
system are among the most complex and health and disease. the emphasis is o.
crucial of the human body. The constant prevention.
stress to which the body is exposed
necessitates compensation by all body
systems. All too often in our care, we
concentrate on those changes that -are
inadequate, mappropriate or ab 'ot.
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The CanadIan Nur8e September 1976
21
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22
Tile Canadian Nursa Septamber 1976
Penny Jessop
Anatomic and Physiologic Dynamics
Shirley Mohyudden, the artist who supplied these special
illustrations for the cardiovascular series is a registered nurse living
in Brossard, Quebec. Her work has previously appeared in the
June issue of The Canadian Nurse. These drawings are adapted
from medical illustrations by Leon Schlossberg.
Aorta - <jfeat aV'ten
from leFt neart to bod"J
Supev-iof VQY\a Célva- \
f fCvYl \'lead.. ðVld..
V'IV\S
f(, pulmoMvy a
i- r
frow. nsl-it \'1e.a
i to \
luV\tj ,
R. pulWloV'iarl/ vel'l\S ;.-
to Ie.
a-tyi\JWl
r
.fi
i!
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þ?
left pulW\oV'ia....
veiV\5 to
/ Ie Ft a'tV-iuW"l
" .. ' LeFt O..t\"iLlW\
! '
.J- ' - ';-- Left coronary 6\rte.ry
..
PV!WlOVli\VIf v
\ve (se.W\IÎuV\aY)
Left pulw.o\1é1\'"'{ a\"1:e.
- fro"'l
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FOS5q oVé\le
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r
TYicuspid valve
-
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syeat Ve.\V1 froM boÒj
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RiGHT __
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Q-
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'vV;
c:? -= a,rte.'(ie9
.. = veiV\s
Cross secti.ol/\
Tile Canadian Nurse September 1976
23
(nnom,nQte arter
\or to. - great o.rter
Frown
Ft heo.rt to bod
_
'upenor ve>'!a caua - grear
e, n Fro.., h"ad
nð. óln.S
19n1 pU(VI\on.ar
arÜ
y
\
=rom ri91\1 heqrl to /'
u"'g
Iqhr pu
,.,onarv Velf1s............
=roWl ngl'lr IU"'9 ---
.0 left he.irt
\or-(\(: v
lve (5"...ilul'lar)
I/j\'\t atril.lW\ -
fricusplo.. valve _
ma II card.lac ve,,,,_
Rlg
t
onar
.rt
R.lgf1t ventricle ------
1t'lI:'e.yior ve>'1a caVèl_
reat ve.\>'\ Fro..... bod.
a'o".d. \e.
s
II'
I.
.
.
----
I(r Glir
It
l'iqr
Antenor
Left carotid arter'f
_LeFt Subc.\aVlo1lVl arte..-y
_ _Left pul'ft'on<lf\j ar-tery-f'roW1
rlgl'lt l1"art to lu...g
- Pulmondry a.rterj
"LeFt pul monar';j vei'lS - Frt>"1
Id'r IV"'9 1:0 le!'t l1eait
---c- PuIWlo.-.ar
11..1." (5ew.du n aY)
_ Mitral valve (""C.USPid)
;---CIYCUWlFI.,x I:>raYlc\l1 of 1'IIe
--; 'co..-o>'1ar'1
ð,!1.ery
,- A.it desce Yl d.'''9
..-- Great ca<dlqc V"""
---
___ Lef't ve>'\tricle.
f
t
v
IV'ltercosto1\ ;;\rt
ries
-===---
LeFt pvlmoV\ar
..ter
.........
--"'"
LeFt pu.l\'Y\or-.ary veiV\5
LeFt pogte"ior .-r
ve>'lt..icular vei... ...--- .
L lie....lnc\e _
.
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f - t · "
,1;' \ /
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Aorta
------
Right pulmOYlàr
arte
------
S<lperior Ve.V>
coiva
-- Righl pull'YlOt'ldrj lI&1nS
/
Left atn UI'I'I
_______ Right ab-iv"!
COronêlr
arter
,
r't'\f
vlor vena c
....
......
'"
_________ Poste'(ior cl.escEV'ldlV'l5
______ co
r'f a....1.e.r:j
__________ . ______ Middle c.ardl
c
.a.Ø<
i- _______
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Poster-iOV'
24
The Cenedian Nurse September 1976
Anatomic and Physiologic Dynamics
Label according to the diagrams at
left,
1
2
3
4
5
12 6
7
8
11
9
4 10
11
8 12
13
:10 14
15
16
Cross-Section of an Artery
Penny Jessop (R.N., St Mary's School of
Nursing, Kitchener, Ontario; B.Sc.N.,
University of Ottawa) has extensive
experience in nursing education. She has been
Nurse Clinician in the intensive care unit of the
Kitchener-Waterloo Hospital and in the
Department of Ambulatory Care, Hamilton,
Ontario. At present she is the director of public
education for the Ontario Heart Foundation.
Bibliography
1 American Heart Association Coronary
risk handbook. New York, American Heart
Association, 1973.
2 Beeson, Paul B. ed. Cecil-Loeb textbook
of medicine, ed. by... and Walsh McDermott.
13ed. Toronto, Saunders, 1971.
3 Levine, S. Clinical heart disease. 5ed,
Philadelphia, Saunders, 1958.
4 Uttmann, David The electrocardiogram.
New York, American Heart Association, 1973.
(Examination of the heart ser., part 5).
5 Abstracts: 48th scientific sessions for
nurses 29th annual meeting, council on arterial
sclerosis - American society for the study of
arterial sclerosis_ Circulation 52: supp. 2, Oct.
1975.
6
14
15
16
13
This unit is designed for self-learning
and review. You may even wish to
keep it at hand as you refer to other
cardiovascular topics, From the
column at the right, select the word or
phrase you feel best completes the
statement.
Correct answers appear on page 33.
. Cardiac development begins in the
. The major
7
structural differences existing prenatally
are__,__._ __
8 9 10
an
_,
11
At birth, closure of the
12
between the atria, and
connecting th
Complete the following using the word
choices at the right.
. Properties of the myocardium include
. and
2
. Because of one of these, na-
the _
3
mely
4
independently thus causin g
or beats arising from
. some cells may depolanze
13
pulmonary artery to the _ _ enable!
14
completion of the circulatory circuit through tt
lungs. This closure is thought to be directly
related to level in the blood
15
. rhe heart chambers after birth are normally
interconnected only by
16
and
also know as the
5
17
valve
outside the
18
As the blood enters the heart
and passes through the __
19
chambers then enters the lungs
via
, the actual
6
. An inseparable relationship exists between car-
diac function and form whether in regards to
cellular activity or the cardiovascular system as
a whole.
20
gaseous exchange occurs in the
layer of the lung.
21
. On returning to the lef
_, blood IS
22
passed to the thel
23
through the
the
to
24
25
Tile Canadian Nurse September 1976
25
I The volume of blood put out in one minute
divided by the heart rate per minute is
known as _
26
I ThiS latter function is directly
related to -
27
and
28 29
Similarly. these three factors are closely
associated with the blood pressure level as it
surges into the arterial system from the strongest
of the four chambers - the left ventricle.
The mechanical contracting-relaxing action of
ttje heart is controlled by specialized nerve cells
I within .the myocardium responding to
the nervous system.
30
The impulse is generated
at the _ . radiates to
31
>ach the
,then
which
32
down the
33
branches to form a single Bundle
:>f His Branch. and then divides into
Bundle Bran-
34
::hes. Small
35
carry
36
the impulse toward the apex.
\ cell level, an electrical potential IS set up by the
3)(change of ions of and
37
across the cell wall. This
38
31ectrical process is known as
_ _ and __ _' Stimula-
39 40
ion of the nerve acts to inhibit
41
mpulse conduction.
'IIormally, depolarization of the ventricles
akes seconds and occurs 60-90
42
imes per minute. ThiS is followed by repolanza-
ion of the ventricles. mechanical contraction and
1 resting or . Throughout the
43
"Omplete cycle, eacn cell maintains
S . Electrocardio-
44
. raphic representation of this phenomenon
tuld be briefly outlined as follows:
wave =
45
- passage of
46
he impulse from the natural
.acemaker to the AV node
= ventricular
47
48
Wave = repolarization of the
49
. Changes In circulatory system structure and
functions are not only directly measurable in the
cardiac cycles, but also in other major bodyfunc-
frons. For example, impaired renal activity may
result in
50
51
52
cerebral arteriosclerosis may manifest
as
53
54
55
56
__,or
57
. The development of arteriosclerosis is. in part. a
natural change with age. However, from con-
tinued studies such as that in Framingham.
Massachusetts we realize many factors
related to the environment can likewise influence
health status. Can you identify these risk
factors:
58
59
60
61
62
_ __, and
64
63
65
. What changes are you prepared to make In your
life style. in teaching for primary prevention, and
working toward secondary prevention?
More on "Changes" to follow.
junctional block
SA Node
rhythmicity
A V Node
automaticity
irritability
ectopic beats
torpidity
stress
aorta
tricuspid valve
common bundle
left ventricle
umbilical vein
sinoatrial node
semilunar valve
first trimester
nutrition
pericardial sac
heart rate
tonicity
umbilical arteries
bicuspid valve
right
stroke volume
autonomic
ductus arteriosis
foramen ovale
pulmonary arteries
atrium
blood volume
atrioventricular junction
mitral
prostaglandins
parenchymal
left
lack of exercise
smoking
obesity
stroke
JRS complex
Purkinje fibres
electrolyte imbalance
depolarization
vagus
recessive
P-R interval
3-4.2
ventricles
mental confusion
repolarization
syncope
potassium
ocular
hypertension
congestive heart failure
sodium
age
atrial depolarization
electrical potential
refractory period
cerebral haemorrhage
transient ischemic attacks
heredity
hyperlipidemia
O.04-Ð.09
26
The CanadIan Nurse September 1976
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A straightforward approach
to patient assessment and charting
Where to begin? Often a
nurse's observation and
charting skills are tried severely
when there is too much going
on - and all at once. A tangle
of tubes, a fortress of
machines, bottles, trays,
charts, parades of medical
staff, even the cleaning man's
ever present mop - all present
barriers to a clear and thorough
nursing assessment of the
patient who lies in the middle of
it all...
Lynda Ford
It doesn't much matter where a nurse
works - methodical observation and
evaluation of a patient's state of health is
as important In an outpatient department
as it is in an intensive care unit. The
confusion of a busy hospital setting can
distract the nurse from signs that tell of
what is going on with Mr. Jones. Whether
Mr. Jones has just had his appendix out or
has undergone an aorto-coronary bypass
graft, the signs will be there to let us know
whether or not all is well. .
Education and experience teaches a
nurse what to look for relative to a
patient's particular condition. Sometimes,
though, it's difficult to pinpoint what is
wrong, whether it's because Mr. Jones
finds it difficult to verbalize, or because
he's confused or unconscious.
Mr. Jones is much more than a
bandaged abdomen or a heart. The
"whole patient" concept is pretty easy to
tuck away with other mementos from our
schooling years as something that just
isn't practical when the ward is humming
with activity. But there are times when
finding out what is wrong with Mr. Jones
demands a methodical and total nursing
assessment.
Working as a relief nurse in critical
care areas at Vancouver General
Hospital, I was pleased to discover that a
concise, thorough and uniform method of
patient assessment was in use. Not only
did it allow me to grasp a more complete
idea of what Mr. Jones was up to, but I
could see clearly from previous charting
how he had been progressing in the past.
There are probably valuable
guidelines in use in other centers for
complete patient assessment. Certainly,
the 'Head to Toe' check is nothing new-
there is nothing in it that nurses aren't
already familiar with. But the use of a
systematic check for assessment and
charting is a departure from the usual
haphazard collection of signs that we
often see.
I would like to thank the nursing staff
of the Cardio-Thoracic Unit at the
Vancouver General Hospital for sharing
their 'Head to Toe' check with us. I hope
you find it helpful.
The 'Head to Toe' check is one part of
a set of guidelines drawn up for use in the
post-operative heart unit, Willow
Cardio-ThoracicUnit, V.G.H. The method
certainly has possibilities for application in
other areas, although such a complete
, check is in many cases unnecessary. It
can be used in conjunction with the
monitoring of the patients vital signs, fluid
balance and test results. At the
Cardio-Thoracic Unit, where the twelve
I hour shift is in effect, a complete 'Head to
Toe' check is done at the beginning,
middle, and end of each shift. The
complete check is charted at the
beginning of the shift, and then. only as
changes occur. Any changes in the
patient's condition can therefore be seen
and reported quickly, as they are
thoroughly recorded at least once a shift.
And when Mr. Jones reaches the
convalescent stage of his illness, the
complete check may be altered as
indicated by his condition.
The check involves looking at the
patient systematically, observing and
charting all that there is to be seen. It
forms the basis for informed and total
patient care from a nursing and medical
standpoint. Treatment hinges on accurate
observation. It would take a text to
describe all that a nurse might discover in
her examination of the patient and so I
have concentrated on the method of
observation itself - observation that
follows a methodical pattern - from
head... to toe.
The Cenad,en Nurse September 1976
27
Head to Toe Check Head to Toe Check Head to Toe Check Head tv Toe Chec,k
Head
Observe and chart:
1 the patient's level of consciousness, any
improvement or deterioration
. his level of orientation, if awake
. his mood frame of mind or behavior, if
applicable - is he unusually restless,
upset, or quiet?
. his complaints of headache - how does he
describe it?
. his response to verbal, tactile or painful
stimuli
. his response to Simple commands - IS he
able to follow them?
2 the patient s pupillary reaction - note the
size, equahty and reflex action of the
patient's pupils to light.
3 the patient s limb movement as it pertains to
neurological function - the strength,
equality of mOvement, and sensation
perceived by the pallent. Test hand grasps
for strength and equality, leg strength by the
"push and pull' of both feet.
4 the patient s color - generally. IS he pale,
jaundiced, cyanosed, or is his color good?
Note especially his lips, earlobes, and
nailbeds.
Neck and Chest
Observe and chart:
1 the rate, depth and quality of the patient s
respirations
. the movement of the diaphragm and
thoracic cage
. any assymetric movement of the chest
. any indrawing, tracheal tug, restlessness,
shortness of breath, nasal flaring, splinting
of respirations
2 breath sounds (hsten with a stethoscope
to evaluate the breath sounds of anterior,
lateral, and posterior chest - apices,
midzones, and bases.) Compare sides.
Describe what you are heanng - are the
breath sounds good, slightly diminished,
dimimshed or absent? Does the chest
sound clear, moist, dry, wheezy, or
bronchial.
3 for respirator patients - note the size of the
endotracheal tube or tracheostomy tube -
check for inflation of the cuff, note the type
of ventilator, oxygen concentration,
whether the patient is on automatic or self
trigger, the tidal volume, pressure, chest
expansion and "control".
4 for palients on oxygen - note the oxygen
concentration, flow rate, and type of mask
in use.
5 note any chest incisions, dressings, chest
tubes, the color and amount of drainage,
and type of drainage system in use.
6 the patient s complaints of chest pain -
how does he describe its location and
intensity?
7 the rate, quality, and rhythm ofthepatienl's
heart rate.
Abdomen
Observe and Chart:
1 is the patient's abdomen soft, taut,
rounded, distended, flat, firm, or
board-like?
2 does he have bowel sounds - strong,
fleeting, occasional, or absent?
3 descnbe any abdominal incisions,
dressings or drainage tubes and the type of
drainage present
4 does the patient complain of
abdominal pain? How does he describe it?
Extremities
Observe and Chart:
1 the strength and equality of dorsalis pedis
and posterior tibialis pulses - if absent,
check the popliteal and femoral pulses.
2 note the color, warmth and strength of the
patient's arms. legs and feet.
3 note any dressings or bandages on the
patient s legs and arms, as well as the color
and quality of any drainage.
4 does the patient descnbe any pains or
cramps in his arms or legs?
5 describe the pallent s coordination or galt, if
applicable
Skin
Observe and chart:
1 the texture of the pallent s skin - is it dry or
clammy, cool or hot to touch.
2 are there any areas of skin breakdown?
Check especially coccyx, back of the head
heels and elbows Descnbe them.
Equipment
Observe and Chart:
1 Intravenous Infusions - what solution is
running. the rate of infusion, medication
added, the appearance 01 the site - is the
tubing patent?
. describe the CVP line as above
2 IS the artenalline patent? - does the
patient complain of pain in conjunction with
the site? If the arterial line is in his arm, IS
there any blanching of the arm Involved?
3 ECG - record the traCIng and take a new
traCIng for any change in rate and rhythm.
4 Catheter - note the Size, patency of the
tube. the color and volume of urine draining.
5 Nasogastnc tube - note the size, patency
of the tube, color and volume of drainage-
check for location to be sure It is in the
stomach.
You can see for yourself that
there is nothing in the 'Head to Toe'
check that you haven't heard before.
For a 'Head to Toe assessment of Mr.
Jones, see next month s Issue of The
CanadIan Nurse.
28
The CanadIan Nur.... September 1976
Childhood Cardiac Anomalies:
A Review
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In approximately six out of every 1000
children who are born, the development of
that crucial organ - the heart - differs
significantly from the normal. 1 How a
particular cardiac anomaly is treated
depends on the type of defect, degree of
severity and the child's individual
response. The authors describe some of
the most commonly encountered cardiac
anomalies and look at ways nurses can
help families of these children adjust to
the responsibility of helping them to live
well-rounded and satisfYing lives,
Judith Hendry and Judith Mitton.
Usmg a broad knowledge base, the nurse is i
a key position to assist in the identification (
infants and children with cardiac defects.
Some of the signs and symptoms of
congenital heart problems which the nurse
may assess in children are summarized in
Table 1. Many of these signs may occur
simultaneously. Thus, it is often the
combination of several signs that is indicativ
of congenital heart disease. The discussior
that follows describes some specific cardia
anomalies and their associated symptoms
and treatment.
Patent Ductus Arteriosus
In the fetus, the ductus arteriosus is the norm
passageway between the pulmonary artery
and the aorta which allows blood to by-pas:
the lungs. This ductus usually closes within th
first few months after birth. However, in pater
ductus arteriosus (P,D.A.), the ductus remain
open and oxygenated blood is shunted fron
the aorta, an area of higher pressure, to thE
pulmonary circulation and is reci rculated to th
lungs. This may lead to increased vascular
pressure in the pulmonary system and
diminished blood flow in the aorta resulting i
overloading of the left ventricle
Infants with P.D.A. usually have a
continuous machinery-like murmur in the lei
intraclavicular area. If the shunt is small, a
systolic murmur may be the only finding. 2
These infants are usually acyanotic unless
there are other associated defects.
Spontaneous closure ofthe P.D.A. is rarE
after infancy. When the defect occurs in
isolation it is ligated via surgical interventior
However, if it occurs with other associated
defects it may not be surgically corrected sinc
it allows an increase in blood supply to the
lungs.
The CanadIan Nurse September 1976
Septal Defects
A ventricular septal defect (V.S.D.) is an
abnormal opening in the septum that
separates the right and left ventricles. 3 Small
V.S.D.'s may be asymptomatic and even close
spontaneously. However, large defects may
cause considerable shunting of blood during
systole, usually from the left to the right side.
This occurs as a result of higher pressure in
the left ventricle.
Since cyanosis is not usually present. this
abnormally is frequently not discovered at
birth. A harsh murmur which may be heard
between the third and fourth left intercostal
spaces is otten the only clinical finding. "
There may be similar abnormal openin
s
between the right and left atria called atrial
septal defects (A.S.D.). In these defects, the
shunting of blood results in recirculation of
oxygenated blood to the lungs and increased
volume load in the right ventricle. Poor tissue
oxygenation may lead to growth retardation.
Cyanosis is not usually present but may
result from left-sided heart failure or
pulmonary hypertension.
In most cases, the prognosis for children
with operable defects is good. When open
heart surgery is indicated, the smaller defects
may be sutured closed and largerdefects may
be closed with a type of synthetic patch
Table I
Coarctation of the Aorta
A coarctation of the aorta is a constriction of
the lumen of the aorta, most frequently found
in the region of the aortic arch either pre or post
ligamentum ductus arteriosus. 4 Children with
this defect have high blood pressure In the
upper extremities with related symptoms such
as headaches, frequent epistaxis, flushed face
and bounding radial pulses. The lower
extremities have lower blood pressure and
may be cold with weak dorsalis pedis,
posterior tibialis and femoral pulses. The child
may complain of pain in the legs upon
prolonged exertion.
1 he prognosis varies with the location of
the coarctation and the development of
adequate collateral circulation. Surgical
intervention involves resection of the affected
segment of aorta. Depending upon the length
of the coarctation, the intervention may take
the form of either anastomosis of the
unaffected aortic walls, or insertion of an aortic
graft.
29
Tetralogy of Fallot
This defect includes four associated
anomalies: a ventricular septal defect;
hypertrophy of the right ventricular wall;
pulmonary stenosis; and dextraposition of the
aorta. Blood entering the right ventricle cannot
be totally accommodated by the stenosed
pulmonary artery. Some of this blood may flow
through the V.S.D. and into the aorta causing a
mixture of oxygenated and unoxygenated
blood in the aorta.
Seventy-five per cent of children with
Tetralogy of F allot (T. O.F.) are cyanotic by one
year of age and at an early stage develop
clubbing.. The infants may have hypoxic
attacks in which vigorous crying may lead to
dyspnea and severe cyanosis. Placing the
child on his abdomen in a kneechest position
may help to relieve the dyspneic attacks.
When the child starts walking, he may
spontaneously prefer the squatting position to
relieve dyspnea.
Total correction of the defects may be
done in the first few years of life. However,
palliative surgical procedures may be
completed prior to total correction to increase
the flow of blood to the lungs. Examples of
these Include the Blalock-TaussIg procedure,
an anastomosis of the left subclavian artery to
the pulmonary artery, and the Potts and
Waterston procedures, each of which involves
an anastomosis of the aorta and the
pulmonary artery. These procedures result in
an increase of blood flow to the lungs,
improving exercise tolerance and reducing
cyanosis.
. Clubbing-Rounding of the fingers especially
the thumbnails with thickening and shininess
of the terminal phalanges.
Signs and Symptoms of Congenital Heart Disease
In Infancy
- anoxic attacks
- choking spells
- dehydration
- diaphoresis
- exhaustion
- failure to thrive
- feeding problems
General
- alterations in pulse rate and
rhythm
- alterations in respiratory
rate, depth and rhythm
- anorexia
- coughing
- cyanosis
- dyspnea
- fatigue
- flaring nostrils
- growth retardation
- heart murmur or thrill
- indrawing
- irritability
- pallor
- recurrent respiratory infections
- restlessness
- shortness of breath on exertion
In Childhood
- alterations In blood pressure
- clubbing
- decreased exercise tolerance
- poor physical development
- squatting (seen in children with
Tetralogy of Fallot)
30
Tile CanadIan Nurse September 1976
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Tetralogy of Fal10t
Reprinted with permission from the illustrations of Congenital Heart
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Columbus, Ohio
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Complete transposition of the great
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The CanadIan Nurse September 1976
Transposition of the Great Vessels
In transposition of the great vessels (T.G.V.),
I-Je developing pulmonary artery and aorta fail
o rotate during the fi rst few weeks of fetal life . 5
The aorta arises from the right ventricle
nstead of the left and the pulmonary artery
:Irises from the left ventricle instead of the
ight. Thus oxygenated blood is recirculated to
the lungs and unoxygenated blood is
ecirculated to the body. The condition is
ncompatible with life unless there are other
jefects which allow the mixing of oxygenated
:lnd unoxygenated blood, such as a V.S.D.,
o\.S.D., or P.D.A
Infants with T.G.V. become cyanotic soon
:lfter birth. They may have difficulty with their
eedings. sucking eagerly at first but soon
coming dyspneic and exhausted.
Treatment may consist of creating an
:ttnal septal defect by means of a balloon
atheter during cardiac catheterization. 6 A
:atheter is passed through the foramen ovale.
nflated, and pulled back to tear a larger
.assageway for mixing of blood. Complete
edirection of the flow of blood may be
chieved by the Mustard procedure In this
5urgery, oxygenated blood from the
ulmonary veins is directed to the right
entricle by excising the atrial wall. This
xygenated blood is then pumped to the aorta
: d to the systemic circulation. Unoxygenated
.Iood from the vena cava is tunneled through a
. urgically created pericardial pouch into the
left ventricle. From here the unoxygenated
.Iood will be pumped to the lungs. 7 The
rognosis of infants having T.G.V. has greatly
mproved since the advent of these
.rocedures.
31
Children with congenital heart disease:
some parental concerns and problems
The nurse who understands the degree of
stress that diagnosis of heart disease in their
child may provoke in parents, can help them
to cope with the" feelings and, indirectly, do a
great deal to Improve the quality of life of the
child with a cardiac defect
Since the heart is considered the most crucial
organ of the body and inter1erence with its
integrity tends to be regarded as potentially
life-threatening, it is only natural that heart
disease of any nature provokes anxiety in both
parents and their families. When it is a child
who has heart disease, the stress to parents
may be profound and exacerbated by guilt
feelings and fears.
Parents of a child with a congenital heart
defect, or indeed any chronic condition, need
support and practical guidance to maintain a
lifestyle that is healthy for the sick child, for the
parents and for other members of the family.
This kind of guidance can only be successfully
given and utilized if those working with the sick
child function as a team and include the
parents as members of that team. Since the
parents must assume the responsibility of
caring for their child at home, carrying out a
medical regimen designed to foster his optimal
growth and development, effective health
teaching is of utmost importance. Most
parents do everything they can to provide the
best possible care for their child. When
expected results are not attained, it is more
often due to a lack of effective health teaching
than to a lack of parental concern.
In an effort to find out more about the
specific health education needs of these
families, the authors conducted a number of
interviews with parents of children who were
hospitalized because of cardiac anomalies.
They found that mothers of these children
shared many common concerns about their
role as parents of children with cardiac defects
and were experiencing many similar problems
In looking after these children. In these
interviews, the mothers often expressed a
need for recognition of the job they had done
and were doing in maintaining their child's
health status. Their self-image received a blow
when they had to deal with the fact that their
child was not physically per1ect and they
needed reassurance from the nurse that what
they were doing was in the best Interests of
their child.
Mothers also expressed the desire to be
given information about their child without
having to ask for it all the time. This voluntary
information-giving seemed to indicate to them
that the health personnel recognized them as
a part of the health team.
While all mothers expressed satisfaction
with their doctors, stating that they were kept
well informed about their child's condition and
prognosis, significantly, they did not see
nurses in the same light. One mother
wondered if nurses saw her as a "nuisance"
She said that few nurses volunteered
information about what they were doing for her
child and she had to ask for clarification,
adding, "After awhile I start to feel guilty
asking". (This mother made her comments
shortly after her child had undergone
32
The Canadian Nurse September 1976
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corrective cardiac surgery and it is probable
that her perception of the situation was
influenced by a high level of anxiety.) When
teaching parents about their child's condition
it would appear that nurses must consider the
effects of anxiety on parental comprehension
of explanations and use repetition and
reinforcement judiciously.
Discipline and limit-setting for the cardiac
child is another area of concern to mothers.
They have been advised by health personnel
to treat the child normally, to set the same
limits and follow the same discipline practices
as they would for any other child. This often
proves difficult for a number of parents. They
worry about the effects of discipline on a child
with a cardiac defect and often, they feel guilty
about the anomaly and try to compensate by
giving in to the child's every whim. This
approach frequently leads to fretful and
demanding children and increases the
parents' uncertainty about their abilities to
care for their child appropriately.
Parents who do set firm guidelines for
their children also express concern that their
methods may not be completely appropriate.
When these children require hospitalization,
mothers often comment that it is difficult to
maintain the discipline practices carried out at
home. Their statements appear to indicate th at
they are concerned about the nurse's
perceptions of their abilities in this aspect of
parenting.
Tied to the area of limit-setting is the
related aspect of overprotection. Parents often
feel a certain reluctance in allowing a cardiac
child to seek his own level of activity and may
curtail activities more than actually
necessary. Glaser describes parents of these
children as being in a "chronic state of anxious
watchfulness".B Striking the delicate balance
between allowing independent action and
providing sufficient disciplinary guidance is a
difficult task for any parent. It seems to be even
more problematic for the parents of a child with
congenital heart disease because of their
concern about the interaction of discipline and
the child's physical condition. Health
personnel should be aware of the dilemma
parents often see themselves in and
encourage open discussion of their concorns.
The presence of a child with a cardiac
defect puts varying strains on all family
members. Parents sometimes find that they
focus the greater part oftheir attentions on th is
child to the detnment of their other children.
Siblings may not understand why the cardiac
child receives extra attention and special or
different privileges. They may feel neglected
or develop behavioral manifestations to draw
attention to themselves. On the other hand,
they become very protective of the child and
assume an unrealistic responsibility for him.
The feeling of responsibility associated
with caring for a child with a cardiac defect
often causes parents to ignore their own needs
and may lead to increased frustration and
marital tension. "A person or a couple who is
emotionally and physically exhausted cannot
continue to give to others in a healthy way.
Many parents... feel guilty about uSing time or
other resources to meet their own needs, and
they need help in understanding the vital
importance to the family of their doing Just
that. "9
Clearly, caring for a child with a cardiac
defect is a complex problem that goes far
beyond the hospital walls. Recognition of
some of the difficulties shared by these
families in their home environment can help
nurses to find ways of making parents effective
and responsible members of the health team
by giving them the support and encourage-
ment they need. ..
Judith M. Hendry (R.N., Hospital for Sick
Children, Toronto: B.Sc.N., University of
Toronto: M.Sc.N., University of Western
Ontario) is presently a lecturer in the Faculty of
Nursing, University of Toronto. Judith I. Mitton
(R.N., Moncton Hospital School of Nursing:
B.N. and M.Sc. (A), McGill University) is
presently Assistant Professor in the Faculty of
Nursing, University of Toronto.
References
1 Pidgeon, Virginia. The infant with congeni
heart disease. Amer. J. Nurs. 67:2:290-293. Fe
1967.
2 Scipien, Gladys. Comprehensive pediatric
nursing, by. . . el al. Toronto, McGraw-Hili, 1975.
566-568.
3 Nelson, Waldo E. ed. Textbook of pediatr;,
ed. by... et al. 9th ed. Toronto, Saunders, 1969.
967.
4 Hall, David P. Coarctation of the aorta. Nu
Clin. North Am. 2:3:529-535, Sep. 1967.
5 Altshuler, Anne. Complete transposition of t
great arteries.Amer. J. Nurs. 71:1 :96-98, Jan. 19'
6 Rashklnd, W.J. Creation of an atrial septé
defect without thoracotomy, a palliative approact
complete transposition of the great arteries, by.
andW.W. Miller.JAMA 196:991-992,Jun.13,191
7 Mustard, William T. Pediatric surgery. 2 Vol
by... etal. 2ded. Chicago, YearBook Medical, 191
p.554.
8 Glaser, H. Emotional implications of
congenital heart disease In children, by... et al.
Pediatrics 33:367-379, Mar. 1964.
9 Roberts, Florence Bright. The child with he
disease. Amer. J. Nurs. 72:6: 1 080-1 084, Jun. 19'
Bibliography
Gudermuth. Susie
Mothers' reports of early experiences of infants
congenital heart disease. Matern. Child Nurs. y
4:3:155-164, Fall 1975.
Linde, LM.
Attitudinal factors in congenital heart disease, b
et ål. Pediatrics 38:92-101, Jul. 1966.
/
33
The CanadIan Nurse September 1976
Quick Change
Quiz
The following mini-quiz is designed to
test your familiarity with the
cardiovascular system and its
problems.
Mark true (T) or false (F)
1 Intracardiac pressure is normally
the highest In the left atrium. D
CHANGES
2 Genetic counselling IS essential for
all parents of children with congenital
cardiac anomalies. D
Anatomic and Physiologic Dynamics
Answers
Diagrams
1 supenor vena cava
2 sinoatrial (SA) node
3 atrioventricular (A V) node
4 posterior division - left bundle branch
5 anterior division - left bundle branch
6 Purklnje fibres
7 inferior vena cava
8 tricuspid valve
9 apex
10 interventncular seplum
11 interatrial septum
12 left atrium
13 lumen
14 tunica intima
15 tunica media
16 tUnica adventitia
3 Prophyllactic penicillin is a
long-range form of management in
rheumatic heart disease. D
4 Newborns with pulmonary atresia
are almost entirely dependent on patent
ductus for pulmonary blood flow. D
5 Slight slowing of heart rhythm m
be evident on E.C.G. during inspiration. U
6 Arteriosclerosis is a condition of the
elderly. D
7 The most reliable evidence of
streptococcal infection capable of
causing rheumatic fever, IS a throat
culture. D
Text
1 rhythmicity
2 automaticity
3 irritability
4 automaticity
5 ectopic beats
6 SA node
7 first trimester
8 umbilical artenes
9 umbilical vein
10 ductus artenosis
11 foramen ovale
12 foramen ovale
13 ductus arteriosis
14 aorta
15 prostaglandin
16 tricuspid valve
17 bicuspid valve
18 mitral
19 right
20 pulmonary artenes
21 parenchymal
22 atnum
23 left ventncle
24 semilunar valve
25 aorta
26 stroke volume
27 heart rate
28 tonicity
29 blood volume
30 autonomic
31 sinoatnal node
32 atnoventncular junction
33 common bundle
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34 left
35 nghl
36 PurkinJe fibres
37 potassium
38 sodium
39 depolanzation
40 repolanzallon
41 vagus
42 0.04 - 0.09
43 refractory
44 electrical potential
45 atrial depolarization
46 P-R interval
47 QRS complex
48 depolarization
49 ventricles
50 congestive heart failure
51 hypertension
52 electrolyte imbalance
53 mental confusion
54 syncope
55 cerebral haemorrhage
56 transient Ischemic attacks
57 stroke
58 heredity
59 obesity
60 lack of exercise
61 stress
62 smoking
63 age
64 hypertension
65 nutrition
34
The Canadian Nurse Seplembar 1976
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Sandra LeFort
The Hospital for Sick Children in Toronto is
known worldwide for its research, diagnostic
techniques and treatment of many childhood
health problems. HSC has kept abreast of new
scientific and medical developments in the
field of pediatrics and indeed, has often been
the forerunner of medical advances in
childhood diseases.
Congenital heart disease has been one
focus of intensive research at the Hospital for
Sick Children. In the diagnosis of heart
ailments in the young, cardiac catheterization
has been a vital tool since it was first
introduced to Canada in 1946 by Dr. John D.
Keith, then HSC's Chief of Cardiology. Since
that time, there have been amazing advances
both in technology and in the surgical
treatment of heart problems.
HSC has the largest patient load of any
children's cardiac centre in North America and
performs an average of 700 to 800 cardiac
catheterizations a year in two laboratories.
Earlier this year, HSC purchased new
equipment for one of its cardiac
catheterization labs with a $300,000 grant
from the Variety Club of Ontario.
At The Canadian Nurse, we were
interested in finding out more about this
equipment to see what advantages it offers
Recently, I visited the Hospital for Sick
Children to talk to Dr. Peter Olley, Chief,
Section of Laboratories, Division of
Cardiology As we talked, I learned a great
deal about the general 'workings' of the
r--
The Canadian Nurse September 1976
35
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The eqUiP 0 consumptiOn. to regulate t e
measures 2 the patient's face
placed over
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quipment and its operation. Dr. Olley
xplained that the conventional
atheterization equipment has one X ray tube
nd one image intensifier which are in fixed
Jositions. To obtain different views of the
leart, the patient must be rotated at different
13ngles while strapped to the table. A more
ecent advance involved a bi-plane system
Nhich had a double set of X ray tubes and
image intensifiers - both in fixed positions.
irhis enabled horizontal and vertical pictures to
e taken simultaneously and displayed on two
elevision screens. Angled pictures, however,
'till necessitated the rotation of the patient.
The newest equipment, which is the first
f its kind in North America, is now in full
peration at HSC. It also has a double set of X
ay tubes and image intensifiers. However,
lhile one plane (horizontal) is fixed, the other
lane (vertical) is attached to a U-arm (see
igure I) which can be rotated around the
>atient. Thus in most cases, the patient
l emains flat on his back during the procedure.
To illustrate the operation of the
quipment, Dr. Olley showed me the new lab
...here a cardiac catheterization was in
fregress. A young boy was being catheterized
10 evaluale Ihe eff;c;ency of h
art;'cal m;ual
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Figure 1 Before completion of the laboratory thIs picture of the V-arm
was taken showing the image intensifier on the top and the X ray tube
on the bottom.
36
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The CanadIan Nurse September 1976
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valve which had been surgically inserted a
year ago. The patient was drowsy but awake
throughout the procedure, and the two T.V.
screens simultaneously showed the workings
of his heart.
At this point, Dr. Olley stated that there are
two major advantages of the new equipment
over the old. One is the increased detail in the
pictures taken of the heart. This is especially
important for the precise location of anomalies
In complex congenital heart disease.
The other main advantage lies in the
increased safety to the patient: there is less
possibility of catheter displacement especially
in the newborn, since rotation of the patient is
not usually necessary; fewer radio-opaque
iodine injections are requi red since two sets of
pictures are obtained with every injection of
dye; and, there is some reduction in the
amount of radiation given to the patient.
In reviewing with me the reasons for
per10rming cardiac catheterization, Dr. Olley
pointed out that there are many diagnostic
tests which can be done during the procedure.
c
Depending on the heart problem, some or all of
the following tests may be per1ormed:
- measurement of 02 content of the blood in
the heart chambers which can help in locating
septal defects
- establishing the presence of and the
measurement of left-to-right and right-to-Ieft
shunts within the heart by the injection of a
green dye
- measurement of the patient's 02
consumption
- measurement of intracardiac blood
pressure which, when compared to normal
values, helps in the diagnosis of stenotic
valves and pulmonary hypertension.
- assessment of the conduction system of
the heart by recording the electrical activity
directly from the Bundle of His
- assessment of the heart muscle as a pump.
These and other tests are usually
conducted while the patient is at rest. They can
also be done to test the heart during exercise
by having the patient do isometric exercises or
by infusing certain drugs, eÇJ. Isuprel,
Propanolol (Inderal), and Priscoline.
Depending on the number of tests done, the
procedure can take from 45 minutes up to four
or five hours - a long time for any patient,
child or adult.
After these preliminary tests are
completed, the angiograms are done by the
injection of radio-opaque dye into the heart
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The CanadIan Nurse S.plember 1976
37
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chambers. Pictures of the heart taken on
35mm film give a permanent record of
structural defects of the heart, volume of the
heart chambers, and general heart function
Treatment of newborns with some types
of cyanotic congenital heart disease may be
performed during a cardiac catheterization.
For example, recent studies done at the
Hospital for Sick Children have shown that the
ductus arteriosus in normal babies is
extremely sensitive to E-type prostaglandins
which cause the ductus to relax. In some forms
of cyanotic heart disease, the ductus is the
only opening that allows the mixing of
oxygenated and unoxygenated blood. During
a cardiac catheterization, doctors are now able
to give an infusion of E-type prostaglandins
which results in the relaxation of the ductus,
thereby increasing the amount of oxygenated
blood getting to the lungs. Although this is only
a temporary measure (lasting for a few days at
the most), it gives the health team time to
consider permanent treatment.
In children with transposition of the great
arteries (T.G.A.), a catheter with a ballon on
the end can be used to create a large
B
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Nurse Pat Grande gives 02 to a patient Image intensifier 'A' is
attached to a U- arm and can be rotated.
38
The Canadian Nurse Seplembar 1976
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atrial septal defect so that the mixing of
oxygenated and unoxygenated blood is
increased.
To conclude, I found the new equipment
most impressive. Although not drastically
different from older models, it seems to be a
better, safer way to perform cardiac
catheterizations and certainly appears to give a
more detailed picture of that most vital organ
- the heart. The number of children
undergomg this diagnostic procedure would
seem to demand the use ofthe best equipment
available. A more accurate picture of cardiac
anomalies prior to surgery gives the surgeon
more complete information about the child's
condition before the operation. And, as Dr.
Olley states, the effect of using the new
equipment will hopefully be seen in improved
surgical results for children with cardiac
problems. ...
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During a cardia!; carnetization, Dr. Peter Olley (center) and others
observe the position of the catheter on a television screen
We at The Canadian Nurse extend thanks to The Hospital for Sick
Children for the opportunity to spend some time vlsitmg their cardiac
catheterization laboratories. Special thanks goes to Dr. Peter Olley
for the time and effort spent in helping us with this article.
The Canadian Nurse September 1976
39
Clinical Word search 00.2
Solve the clues. The bracketed number
mdicates the number of letters in the word or
words in the answer. Then find the words In the
accompanying puzzle The words are in all
directIOns - vertically, hOrizontally, diagonally,
and backwards. Circle the letters of each word
found. The letters are often used more than once
so do not obliterate them. Look for the longest
words first. When you find all the words, the
letters remaining unscramble to form a hidden
answer. (Answers page 53)
LIP A C C LOT D
RETRABSHOC
IPARAOIOGA
I APE R S L P C R
S E I R A L
R P N L A I
AUHOTD
N L S Y I R
USN I G T I L T S R BON E D
L E S L T MAC T T SIN U S I
I IDCI IOLUAGPRNYO
M HIT HAD M L S E L U N E V
ERACV I ERA I PHONOA
STANGLHMANR I TOGS
EROOOESR I COBD lac
BDXTASLOWTOMI LUU
E I S R E L D NUB R D E F R L
N Y TEL E MET R Y ANT D A
SMYOCARD I UMNLEER
ADAMS NO I TCRAFN I R
1 Foxglove derivative, stimulates vagus nerve.
(7)
2 A four chambered muscular organ
responsible for cIrculation of blood. (5)
3 Pertaining to those vessels carrying bright
red oxygenated blood. (8)
4 The pulse in tachycardia. (5)
5 On the way back, between capillaries and
veins. (6)
6 A companion of sweat and tears. (5)
7 Although their walls are only one cell thick,
they're often found In beds. (11)
8 This arrythmia results from interference in
impulses from the S.A. node. (5)
9 Part of conduction system, not her s. (3) (6)
10 Valve joining nght atrium and ventricle (9)
11 Sub-acute bacterial inflammation. (12)
12 Cardiac muscle. (10)
13 Bicuspid valve. (6)
14 The beat is not usually 4/4 time. (5)
15 Phone-in E.K.G. (9)
16 That period of the cardiac cycle when the
heart muscle contracts. (7)
17 Artery commonly used In blood pressure
measurement. (8)
18 A mass of cardiac muscle fibres 'Ying on the
right lower part of the interatrial septum of the
heart. (1, 1,4)
19 Pertaining to the circulatory system (14)
20 Device used in B/P measurement. (16)
21 What captured criminals and some patients
have in common. (6)
22 Extremely rapid, irregular heart beat which
usually precipitates cardiac standstill. (12)
23 Type of valve preventing backflow in veins.
(9)
24 Thrombus. (4)
25 Because of the nature and locatIon of the pain
associated with oesophageal reflux, it can be
said to mImic on cardiac pain, (7)
26 Lactic Dehydrogenase. (3)
27 Electrocardiogram. (3)
28 Serum glutamic oxaloacebc transaminase.
(4)
29 Partial thromboplastin time. (3)
30 Erythrocyte sedimentation rate (3)
31 Characteristic pulse In bradycardIa (4)
32 Hora somni. (2)
33 Pro re nata (3)
34 Nil per os (3)
35 Quater in die (3)
36 Shortness of breath (3)
37 a cardiogram in which the heart sounds
produced are indicated graphically (5)
38 the physical or mechanical restoration of
damaged tissues (6)
39 development of a localized area of Ischemic
necrosis (10)
40 Stokes syndrome, characterized by
sudden attack of unconsciousness,
frequently accompanies heart block (5)
40
The CanadIan NUT'" September 1916
Mary L.S. Vacho,
ced Proximity to
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The CanadIan Nurse September 1976
41
I The author, a nurse and sociologist, dons
her other three hats to describe what
nurses can do to cope with the stress they
encounter on-the-job every day. In this
I paper, prepared for the 1976 CNA annual
I meeting and convention, she speaks as a
consultant to staff in a cancer hospital,
. consultant to cancer patients and their
I families and. finally, as a consumer.
.
II]
the
Cliel1t
There was a time when we were trained as
nurses to deal with our emotional response to
the disease, disfigurement and death that
surround us in Our daily work. We were taught
to believe that the "good nurse" did not
have "bad feelings." She did not quake and
tremble when at age eighteen she washed the
genitals of a man her fathers age. She did not
panic when the alarm rang on her patient in the
ICU. Nor did she want to run from the room
when a patient she cared for postoperatively
suddenly and fully conscious started to
hemorrhage from all orifices. Most important,
she did not break down and cry when a patient
that she had tenderly cared for died.
Oh yes, those were the good old days
when we put on our professional manner with
cur uniform. We were secure in the knowledge
that we could cope; we were unflappable
because we had to be. We knew that a good
nurse was cool, calm and competent.
Certainly we were good nurses then
we
must have been - we sure tried to be.
In those days not only were we secure in
our roles but the patients also knew their roles
They knew enough to be passive and
compliant. We knew what we were doing and
they dldn't question us. They were patients.
not clients or consumers and they dldn t hassle
us about patients' rights, husbands in our
sacrosanct delivery rooms or death with
dignity. Family members knew their place, too.
When we told them it upset their children when
they came to visit, they stayed away. They
waited outside the ICU without continually
wanting to see how the patient was dOing.
Most of all they did what they were told .
Why have things changed so much? Why
are issues we resolved years ago suddenly
problems? Why are we suddenly asking
ourselves these questions?
If you are a real nurse you are not simply
saving a life. You have come to know this
patient and you recognize the stress his illness
presents for him and his family. Your struggle
is for a life that means something to you. The
loss of that life is a loss for you. If you feel this
loss, you can take just so many like it before
you quit or become callous, preaching the
gospel of non-involvement - "Don't let it get
to you, it's all in a day's work."
Technological changes and enforced
proximity to stress also create other problems.
Often our new knowledge only makes it
possible to prolong the dying process. Helping
individuals and their families dUring this time is
E n "
VIronment
- Why do we have problems wIth stress in our
interactions with patients?
- What are our biggest problems and how do
we cope wIth them?
- What can we do to resolve some of our
difficulties?
Let us start with the question of why we
are under stress. Haven't we always been
close to clients and their stress? The answer
is, no, not in the same way we are today.
Technological advances often require us to be
either right at the bedside of a critically ill
patient or within quick reach. This is not like the
old days when a dying patient rang his bell and
you "Could simply shut it off or ignore it. Now
you are there immediately - your adrenalin
starts working, your pulse and B.P. increase.
As you work to save a life, this stress is
palpable.
extremely difficult. It has many rewards but the
stress is tremendous. Certainly there is
satisfaction when you have been able to give
excellent palliative care - but there is a sense
of loss and a feeling of "How can you die after
all I've done for you." It's not logical but
feelings aren t -let's realize that. It was much
easier in the days when we didn't
acknowledge such feelings. but it's much more
real now.
Another reason for our stress has to do
with the pressure on us to live up to our role as
professionals. Society expects that now that it
pays us decent wages. we had better perform
at a higher level and be more accountable than
we have been heretofore. The client is no
longer a passive recipient of what9ver we wish
to dispense. Consumers know that Our
salaries are paid out of their tax dollars and
they are demanding our help in meeting their
health needs and making changes in the
health care system .
The Canadian Nurse Seplember 1976
42
Enforced proximity to demanding
consumers is a major SOurce of stress for
many nurses today. Learning how to
recognize and deal with this stress is a
challenge which is extremely threatening to us
because it hits us where it hurts- in our image
as competent professionals.
J believe the biggest problem we face IS
ourselves, Before making any changes to
operative group support.
3 The lack of understanding and
acceptance of their own feelings led to a lack
understanding and acceptance of the feelin
of patients. In addition, the nurses were
divided about their feelings regarding the
impact of cancer and the effectiveness of
treatment. Their attitudes ranged from: "Wh
do they bother taking treatment, they're onl
going to die anyway" to "Why should peop
be so upset just because they have cancer.
Conflict was compounded when patients die
because the hospital was seen as an activo
treatment center and not a place where peopl
came to die,
4 Because of lack of insight into their
situation, nurses were unable to function in
their accepted role of maintaining smooth
interpersonal relationships and this led to
anxiety which the omnipotent and omnlscier
physician was expected to resolve.
5 When the physician failed to perform th
expected magic and intervene to improve tt
situation, problems erupted. Staff discord
increased and patient care deteriorated.
6 These problems all became particular
you because people are begging to take your
job." Some of the best nurses I know have
received this treatment. They have
responded, not with anger and assertiveness,
but with the passive-helpless attitude that has
become all too common in nurses today.
It is socialization that has encouraged
women to respond in this way. Also, many of
us who enter nursing are very idealistic
people, prone to develop depression. When
we are able to help clients and to achieve
recognition we are pleased. But when people
suffer and die, Our self-esteem is threatened,
or our ideas are challenged or ignored, our
depression surfaces and we become passive
and helpless and/or develop psychosomatic
symptoms. This understanding of ourselves is
crucial to our resolution of the difficulties we
encounter in the client environment.
What can we do to surmount these
difficulties? Previously, when we were
frustrated and under stress we could change
jobs. In tcjay's economic climate this is no
longer possible. Therefore, we have to
develop new coping strategies.
Some of us, as individuals, are able to
SfRE$
alleviate stress in the client environment we
must, as nurses, come to terms with our own
identity. To recognize ourselves as competent
professionals requires a genuine sense of
self-esteem that is sadly lacking in many of
today's nurses. Sure we feel secure when we
put on a uniform and exert power over helpless
patients and family members. That's not what
I'm talking about. I mean the genuine sense of
competence and self-esteem that comes from
keeping abreast of changes in our profession
and community. ...that respects,
acknowledges and utilizes the changes
brought about through the Women's
Movement. ...that is not threatened when
challenged by a client with innovative ideas
and/or a higher level of education than our
own. ...that does not retreat into
passive-aggressive games with medical
colleagues and administration but makes
demands and, more important, seeks and
accepts responsibility.
All of this is made mOre difficult by recent
budget cutbacks that have threatened our
jobs. More than one nurse who has made an
innovative suggestion has been warned:
"Don't forget the door swings both ways. We
don't have to put up with any complaints from
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acute when patients In whom the staff had
significant personal investment were dying. I
these situations the feelings of individual
nurses were aroused. They were unable to
share these feelings with one another arid
therefore had trouble dealing with the patien
They expected the doctor to help but he wa
often impotent, because of his own difficultie
with dying patients. The nurses could not
understand this because ot the power and
competence they projected onto the doctor
.. As the nurses became aware of and bega
to accept their own feelings of anger,
depression, frustration, hopelessness and
helplessness they were able to share them
with one another and receive support. This
then freed them to use their natural empathy 1
accept and understand these same feelings i
patients without feeling that they had to forc
patients to either repress or ignore their
feelings in order for the expected smoother
interpersonal relationships to occur.
Gradually, the nurses became able at
least to entertain the idea that perhaps the
improve our work situation by developing
expanded roles, assuming new
responsibilities and achieving increased
visibility and credibility. This works on an
individual basis but accomplishes little for the
rest of the profession.
Group action is often the best approach to
a major problem. Through group meetings
nurses can identify their needs and develop
constructive approaches to their problems.
The nurses 'at Princess Margaret Hospital in
Toronto, for example, were having difficulty
dealing with dying patients. They decided to
ask for outside help. Gradually, working with
the nurses, we were able to conceptualize
their difficulty as follows:
1 The nurses had been socialized to know
that the "good nurse" never has "bad"
feelings. As a result they were working in
relative isolation, each one feeling she was the
only "bad" nurse, the only one who at times felt
angry, depressed, frustrated, helpless and
hopeless.
2 This led to mistrust. The nurses were
hesitant to be open with one anotherforfear of
criticism and, as a result, there was very little
The CanadIan Nurse S.plember 1976
ïysician might be experiencing some of the
'lme feelings they had. At this point they were
':>ie to decrease their expectation of support
om the doctors. They began to feel that it
'light even be possible. through the support
ley gained from their own group, to be able to
Her some help to the physicians in the grief
ley faced when patients died or were dying
'his increased insight and also gave the
Jrses the initiative to approach physicians
ith the problems they observed and to
Jggest alternative approaches.
In view of the socialization process of
lomen, such independence, initiative and
ggressiveness are noteworthy changes for
urses. At times, their expanding roles created
IHrculty because they had considerable
mbivalence about accepting the
>sponsibility that went with assuming
litiative. It was much easier to criticize the
octor than to take the responsibility for
litiating change,
By being willing to lour( at their own
'ehngs and share them with their co-workers
lie nurses gained new insights and strengths
milar perhaps to those gained in some
nurses lies. To cope with our enforced
proximity to stress in the client environment,
we must work together to gain insight into the
stress and evolve more effective coping
mechanisms. We must stop pulling against
one another and utilize the idealism and
energy of our younger members, the maturity
and competence of the middle aged and the
wisdom of the older nurses among us.
Working together we may get
somewhere, struggling alone we will fall prey
to the stress diseases endemic in society
today. ..
Mary Vachon (R.N., B.S.N., Boston
University, M.A., University of Toronto) is in a
unique position to help health workers and
patients cope with their "feelings" as people.
As Mental Health Consultant, Commumty
Resources Service, at the Clarke Institute of
Psychiatry, she was the principal investigator
in a study of the newly bereaved which
indicated that their needs were not being met
by either professionals or the community, This
resulted in the establishment of a self help
program for the recently widowed.
STRESS
nsciousness-raising groups. This enabled
'1em not only to increase their understanding
f patients but also to expand their capacity to
ssume initiative and leadership in patient
are. Relationships with physicians then
'I1proved because the nurses were able to
balize that the doctors were also having
Ifficulty In caring for dying patients. As
Iressures from the nurses on the physicians
ecreased, the doctors became much more
illing to discuss treatment programs and to
ten to the nurses' suggestions. This was not
tways easy for the nurses because of the
-sponsibility inherent in assuming initiative
nd some nurses were sufficiently ambivalent
bout this new role that they retreated to their
rmer passivity and the security of the status
uo For those who were willing to change,
owever, the rewar.ds were great."2
Th:s is one example of the effectiveness
. grou
effort. This is where our strength as
As she describes in this article, her role
as Psychiatric Nursing Consultant at the
Princess Margaret Hospital also enables her
to assist nurses m learnmg how to assess,
cope and deal constructively with the feelings
that are expressed by cancer patIents. She is
a lecturer in the Dept. of Psychiatry, University
of Toronto and is also presently working
rowards a Ph.D. In Sociology at York
University, Toronto.
References
1,2. Excerpted from Vachon, M, L.S., Lyall,
W.A,L. and Rogers, J. .. :he Nurse In
Thanatology: What She Can Learn from the
Women's Movement" in Living, Dying and
Those Who Care. Columbia University Press,
(in press, expected publication January,
1977).
43
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44
The Canadian Nurse September 1976
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I have three treasures which I hold and keep.
The first is mercy: the second is economy:
The third is daring not to be ahead of others.
From mercy comes courage: from economy comes
generosity:
From humility comes leadership.
The Tao Te Ching,
Chapter 67
The CanadIan Nurse September 1976
Ingrid Bergstrom
I
In any society there are people who are attracted to
banners and causes - some good, some bad: some
effective and others not so effective. Then there's
another group - people who are aware of those
causes but don't ever get involved. Instead, they
quietly seek 10 fulfil themselves by living out what
they feel to be productive lives. Many of them do it
well. The most successful all seem to have one thing
in common - a flair for getting on with it.
Mary Berglund is a person like Ihat. She s a
registered nurse and lives In Ignace, Ontario. about
150 miles north of Thunder Bay. I'd heard stories
about Mary - how she'd treated people in her home,
how she'd hitched rides to make house calls. and
how she'd never made a cent for all this work - that
she'd considered it all just part of the work of
day-to-day living. I was intrigued. Mary sounded like
a breath of fresh air so I made arrangements for a
visit.
The two and a half hour drive up the Trans
Canada highway ended at a flat bare-looking little
town, edged in northern pine, with several new
motels and a Chinese restaurant on the outskirts. A
sign said "Welcome to Ignace." I had arrived. I
stopped at a grocery store and asked if anyone knew
where Mary Berglund lived. A lady pointed a finger,
"Oh sure, Doc Berglund, just turn right at Ihe corner,
she lives across the road from the post office in the
white house."
There's hardly a soul in Ignace who hasn't heard
of Mary, much less had to go 10 her for help of one
kind or another. Her reputation has spread as far
west as Winnipeg and as far east as the Quebec
border.
I knocked on the door and a vigorous, croaky
voice hollered "Come on in..." I was invited to "park it
on a kitchen chair while she got us some 'dregs'
she'd been keeping warm since breakfast". Great
dregs.
I was surprised at her appearance. Physically,
she stands about 5 foot nothing and looks like
everybody's idea of grandma, Somehow, I'd been
expecting a tall, thin, authoritarian type of person.
Her complexion is clear and rosy colored. Her blue
eyes sparkle when she smiles. which is often, and
when she speaks she looks you straight in the eye.
She has an open casual manner and I could tell right
away I was going to like her. She looks about 60. The
day I saw her happened to be her 73rd birthday.
We settled back with cigarettes and coffee. How
did she get started with this outpost nursing? What
did it involve? Well, it seemed she arrived there in
1932 along with her husband Tony. He'd taken a job
with the CP R and Ignace was going to be their home.
Nine years earlier, Mary had graduated from
McKellar School of Nursing in Fort William. Marriage
at age 30 had called a halt to her practice, not that
she minded much. She was ready to settle down. to
raise a family, and for several years, that's just what
she did. Mary looked after their three children and
Tony worked for the railroad whose shunting area
adjoined their small backyard. The only thing that
I
45
made their life different from small village life today
was a definite lack of modern conveniences and the
fact that almost everyone around was very poor.
In 1939. when war was declared. doctors were
needed overseas. Ignace's doctor was among those
who went and the little town of 600 found itself with no
medical help at all. It wasn t long after that the whole
thing started. People came knocking on Mary's
kitchen door. Oh. they'd known all along that she was
a nurse. but until the doctor left, they d never had to
think about it. In an area subsisting mainly on
trapping, hunting and fishing along with some
industrial work. there are bound to be accidents. And
there were. Fish hooks had to be extracted. cuts
sewn up, burns bandaged and broken legs set They
came to the door at any time of the day or night. No
one was turned away. Doctor or no doctor the
population continued to grow and Mary found herself
delivering babies - in trains, cars, pick-up trucks
and on the floors of one-room shacks She can t even
guess how many babies she's dehvered - "A lot, for
sure."
I ask how she financed herself - most people
didn t have too much money then - people in that
area still don't. "People paid what they could,' she
says. Her journals tell of her daily encounters. I
thumb through, fascinated.
August 17/49: Bandaged Indian woman's foot. 25
cents. Set J. Schroeder's foot, broken in fall from
roof
Total take - 25 cents
August 30/51: Cinders removed from Indian's eye-
gratis. Visited Catrelli baby - OK now. Gave Jor-
genson 1 cc penicillin. Foot looks better. Called at
Zurukas - infection in Mrs. Z's finger clearing
Total take - $6.00
OClober 13/52: Accompanied OPP to Dryden
Hospital with mjured man picked up on highway
Gave Mrs. McCool shot - tetanus. Gave Mr.
McCloud 1 cc penicillin
Total take - $2.00
There is, it seems, a notation for almost every
day from 1940 onwards I ask about her declaration
46
The Canadian Nurse September 1976
of funds received, the "total take-- at the end of each
day's entry. "Well," she says, "all that money went to
buy more bandages, more medicine - people are
proud you know, they don't like to take anything for
nothing and they gave me what they could afford.
Sometimes it was only a dime, other times maybe
vegetables from the garden. Tony didn't finance the
medicine at all, it had to come out of what I could
collect. I kept track of it for the income tax people.
The doctors in Dryden - that's our closest hospital,
68 miles away - they were good, I was always in
touch with them and they'd advise me in a lot of the
cases, I had to have controlled drugs here too - the
doctors would sign forthem and I'd pick them up, I felt
a bit more confident knowing that they trusted me to
that extent; they just told me to use my own
discretion. I've had to administer morphine, heroin,
stuff like that - even with penicillin you know, you
take a chance if the patient turns out to have a bad
reaction. What else could I do? There wasn't I'd heard that Mary had made as many as 25
anybody else to help. Nothing like that ever house calls in a day - was that true? "Oh yeah, it
happened though -no bad reactions. I guess I been was easier for me to get around than have them
pretty lucky..." _ come in all the time. Somebody was always giving
Over and over again, she mentions the fact that. mea ride. I never learned to drive, not even abikeso
she's been very lucky - I venture the opinion that mostly I walked. Had to snowshoe into one place to
perhaps luck didn't have so much to do with it as hard give an old man his liver shot, did that all one winter.
work. Why did she choose to take on this But a lot of the time they'd come to the house. I've
responsibility when so many others would have said seen as many as 40 people here in a day. They even
'I've got a husband and three kids to raise, I just don't used to sit outside on the grass. waiting theirturn.l'd
have the time?' break to get Tony and the kids their meals and then
Her answer is honest and touching. "Well, you get on with it. "She laughs. She tells me she used to
know, I took the Florence Nightingale pledge at charge $1.00 for a patient at her place. $2.00 for a
nursing school. If you take it, you gotta mean it. I house call - when she could get it. Her charges
didn't have a choice. it was something I had to do. remained the same until her retirement four years
ago.
She excuses herself to go out and move the
sprinkler and I try to imagine the activity that took
place in this little kitchen. Her stories fill my mind -
the one about the fellow standing on a large oil tanker
truck enjoying the summer breeze. He decided to
light a cigarette and the inevitable happened. The
blast threw him some 35 feet through the air. His
friends dragged him across Mary's kitchen floor to
her medical office - the family bathroom. They
propped him on the toilet seat and Mary went to work
She had a small table set up beside the Sink -
anyone else usually ended up standing up in the tub
or sitting on the edge of it. Lace curtains flapped at
the window and African violets lined the sill. She did
her work quietly and efficiently.
I remember another story about the fellow who
mangled his hand in some machinery and how she
had to use her breadboard in the kitchen as the work
area because the bathroom was in use.
Mary comes back in, commenting on the garden
and the fact that it's growing so well. "Going to have
to freeze a lot of stuff this year."
Before we can start talking again there's a knock
on the door. One of the little neighbor girls has a large
bouquet of lilacs - and a happy bi rthday wish. Mary
is delighted. In her conversation with the child there
is no age boundary; they speak as fnends rather than
youth to aged.
I ask her to tell me some more stories. "Well, I
remember the time a fellow got his leg chopped off
back up there on the tracks." She nods northwards.
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That sail." She pauses and stirs the supper on the
stove again, stares into the pot and says softly,"You
know that verse, you are thy brother s keeper-well,
I believe that. I got the skills and the knowledge, so I I
use 'em. We're not here for long and you get back,
what you give out. I am a lucky person. I got friends, '
people care. I consider myself very fortunate."
November 15/54: L Jorgenson brought in little
Indian girl with scalded feet. Looks good, cut away
considerable skin and applied Spectrocin ointment.
Bill Gaskin came in with abscessed tooth. Gave pen
tabs twice a day and 292's. Bob Potsin came in to
have a suture removed from finger. L )oks good.
Mrs. Fletcher came with her daughter and baby,
looking well. Bandaged Mrs. F's foot, cut on sole.
Doing well,
Total take - $7.35 and two lovely cauliflowers
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OSTOMY PRODUC"TS
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48
The Canadian Nurse September 1976
--
-
-
..
"I was just doin' up the lunch dishes and Bill comes
runnin' in saying 'Mary, come quick and bring your
bag! ' They were always saying that, hardly ever an
explanation - just Mary, come quick and bring your
bag. Never knew what to expect. Anyway, this time I
went.
Seemed the poor guy had got his leg caught in a
coupling and one of the box cars had backed up.
Before he could whistle Dixie, his leg from mid-thigh
down was gone Luckily I had some sutures to stop
the bleeding. Before I got there they'd made a
tourniquet out of his braces. Had some stuff for shock
and I got some hot water bottles filled from the house.
Made sure the kids had something for supper and
arranged forthe station master to clear the track from
Ignace to Dryden. We got hold of an engine and
caboose and whipped him into the Dryden hospital.
That was the day I found out they didn't make
caboose doors wide enough to get a stretcher on.
We had to tie the poor man on and tip him sideways. I
stayed in Dryden that night and came back next
morning in time to take care of the kids.
On account of that incident, the CPR people had
water piped into the house for me. That was a real big
thing in those days you know - 1951 it was. Never
got a water bill either - even to this day. The
railroad's been good to me. Mind you, I stitched up
quite a few of their boys too."
Whatever happened to the fellow who lost his
leg, Mary?
"Oh, he's livin' up in Kenora now, I hear from him
occasionally - says I saved his life. Well, I did what I
could, what had to be done." She says it shyly as she
butts her cigarette, then looks up and smiles. "Did I
tell you, I got some notes from people, iftheycouldn't
come they'd always get hold of some way of lettin'
me know they were sick."
She goes over to a drawer and starts
rummaging through it. "I didn't save all the notes,"
she says, "but I remember one day this little kid
comes knockin' the door. I went and answered it and
he didn't say anything, just handed me this piece of
paper. It was written pretty poorly in pencil and it said:
"Dere nurs, I am sic, I did not shit for five days. You
can come and see me if you want. ' She lets go a
belly laugh and claps her hand over her mouth after
saying the four letter word. ("Drinkin , smokin' and
spittin', that's me - I don't hold much with cuss in '. ")
She went down the track a couple of miles to see the
patient. Old she get him moving? I ask. "Oh sure,
he's still movin', I guess."
Another note she shows me has an almost
heart-breaking message. It is written in a childish
scrawl from an obviously worried mother of many
children. 'Dear Mrs. Berglund' It read, 'do you got
anything to make the blood come not to buy another
baby. I am sick, it is a month. Please come. Yours
truly.'
The story had a happy ending - it was a false
alarm. "But you know, the worry that woman went
through, it almost made me cry. "
September 17/52: Johnny Defoe with a flesh and
bone wound. Cut leg with axe, choppmg down
poplars, axe slipped. Changed bandages Looking
a bit better. Mrs. McCool gave me 48 cents -
payment for bandages.
Total take - 48 cents
September 30/52: No visitors today - had a rest.
Did laundry and ironing and waxed the floors.
We get talking about school children and I
mention I'd heard that she wentto a lot ofthe little one
room schools in the area to innoculate the children.
Public health nurses, it seems, did not work in the
district for several years. "Well, you know the
government, take your money and forget all about
you," she comments dryly.
Mary had asked doctors In Dryden for the serum
and paid for it with her daily "takes." She took on this
job herself because, as she says sensibly, "what are
you gonna do? Either they got vaccinated or I looked
after them next year. It was a whole lot easier to
vaccinate them.' Again, a lot of the calls were made
on foot - but most times she found someone to take
her - either in a car or by sled. "People up here help
each other - we got to."
She tells about waiting in freezing weather in a
broken down car on the side of the highway with
Verna E. ... who was about to give birth. Verna's
husband who'd been driving went on up the road for
help. The Interval between contractions became
shorter so Mary did the only thing she could. She got
out and flagged down a family in a pick -up truck. The
somewhat nervous driver moved his wife and
children into the back and Mary and Verna crowded
into the front. Up the road they picked up Verna's
husband and made the trip to Dryden in a little over
an hour - not a second too soon either. Verna had a
lovely daughter very shortly after
August 5/56: Called on Cheryl Young -getting over
flu. Given lunch and two packs of cigarettes. Called
on Dennis Smyk - given supper and one dozen
eggs.
Take - 2 packs of cigs and 1 dozen eggs
"And we were grateful for that in those days, too!"
she comments.
The CanadIan Nurse September 1976
49
August 15/56: Dressed Mrs. Hershey's hand,
administered 1/4 cc morphine. Dressed G.
McNabb's hand. Dressed Mrs. Sockin's foot.
Infection has set m. Gave 1 cc penicillin. Pat
Johnson paid $10.50 for previous treatment. Was
given some blueberries - (beautiful).
Take - $10.50
August 16/56: Mrs. Burusky gave me some butter.
Cleansed Mr. Nash's cut head and accompanied him
to Dryden. Paid $5.00,
Take - $5.00 and some butter
For 32 years, Mary diagnosed and treated If
there was any illness she felt she couldn't handle on
her own, she sought a doctor's advice, but a shadow
of fear still lurked in the background. Mary was sure
that one day she was going to get caught for
practicing medicine without a licence.
In 1972 a letter arrived from the Ontario Medical
Association, "I was petrified to open it. I thought,
they've finally got me, this is really the end." In fact,
the letter contained notificiation that she was going to
be honored with a membership in the OMA - the
only nurse ever to be awarded the citation. "It was
thrilling to think they'd do that for me - a backwoods
nurse. "
She went to Toronto and accepted the award
graciously then left again for Ignace. "You never
know what's going to happen and I don't like to be
away too long."
Nor do Mary's honors end there. She has an
Award for Service Medal presented by the Red
Cross. Prime Minister Trudeau sent her an
appreciative letter and autographed photograph
when told of her work in the area. Roland Michener,
when he was Governor General, presented her with
the St. John's Ambulance pin for outstanding
service. The pipeline workers in the Ignace area
gave Mary a wrist watch and luggage. The back of
the watch is inscribed "To Mary, from the pipeliners."
Her scrapbooks are loaded with newspaper articles
and letters to the editor about her along with letters of
appreciation from CPR officials. In 1969 the Ignace
Chapter of the Boy Scouts named her Mother of the
Year and to t0p It all off - she was sponsored by the
town of Ignace and named by the Ontario
government as one of 25 women honored by that
province during International Women's Year. Mary
accepts it all with equanimity. "It's nice to know
you're appreciated."
She turns to me and asks if I'd like to see how
her clinic is coming along. "Sure would," I say. (Her
folksiness is catching). We drive over and take a
look. The Mary Berglund Clinic is being erected
entirely by volunteer labor and seems to be commg
along just fine.
"The fellow who dug the foundation, he's an old
patient of mine - did it for free. Another patient put
up the frame and we got an X-ray machine from the
hospital in Dryden, Should be ready soon." Her face
seems to glow as she looks it over and I get the
feeling this clinic means more to her than anything
we've talked about up to now. On the way back, we
drive pastthe firehall. A big sign with "Mary Berglund
Clinic ContributIons" at the top is nailed to the wall
outside. The giant red thermometer mdlcates that
donations are very close to reaching their goal. The
money is being used to buy buildmg materials and
medical equipment. The clinic was planned by the
people of the town of Ignace so that the doctor they
have now would not have to work out of his home and
and was named in appreciation of Mary's efforts over
the past three decades.
We return to the kitchen and talk some more -
this "backwoods nurse" and I. The conversation
rambles - we talk of the feminist movement and she
says. "You can't always have things the way you
want, you sometimes have to work around situations
and just do what you believe in. Can't say that I hold
m
h with women s lib though, I was always too busy
She moves to the stove to put on the
ever-present coffee pot and as she does a line from
an article by Sally Kempton In Esquire magazine
comes to mind. "WorTIen's liberation is finally only
personal. It IS hard to fight an enemy who has
outposts in your head. 'A realization dawns that the
enemy has no outposts In Mary Berglund shead
She has been victorious simply because It has never
occurred to her to acknowledge that an enemy
exists.
Her journals sit piled on the kitchen table, almost
a foot and a half high - mute testimony to 32 years of
"doing what had to be done." The clock in the living
room chimes seven times and the sky shoots rosy
red rays through the window. I've run out of tape but
am reluctant to leave, so we talk on.
Mary's been widowed several years now, and all
three of her children have marned and moved away
from home. In 1972 Ignace finally got a resident
doctor and "Doc" Berglund retired, although she's
still a St. John s Ambulance volunteer. "I get called
out maybe once or twice a month." She lives alone In
this modest white frame house, along with 1 08
potted plants - another of her passions.
As we chat she leans back on the kitchen chair
and smiles - a sunshIne smile. There is a serene
vitality about her. Is It passed from countless
generations or borne of her own self-knowledge I
wonder. Somehow or other, I think It s the latter.
"I've got friends," she says, "I've never had to go
hungry or cold - or lonely, so I'm a rich woman In
that way - What more could anyone want?" Indeed.
Driving down the highway I remember her
answer to the question "Would you do it all again,
Mary?" This charming grandmotherly lady with the
edge of northern Ontario roughness lit a cigarette
and looked me straight in the eye.
"Sure I would. I wouldn't have a choice, would IT..
The aurnor, a former policewoman, world traveller and now
freelance writer would just lIke to say that Mary Berglund.
through her words. actions and general air of well-being,
taught the author more aboutlivmg successfully than she'd
ever known before - and she is grateful.
50
The Canadian Nurse September 1976
Figure 1
o
T 011 m0 About Your Piúture.",
........................................................................
Three-and-a-half year old Tammy appears to be a model patient. Although she
was admitted to hospital, in isolation, less than twenty-four hours ago, she sits or
lies quietly in the crib. She rarely cries, except when mother comes, but neither
does she smile. The nurse who is caring for her says she is a "good" patient.
She appears to have adapted well to hospital. But has she?
Figure 2
>(
X 7?fx
x#c
,!
/z><. f0<
'i-..
Beverley McCann
The effects of maternal-child separation
upon preschool children have been well
documented during the past two decades.
In children under five, the behavioral
changes that may be expected include
various stages of separation that are
characterized by protest, despair and
denial. According to this description,
Tammy should be crying or exhibiting
some behavioral indication of protest.
Why is it then, that she appears calm, a
little shy perhaps. but certainly not vis ibly
disturbed? Are there any behavioral cues
that suggest that she too is experiencing
stress induced by hospitalization and
separation?
Research has shown that denial,
repression and projection are the defence
mechanisms that preschoolers most
often use to reduce anxiety. Overt
behavioral manifestations of these
feelings include withdrawal and
regression. 1 Hospitalized children often
exhibit regressive behavior,
characterized by a return to an earlier
stage of development. For example,
four-year old Mark, hospitalized with
burns to his left side, who was previously
toilet trained and able to feed himself,
sudde
y becomes incontinent or asks to
be fed. Perhaps Tammy has withdrawn,
for she hides her eyes when the nurse
approaches. Can nursing intervention
modify behavioral manifestations of
separation-anxiety or is hospital-induced
trauma inevitable?
Deliberative Approach
I believe that nurses can effectively
assist the hospitalized preschooler to
cope with the stressful effects of
separation induced by hospitalization.
They can do this by utilizing a deliberative
approach to nursing care. Wiedenbach
describes deliberative action as:
"interaction directed toward the fulfillment
of an explicit purpose and carried out with
judgment and understanding of how the
other means the behavior he is
manifesting, either verbally or
non-verbally. "2
For pediatric nurses, deliberative action
implies recognition and interpretation of
the child's behavioral cues of anxiety and
purposeful formulation of a plan of care
that will help him to cope. Such a plan
could include the following components:
. Consistency of care
. Involvement of the parent or usual
mothering figure
. Encouraging emotional expression
. Consistency of care
If we believe that total patient care is
beneficial for all patients, then for
preschool children it is imperative. The
literature indicates that
separation-anxiety is lessened by a
consistent mothering figure. thus
providing the child with the security and
affection he would normally receive at
home. Consistency of care implies the
establishment of a trust-relationship
between nurse and child over the several
The CanadIan Nurse Seplamber 1976
51
I
,.....................................................................................
days the nurse cares for the child. be selected not simply because of the .
I Consistent care: not only ben
fits the diversion they offer. but also because :
I child, but It provides nurse-satisfaction as they provide a medium for emotional .
I well. In experiencing the child's
aily expression. :
'progress, a strong bond of affection When Tammy received paper and .
i develops between nurse and child. With crayons for drawing, I said, "Draw me a ..
:
I an increased opportunity to observe the picture about what it is like to be in the .
i child, the nurse can better interpret the hospital." Quietfy and thoughtfully, _:
I meaning of the his behavior and thus, Tammy went to work. In the center, she .
more effectively respond to his needs. drew a series of bars. (See Figure 1). To
:
I . Parent involvement the left of the bars, she drew a circle. On · "' .
i Mothers rooming-in with their the right of the bars were rows and rows of Author Beverley McCann is an Instructor :
hospitalized preschool children may be "X's." of Pediatric Nursing at Ontario's :
,the ideal means of preventing "Tell me about your picture, Tammy," I FanshaweCollegeSchoolofNursing, St .
I separa
ion-
nxiety
but this solution is as
ed. . " '. Thomas Campus. She prepared this :
often either Impossible or Impractical. That s me, she said, pOinting to the article while completmg the clinical .
Many mothers work outside the home; bars, "but you can't see me because I'm nursing component of the Masters ·
some have younger or school-age inside. .. program at the University of Western :
children at home who need their mother's "Who is this?" I asked, pointing to the Ontario ·
attention, and many hospitals have no round cIrcle on the left. Explaining some of her reasons for :
physical arrangements for rooming-in. . ".Oh,that's Mommy," she saldwlsttully, writing it, she says, "The experience of :
Parents should, however, be encouraged Indrcatln.g the faceless circle. "and that's hospitalization with its strange .
to visit their child each day. Many parents, all the kisses she has for me." She surroundings and unfamiliar people can ·
like Tammy's mother, express guilt or pointed to the rows of ''X's.'' We talked be frightening for any child, especially for :
dismay when they notice that their child about her picture. one under school-age. However' as a :
cries when they appear or leave. If the pediatric nurse for several years, and as .
nurse explains that their child's crying The language of children a mother of three young children, who :
indicates protest against separation and Clearly, Tammy was experiencing have experienced hospitalization, I .
is a healthier emotional sign than apathy, gnef due to parental separation. The believe that nurses can help to minimize :
she can help to reassure parents who are faceless mother represented Tammy's this emotional trauma. .
wondering whether it might be better if repression of her anxiety due to The nurse, in conjunction with the child's :
they did not visit. Mother-substitute separation. Even her kisses could not family, has the unique opportunity of .
figures such as regular babysitters or penetrate the crib-caqe. Children paint formulating a plan of care that will :
grandmothers should also be encouraged what they feel,4 and the mere expression significantly reduce the anxiety imposed .
to visit, especially if mother is working and of this feeling often helps them. The by separation and illness.' .. :
cannot visit at certain times of the day. tremendously important role of play in :
Parents usually take considerable assisting children to express and work .
interest In the daily activities of their child, through their anxieties has also been well Bibliography :
such as meals, sleeping and play. Many documented and child psychiatrists have Bowlby, John, Child care and the _
ofthem welcome the opportunity to assist been utilizing play therapy to rehabilitate growth of love. 2d ed. New York, :
in the care of their child, by feeding or emotionally crippled children for many Penguin, 1965. .
bathing him. The experience of sharing in years, Petrillo, Madeline, Emotional care of :
his care may be emotionally satisfying for In the light of the feelings that Tammy hospitalized children; an environmental .
both parent and child. had indicated she was experiencing, I approach, by... and Sirgay Sanger. :
. Encouraging emotional expression decided on a consistent care plan Toronto, Lippincott, 1972. .
The literature strongly supports the intended to meet some of her needs Robertson, James Young children in :
concept of allowing children to express during this period of stress. After four days hospital. 2d ed. Kennebunkport, Me., .
their feelings. Vemon declares, "if the of consistently caring for Tammy each Tavistock, 1970. :
child is encouraged and helped to day, I once again asked her to draw me a :
express hIS troubled feelings to an picture. "Draw me a picture of how References .
understanding person, he is often Tammy is feeling, "I asked. Although she 1 Mussen. Paul Henry, Child .
relieved by being able to relate and was still not allowed out of bed, the tone of development and personality, by m and :
communicate these feelings.3 These this picture was much different (See John J. Conger. 4th ed. New York, .
feelings maybe expressed either verbally Figure 2), This time Tammy was in the Harper and Row, 1974. :
or non-verbally through play. pictll'e, She drew herself as standing up, 2 Wiedenbach, Ernestine, Clinical .
conversation or general activity, Verbal looking over the bars of the crib. There nursing: a helping art. New York, :
expressions are more obvious and was one important difference. This time, Springer, 1964. p. 41. -
therefore mOre easily recognized. The Tammy was visible in the picture and she 3 Vernon, David A., Psychological :
n
rse, if she is observant, can also was smiling! responses óf children to hospitalization :
discover many non-verbal expressions of Can a deliberative nursing approach and illness: a review of the literature, .
emotion in children, Play materials should which Includes consistency of care, by... et al. Springfield, II., C.C. Thomas :
involvement of the parent in the child's 1965, .
care, and the encouragement of 4 Fader, Jean. I paint what I feel. _
emotional expression assist in reducing Canad. Nurse. 68:7:31-33, Jut 1972. :
the adverse effects of hospital-induced .
separation in young children? I am :
rnnvinrøn th::lt it r::ln .
52
The Canadian Nur.. September 1178
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The Canadian Nurse Sep\ember 1916
53
POSEY fOR PATIENT
COMfORT. SAfETY. CONTROL
I The puzzle on page 39 is one of a series by Mary
Elizabeth Bawden (RN B. Sc. N.) who is
working at the Rheumatic Diseases Unit,
University Hospital, London, Ontario as Team
Leader. This was a welcomed addition to the
Cardiology series... Hope you enjoyed working
out the hidden answer.
The new Posey Products shown
here are but a few of the many
products which compose the com-
plete Posey l.ine. Since the intro-
duction of the original Posey Safety
Belt in 7937, the Posey Company
has specialized in hospital and
nursing products which provide
maximum patient protection and
ease of care. To insure the original
quality product, always specify the
Posey brand name when ordering,
The Posey Safety Bar Kit with soft
padded bar provides a quick, simple,
and effective method of preventing a
patient from "scooting" forward in
any standard wheelchair. 8151,
Clinical Wordsearch
Answers
Puzzle # 2
1 Digoxin
2 Heart
3 Arterial
4 Rapid
5 Venule
6 Blood
7 Capillaries
8 Sinus
9 His Bundle
10 Tricuspid
11 Endocarditis
12 Myocardium
13 Mitral
14 Pulse
15 Telemetry
16 Systole
17 Brachial
18 A.V. node
19 Cardiovascular
20 Sphygmomanometer
21 Arrest
22 Fibrillation
23 Semilunar
24 Clot
25 Imitate
26 L.D.H.
27 E.C.G.
28 S.G.O.T.
29 P.T.T.
30 E.S.R.
31 Slow
32 H.S.
33 P.R.N.
34 N.P.O,
35 Q.I.D.
36 S.O.B.
37 Phono
38 Repair
39 Infarction
40. Adams
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The Posey Foot-Guard witb new
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The Posey Houdini Security Suit,
constructed of cool breezeline ma-
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in the complete Posey line. 3411
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The Posey Body Holder may be
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to secure chest, waist or legs. There
are sixteen other safety belts in the
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ties),
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The Posey Finger Control Mitts
You can see the varied applications
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ete. One size fits all. Washable -
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Send for the free new POSEY catalog - supersedes all previous editions.
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Hidden Answer: Cardiac Nursing
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Send your order today!
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54
The Canadian Nurse September 1976
FUNDAMENTALS
New 2nd Edition! THE COMPOSITION AND FUNCTION OF BODY FLUIDS. By P
Shirley R. Burke, B.S.N., M.S.N.Ed. Provide your students with a basil>
understanding of essential cell function and principles of body fluids in an re p are you r
effective and efficient manner. This text examines the role of body fluids in .. '
maintaining health, and ways in which deviations in their quantity and t d t f
composition can affect the well-being of patients. A new section with pertinent
data on blood clotting adds to the value of this new 2nd edition. Students will 5 U ens 0 r
also find new information on aims and objectives of fluid therapy. February,
1976. 128 pp., 21 iIlus. Price, $5.25.
New 2nd Edition! BODY FLUIDS AND ELECTROLYTES: A Programmed
Presentation. By Norma Jean Weldy, R.N., B.S., M.S. In programmed form, this
useful text presents basic principles of normal body fluid and electrolytes,
common abnormalities, and clinical applications - proceeding from the simple
to the complex. Basic anatomy, physiology. and chemistry are carefully
integrated throughout. The section on electrolyte imbalance has been
considerably revised with new material on potassium imbalance and updated
questions. This 2nd edition also includes an index and updated references.
March, 1976. 130 pp., 24 iIlus. Price, $5.80.
THE NURSING PROCESS: A Scientific Approach to Nursing Care. By Ann
Marriner, R.N., Ph.D. A compilation of various theoretical concepts, this text
explores all four phases of the nursing process and discusses tools used in the
implementation of each phase, Each chapter includes an annotated bibliography
and selected readings. This is the first book to provide such detailed information
on all aspects of problem-solving in nursing. It can help provide your students
with a foundation for effective and efficient nursing intervention. 1975,256 pp.,
illustrated. Price, $7.30.
BASIC SCIENCE
New 7th Edition! AN INTRODUCTION TO PHYSICS IN NURSING. By Hessel
Howard Flitter, R.N., Ed,D.; with 1 contributor. The new 7th edition of this
popular text provides students with a basic knowledge of the principles of
physics as they relate to specific nursing procedures. The fundamentals of
physics are applied to patient care, therapeutic procedures, and currently used
equipment. New discussions examine: metric system; radiation in the
preservation oHood: brain pacemakers; and more. May, 1976. 302 pp., 180 illus.
Price, $9.40.
MEDICAL-SURGICAL
A New Book! NURSING MANAGEMENT OF RENAL PROBLEMS. By Dorothy J.
Brundage, M.N. A clear presentation of the physiologic and psychologic bases
for nursing intervention, this unique text approaches nephrology as a vital
subsystem of the whole body system. It offers in-depth information 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 restoration are carefully detailed, with special attention to
dialysis and transplantation and their psychosocial aspects. January, 1976. 214
pp., 20 iIlus. Price, $7.10.
A New Book! ELEMENTS OF REHABILITATION IN NURSING: An Introduc-
tion. By Rose Marie Boroch, R.N., M.A. This dynamic new book approaches the
theory and practice of rehabilitation from a psychosocial perspective.
Contributions by specialists in community health, orthopaedic rehabilitation,
and sexual function stre!il> ways to meet the physical, emotional and social needs
of the rehabilitating patient. Informative discussions offer new insights on the
health care environment; physical and psychosocial functions in health related
therapies; application of the nursing process; and much more. October, 1976.
Approx. 320 pp., 60 iIlus. About $8.35,
New 3rd Edition! THE PROCESS OF PATIENT TEACHING IN NURSING. By
Barbara Klug Redmon, R.N., B.S.N., M.Ed., Ph.D. Greatly revised and expanded,
this new 3rd edition presents important principles and methods for patient
teaching. Organized around elements of the teaching-learning process, new
discussions explore: the Patient's Bill of Rights; social learning; behavioral
objecti ves as educational tools; proposed taxonomy of perceptual domain; a care
plan using behavioral modification; and more! June, 1976. 282 pp., 14 figs. Price,
$8.15.
New 3rd Edition! NURSING CARE OF THE CANCER PATIENT. By Rosemary
Bouchard, A.B., A.M., Ed.D., R,N. and Norma F. Owens, A.B., A.M., Ed.D., R.N.
This new edition presents up-ta-date discussions on prevention, detection and
diagnosis of cancer, and explains the effects of cancer on all major body systems.
The authors discuss traditional cancer therapy - surgery, radiation, and
chemotherapy - and detail nursing approaches to each one, The rehabilitation
and terminal care of the patient are explained. Special consideration is given to
the psychological aspects of primary and advanced disease along with nursing
methods to help provide emotional support. June, 1976. 325 pp., 189 illus. Price,
$9.40.
New
Mosby texts
supplement
your instruction
on all aspects
of modern
nursing.
MOSBY
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THE c. V. MOSBY COMPANY, L TO.
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Tha CanadIan Nurse September 1976
55
MOSBY
TIMES Mln
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every nursing
situation they might
encounter. . .
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CRITICAL CARE
..
1
New 2nd Edition! IUGH RISK NEWBORN INFANTS: The Basis for Intensive
Nursing Care. By Sheldon B. Korones. M.D.; with the editorial assistance of. and
a chapter by. Jean Lancaster. R.N.. M.N. This important new edition can inform
your students of the most up-to-date advances in perinatal medicine and nursing
care of the high-risk infant. Detailing the why's behind many specific
procedures. Dr. Korones emphasizes perinatal care procedures and understand-
ing of intrauterine antecedents. This revised and expanded edition features: a
new chapter on thermoregulation; recent data on ventilatory and respiratory
support; and more! June. 1976. 280 pp., 113 illus. Price. $11.05.
A New Book! TECHNIQUES IN BEDSIDE HEMODYNAMIC MONITORING. By
John Speer Schroeder. M.D, and Elaine Kiess Daily, R.N.; with 4 contributors.
This new guide is the first comprehensive text on continous bedside
hemodynamic monitoring. It provides current. detailed information for
noninvasive and invasive monitoring of cardiovascular function - with special
emphasis on the clinical critical care setting. Each chapter includes a review of
physiologic principles and problems and solution tables. February, 1976. 224
pp,. 140 illus. Price, $7.85.
"
l
MATERNAL-CHILD HEALTH
,
A New Book! MATERNAL-INFANT BONDING: The Impact of Early Separation
or Loss on Family Development. By Marshall H. Klaus, M.D. and fohn H.
Kennell. M.D. The authors of this new book stress that the time immediately after
birth is critical for both newborn and parents: initial interaction may have a
profound effect on family development. The book examines factors that enhance
or inhibit this earliest relationship and offers new approaches for care of the
newborn and family. Discussions include commentary by psychiatrists and
pediatricians; interviews with parents; statistics; and more. August. 1976,
Approx. 224 pp.. 49 illus. About $9.40 (C); about $7.30 (P).
\
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ISSUES, TRENDS, ADMINISTRATION
"-'
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",
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-
A New Book! CREATIVE HEALTH SERVICES: A Model for Group Nursing
Practice. By Rothlyn Zahourek. RoN.. M.S,; Dolores M. Leone. R.N., M.S.; and
Frank
Lang. R.N.. M.S. This unique new book recounts the successes and
failures of a group of nurses who organized a group practice for primary health
care. It examines goals and guidelines for group practice, and analyzes its
potential in terms of community. financial, human and physical resources.
Operational aspects are thoroughly discussed. May. 1976. 154 pp. Price, $7.30.
A New Book! MANAGEMENT FOR NURSES: A Multidisciplinary Approach.
Edited by Sandra Stone, M.S,; Marie Streng Berger. M.S.; Dorothy Elhart. M.S.;
Sharon Cannell Firsich. M.S.; and Shelley Baney fordan. M.N. Incorporating a
variety of disciplines, this collection of selected readings provides the basic
concepts necessary for students to develop and improve nursing management
skills. Each of the three sections contains material relevant to the organization as
a whole and to the individual in a leadership or management position.
Discussions provide details on organizational structure. personnel, and
economic or extrinsic factors. January. 1976. 292 pp.. 24 illus. Price. $8.95.
NURSING ADMINISTRATION: Theory for Practice with a Systems Approach.
By Clara Arndt. R.N.. M.S, and Loucine M. Daderian Huckabay. R.N.. B.S.. M.S..
Ph.D. This practical book synthesizes theories of business management.
behavioral science. and scientific method into a cohesive conceptual text for
nursing administration. Using a new general systems frame of reference,
discussions demonstrate theory in terms of setting objectives. budgeting,
planning, organizing, directing, and controlling. 1975, 308 pp., illustrated.
Price, $13.15.
f
.
\
..
56
The Canadian Nurse September 1976
II.).)I.
Decision Making in the
Coronary Care Unit, second
edition by William P. Hamilton
and Mary Ann Lavin, St. Louis,
TheC.V. Mosby Company, 1976.
Approximate price $6.B5.
Reviewed by: Mrs. Candace
Paris, Instructor, Niagara
College of Applied Arts and
Technology, SchOol of Health
Sciences, Division of NurSing,
The Mack Centre of Nursing
Education, St Catharines,
Ontario.
This slim, wire-bound, paperback
text is intended as a practical teaching
method for effective utilization of the
"nursing process" in the Coronary
Care Unit.
The book consists of nine
chapters dealing with specific cardiac
problems, and a tenth chapter of
practical exercises. Each chapter has
a similar format. This Includes a bnef
introduction to the problem, ego "Care
of the Patient With Low Blood
Pressure", followed by a series of
three to ten clinical situations. Each
situatlbn IS described through
background information, present
situallon, E.C.G. rhythm strip, goal
and intervention. The reader is
encouraged to formulate his own
approach to the problem before
reading the authors' suggestions. The
authors have explained that although
responses to problems may be varied.
their suggestions should act as a
catalyst for discussion.
The problems discussed in this
book include cardiac pain, irregular
pulse, fast pulse, slow pulse,
transvenous pacemaker. low blood
pressure, shortness of breath, sudden
death and patient education.
The consumer population for this
book is probably limited to
professionals who work with cardiac
monitoring equipment. It is a useful
text not only for new staff orientation
but for in-service education of
experienced staff as well.
I.JI).eil. e !J ['"I)(lilte
The following publications, received
recently by the Canadian Nurses'
Association Library, may be borrowed
from the Library by C.N.A. members,
schools of nursing, and other
institutions. Publications marked R
however, include reference and
archive material and are not available
for loan. Theses, also marked R are on
reserve, and are loaned on an
interlibrary basis only.
Loans from the C.N.A. Library
may be requested by a letter stating
the title of the publication, the author's
name. and the item number specified
in the following list, or by a standard
Interlibrary Loan form. Three
publications may be borrowed at one
time. Borrowers are requested to
cover mailing charges for sending and
receiving loaned publications.
If you wish to purchase a book,
contact your local bookstore or the
publisher.
Books and documents
1. Black, Isabel. Pathways in nursing
In Ontario, by... et al. Toronto, 1971.
1v.
2. Childbearing: a nursing
perspective, by Ann L. Clark and
Dyanne D. Affonso. Philadelphia,
Davis, c1976. 945p.
3. Cognitive theory, vol. 1. Edited by
Frank Restle et al. Hillsdale, N.J"
Lawrence Erlbaum, 1975. 302p.
4. Foster, Sue B. Self-assessment of
current knowledge in
cardiopulmonary nursing; 1,337
multiple choice questions and
referenced answers. Flushing, N.Y.,
Medical Examination Pub., c1975.
243p.
5. Gibson, J. Tyrone, Medication law
and behavior. New York, Wiley,
c1976.407p.
6. Gilbert, Roger. Votre enfant à
/'ecole primaire. Paris, Centurion,
1975. 133p. (Parents et enfants)
This text provides many cardiac
problems and therapies for
discussion, and promotes the
scientific method of problem solving
and evaluation.
Understanding the Heart and
Its Diseases
Understanding the Heart and
Its Diseases by John Ross Jr.
and Robert O'Rourke,
Scarborough, McGraw-HIli
Ryerson LId, .1976.
Approximate Price $4.35.
Reviewed by Heather Chan,
B.Sc.N., Agincourt, Ontario.
This book is easily read and
understood. It explains normal heart
function and the prevention and
treatment of heart diseases including
valvular disorders, arrythmias,
coronary heart disease
7. The green book on drugs for health
professionals, vol. 1 Antibiotics and
anti-infectives. Edmonton, Alta.,
Misericordia Hospital. c1973. 439p.
B. Handbook of learning and
cognitive processes, edited by W.K.
Estes. New York, Wiley, 1975. 303p.
9. Lachaud, Jean-Claude. Le pouvoir
medical source de mala die: essai sur
la iatrogénle. Toulouse. Privat, c1975.
174p.
10. Maistre, Marie de. Les parents et
Ie développement du langage. Pans,
Centurion, c1975. 112p. (Parents et
enfants)
11. Masters, William Howell. The
pleasure bond; a new look at sexuality
and commitment, by... and Virginia E.
Johnston. Toronto, Bantam, 1976.
285p.
12. Mosby's comprehensive review of
cfltical care, edited by Donna A.
Zschoche. St. Louis, Mosby, 1976.
675p. (Mosby's comprehensive
review series)
(arteriosclerosis), hypertension, nean
failure and common congenital
defects. The explanation of common
tests provides useful information
for lay persons. The book concludes
with a look at the history of cardiac
surgery to the present.
The authors' coverage of heart
function meets their goal of providing a
working knowledge at a basic level.
More content on common cardiac
drugs might be included to round out
the text. In general the information
seems current and accurate. Each
chapter lists both general and
scientific references from the 1970's.
Understanding the Heart and Its
Diseases is an invaluable asset to the
health education of the general public
with regard to heart disease. However
it could serve only as a cursory
introduction for the nursing student or
cardiac patient.
13. Oliver. Michael F. Soins intensils
aux coronariens, par... Desmond G.
Julien et Myra G. Brown. Genève,
Organisation mondiale de la Santé,
1975. 85p.
14. Pediatric nurse practitioners: their
practice today. Kansas City, Mo.,
American Nurses' Association, 1975
56p.
15. Ralmbault, G'nette. L 'enfant et ló
mort: des enfants mala des parlent de
la mort: problèmes de la clinique du
deuil. Toulouse, Privat, c1975. 222p
16. Rines, Alice R. Nursing concepts
and nursing care, by... and Mildred L
Montag, New York, Wiley, c1976.
431p.
17. Roberts, Sharon L. Behavioral
concepts and the critically ill patient.
Englewood Cliffs, N.J., Prentice-Hall
c1976. 377p.
lB. Romiszowski, A.J. The selection
and use of instructional media.
London, Kogan Page, c1974. 350p.
TM Canadl.n N&ne Septemllw 1978
57
:19. Roy. Callista, Sister. Introduction
'0 nursing: an adaptation model.
,::nglewood Cliffs, N.J., Prentice-Hall,
:1976. 402p.
20. The Sisters of St. Paul's Hospital.
,::ounting the years unto the year of
ubilee. Vancouver, 1944. 85p. R
21. Smith, Alice Lorraine.
Uicrobiology and pathology. 11 ed.
;t. Louis, Mosby, 1976. 687p.
22. Smith, Manual J. When I say no, I
eel guilty: how to cope - using the
kHls of systematic assertive therapy.
i\lew York, Bantam, c1975. 324p.
23. Symposium on the Preparation of
Health Personnel in Health Education
....ith Special Reference to
!"ostgraduate Education Programs,
\ ::oIOgne, 1974. The preparation of
Jealth personnel in health education.
!lith special reference to
)ostgraduate education
)rogrammes: report on
-ymposiumlconvened by the
egional Office for Europe of the
orld Health Organization, Cologne.
0-14 November 1974. Copenhagen:
)istributed by the Regional Office for
=urope, World Health Organization,
,975. 51p.
'4. World Health Organization.
7troducing WHO. Geneva, 1976.
8p.
'amphlets
5. American Association of Industrial
urses. Standards for evaluating an
ccupatlonal health nursing service.
ev. New York, 1975, c1965. 28p.
1 '6. Barnes, L.W.C.S. The changing
tance of the professional employee.
ingston, Industrial Relations Centre,
)ueen's University, c1975. 24p.
=!esearch series no. 29)
7. Basic Systems, Inc. Anxieté.
'entification et intervention.
raduclion française: Monique
'uture. Québec. (ville) Corporation
es infirmières et infirmiers de la
'gion de Québec, rive-nord, Comité
'éducation, c1973. Amer. J. Nurs.
'. 36p. (C.I.I.A.O. rive-nord.
nseignement programmé)
28. Beard, Richard Olding. The
university education of the nurse.
Baltimore, J.H. Fuerst Co., 1910. p.
111-128. R
29. British Columbia Medical Centre.
Annual report. 1974-. Vancouver,
1975. 19p.
30. Canadian Nurses Association,
Biennial convention. Folio of reports.
Annual Meetmg and Convention.
Halifax, June 20-23, 1976. Ottawa,
1976. 25p. R
31. Caribbean Community
Secretariat. Working party on nursing
education. Report. Bndgetown,
Barbados, 1975. 36p.
32 The first national assembly of
registered nurses of Indian ancestry.
Montreal, Aug. 26, 27. 1975. Ottawa,
1976. 34p. R
33. International Committee of the
Red Cross. Handbook of the Geneva
conventions: Essential rules. Geneva,
1975. 45p.
34. Organization for Economic
Co-operation and Development.
External examiners' report on
educational policy In Canada.
Toronto, Canadian Association for
Adult Education and Students'
Administrative Council, 1976. 20p.
35. Peterson, Margaret H.
Compréhension des mécanismes de
1efenses. Traduction française:
Claire Catellier et al. Ouébec (viii e),
Corporation des infirmières et
infirmiers de la région de Ouébec,
rive-nord. Comité d'éducation, c1973.
Amer. J. Nurs. Co. 1972. 36p.
(C.LI.A.O., rive-nord. Enseignement
programmé)
36. Reunion de liaison avec des
associations d'infirmières et de
sages-femmes pour examiner Ie
programme européen de I'OMS dans
Ie domaine des soins infirmiers et
obstetncaux, Copenhague. Bureau
1974. Rapport. Copenhague, Bureau
régional de I'Europe, Organisation
mondiale de la Santé, 1976. 29p.
37. Walsh, Margaret E. Health issues
of today. perspectives for tomorrow.
New York, National League for
Nursing, c1976. 12p. (NLN Pub. no.
14-1613)
38 Western Interstate Commission
for Higher Education. NurSing
Research Development Project
Instrument index Boulder. Colorado.
1975.
39. Where have all the nurses gone?
London, Nursing Times, 1974. 1v.
Government documents
Alberta
40. The Industrial Health and Safety
Commission Report. Edmonton.
1975. 185p.
Canada
41. Commission de réforme du drOIt.
Droit de la famille: execution des
ordonnances de soutien. Ottawa,
Information Canada, 1976. 53p.
42. Health and Welfare Canada
OccupaVonaJ health In Canada. Part
1: Concepts and magnitude of the
problem by David M. Chisholm.
Ottawa, 1976. 37p.
43.-, Resource guide on smoking
and health for Canadian schools 2ed.
Ottawa, 1976. 43p.
44.-. Health Insurance Directorate.
Health Programs Branch. Emergency
services in Canada. A report prepared
for the working group on special care
units in hospitals, the
federal-provincial sub-committee on
quality of care and research. and the
advisory committee on health
insurance. Ottawa, 1975. 3v.
FURS MUCH BELOW
RETAIL PRICES
NURSES ARE PRIVILEGED TO BUY ALL FUR GARMENTS
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 wisb at no
extra charge,
LEATHER CDAT DEPARTMENT
Famous brand of genuine leather
coats in latest styles æd
colours - plain - fur trtmmed -
';1ãõSI OF"
APPIL
FU R CO. LT}),
Manufacturers of
FINE FURS
119 Spadina Avenue
10th Floor
Toronto, Ont.
M5V 211
Tel.: 363-7209
Show Room Hours:
Daily 8 A.M, to 6 P,M
Sat. 8 A.M. 102 P.M.
.
..
,
.
-
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58
The CanadIan Nurse September 1976
T
I..ilu-u.-!) [".uluh>>
45.-. Research Bureau.
Non-Medical Use of Drugs
Directorate, Health Protection Branch.
Health and Welfare Canada. Smoking
habits of Canadians, 1965-1974.
Ottawa, 1976. 27p. (Its Technical
Report Series No.1)
46. Labour Canada. Annual report
1975 for the fiscal year ended 31
March. Ottawa, Information Canada,
1976.40p.
47. MinIStry of State for Urban Affairs.
Hindsight on the future by John Kettle.
Ottawa, Information Canada, 1976.
61p.
48.-. People do it all the time, by
Rollie Thompson. Ottawa, Information
Canada, 1976. 80p.
49. Santé et Bien-être social Canada.
Direction de la santé communautaire.
Direction générale des programmes
de la santé. Guide descn'ptif des
maladies vénériennes; matériel de
cours disponible au Canada. Ottawa,
1975. 47p.
50. Travail Canada. Rapport annuel
1975 pour/'année tinanciére terminée
Ie 31 mars. Ottawa, Information
Canada, 1976. 51p.
United States
51. Chamber of commerce. Principles
of association management, by... and
American Society of Association
Executives. Washington, 1975. 437p.
52. Division of Nursing. Trends in
registered nurse supply. Bethesda.
Md., 1976. 109p. (U.S. DHEW
Publication no. (HRA) 76-15)
P GIG". ð
tice 1
2477 EST, RUE SHERBROOKE ST. EAST,
MONTRÉAl. QUÉ., H2K 1E8
OFFERS NURSING OPPORTUNITIES IN
VARIOUS TOWNS AND CITIES
THROUGHOUT CANADA.
DO YOU FEEL YOU CAN TAKE ON A NEW
CHALLENGE?
If so, Parabec Ltd offers you this possibility.
Parabec, one of Canada's leading paramedical organizations,
offers you the opportunity of developing a paramedical service
in your area.
Through its team of specialists both in the medical and
marketing fields, Parabec Ltd can bring you the opportunity
you have always looked for, that is combining your nursing
and management experience.
By letting us know your interest we will be happy in discussing
our business opportunity program allowing you to set up a
business in your area and benefiting of our experience.
PARABEC L TO - Marketing Manager
2477 Sherbrooke St. East, Montreal, P.O. H2K 1 E8
53. National Center for Health
Statistics. Current listing and topical
index to the vital and health statistics
series 1962-1974. Rockville, Md.,
Public Health Service, 1975. 21 p.
Studies deposited in CNA
Repository Collection
54. Hebert, Marie Blanche. The family
and society: dating and marriage
patterns in the medical profession
compared, by... and Virginia Carver.
Ottawa, 197? 13p. R
55. Imai, Rose Hisako. Report on
degree nursing programs in British
Columbia. Ottawa, National Health
and Welfare, 1976. 48p. R
56. Manitoba Association of
Registered Nurses. Nursing
education: challenge and change.
Winnipeg, 1976. 213p. R
57. Moore, Doreen M. Stroke:
patterns of inter-institutional uti/izatior
in Edmonton. Edmonton, 1976. 123p
(Thesis (M.H.S.A.) - Alberta) R i
58. National Conference on Nursing
Research, Edmonton, Nov. 3-5,1975
Report submitted by Shirley M.
Stinson to The Research Programs
Directorate, Department of National
Health and Welfare. Ottawa, 1976. 1 v
(various pagings) R
59. Post, Shirley. A Canadtaninstitute
of child health: a feasibility study.
Ottawa, 1976 1v. (various pagings)
Request Form for ., Accession List"
Canadian Nurses' Association Library
Send this coupon or facsimile to:
Librarian, Canadian Nurses' Association
50 The Driveway, Ottawa K2P 1E2, Ontario.
Please lend me the following publications, listed in the .........
. . . . . . . . . . . . . . . . . . . , . . .. ... .issue of The Canadian Nurse,
or add my name to the waiting list to receive them when available.
Item
No.
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\"1.1HHi rie(1
...\(I
el.t iHelllltlltH
'
ritish Columbia
r ad Nurse - Psychiatnc Unit - Position reqUires a R.N. with
hlatnc trainlnc.- and exoenence In Ward Manacement The unit IS
beds with 6 day care units It IS a new unrt opening In January or
uaryol 1977. TheposrtlOnbecomesava"ableNovember 1.1976.
lary according to RNASC contract. Apply In wntln9 to: The D"ecto<
Nursing, Mills Memonal Hospotal, 2711 Telrau" Street, Terrare.
tlsh Columboa. V8G 2W7
..atlng Room Nurse wanted for active modem acute hospital.
ur Certified Surgeons on anendlng stan. Expenence 01 training
.,rable Must be eligible tor B.C. RegistratIOn. Nurses resldenre
"liable. Salary according '0 RNASC Contract Apply 10. O"ector 01
rSlng, Mills Memonal HOSpital, 2711 Tetrau" St.. Terrare. Bnllsh
'.mbla, V8G 2W7
'!Ii.tered and Graduate Nurses requIred 10< new 41-bed acute
:t hOspital. 200 miles norln of Vancouver. 60 miles from Kamloops
nlted fUfntshed accommodation available Apply Director of Nurs-
I. Ashcron & Dlslncl General Hospital Ashcron Bnhsh Columboa
.gisteled Nurses With PSych,alne training Or expenence. for new
chlatnc Unit Opening January or February 1977 Salary according
RNABCconlract. Please apply In writing '0. The Director of NurSing,
Is Memonal Hospital. 2711 Tetrau" Street. Terrace. Bntlsh CoIum-
I. vaG 2W7.
neral Duty Nurses lor modem 41-bed hospllal localed On the
aSKa Highway Salary and personnel pohoes in accordance with
ABC. Accommodation available In residence. Apply Director Of
.slng, Fort Nelson General Hospllal. Fort Nelson, Bntlsh CoIumboa
neral Duty Nurses lor modern 35-bed hospllallocaled In south.
1 B.C. s Boundary Area with excellent recreation faclltles SalarY
j persomel poliCIes In accordance with RNASC Com'ortable
rse 5 home. Apply Director of Nursing, Boundary Hospital. Grand
,BritISh Columbia, VOH IHO
ented: General Duty Nurses for modern 7o-bed hospotal. (48 acute
dS- 22 Extended Care) located on the Sunshine Coasl, 2 hrs. !rom
ncouver Salanes and Personnel Polloes In accordance Wl1h
ABC Agreement. Accommoda11On available (Iemale nurses) In
nce. Apply: The Director 01 NurSing. St. Mary 5 Hospllal PO
7777, Sechelt. Bntlsh Columbia
'.......al Duty Nurses reqUired lor an 87-bed acute care hospllalln
"hem B.C. Resldenre accommodahons available. RNABC poli-
S In enect. Apply to: Directo< 01 NurSing. Mills Memonal Hospital,
11 Tetrau" St.. Terrare, Bntlsh CoIumt>ia. VaG 2W7
)ntario
or RNA, 5' 7"' 0< over and strong, without dependents. to care lor
pound hancllcapped executive With stroke Uve-In. "2 yr. in To
'!o and , 2 yr. in Miami. Prelerablya non-smol<er. Wage: 5190.00 to
1000 weekly net. depending On expenence plus Miami bonus.
resume to. M D.C., 3532 Egllnton Avenue West, To<onto. On.
0, M6M IV6.
;askatchewan
tt. 01 Northern Saskatchewan Health ServiCes requires PubliC
lalth N....... and Nu..... to prOVIde pnmaJy diagnosIS and treat-
nt and emergency care In lSofated communities. QualifIcations:
laureate degree, or nurse pråctltioner COurse and/or two years
nence preferabty In a S1mlar setting. Locaton. Vanous com-
Illes In Northern Saskatchewan. Beg,nnlng salanes 511,664 to
.100 based on qualrtlcabons. and expenence Plus Northern AI-
anre $47.50 to 5145 00 per month depending on the communrty.
tact. Alce Mills, Nursing Supervisor. D.N.S. Health Services. Box
. LaRonge, Saskatchewan, SOJ 1 LO. Phone: 306-425-2033. Ap.
ons and resumes should be lorwarded to: Pubic Service Com.
SlOn, 1820 Albert Street, Regina. Saskatchewan, S4P 2S8
The Canadian Nurse
September 1976
United States
R.N.s' - Immedtate need eXists for your services Excellent salary.
full paid benefits We will assist you with your H-1 Visa lor Immigration
Van,Jus locations available Immedtate lIcensure available rt needed.
Wnte lor an apP"ca'lOn.o Medocal Staffing Servlres. SUite 2122 333
North MChl!jan Avenue, Chicago. IIi no,s. 60601
Texas wants you
If you are an RN. expenenced or a recent
graduate come to Corpus Chnstl Sparkling Ctly by the Sea . . . a cly
bulidlOg lor a better luture. where your opportunities for recreation and
studies are Ilmilless Memonal Medical Center. 500-bed general.
teaching hospital encourages career advancement and provides
Inservlre onentatlon. Salary 'rom 5802 53 to 51.06946 per month.
commensurate with education and expenence Dlflerenhal for
evemng shifts available Benefits Include holidays sick leave.
vacations, paid hospitalization, health. life Insurance. penSion
program. Become a vital Part 01 a modem. up-to-dale hospotal, wnle or
call. John W GOller, Jr., Director of Personnel. Memonal Medical
Center, PO. Box 5280, Corpus Chnstl. Texas, 78405
Registered Nurses - Change and ChaUange?? - Sunny Texas
beckons the expenenced or graduate RN. We oller challenging oppor.
tunltles In small or large corrvnunltles In ChoICe surroundings With
beautiful weather 10 months out of the year. Included are great
benefits. career adYancement evening Shift differentials Fare and
accommoda
ons assumed by Our clients Salanes I",,,. 59600 to
$12.000 per year 12 month Mntracts mlr}.mum With ophons Send
resumes Immediately to: Uedi-Search, 909 Burner W,chila Falls,
Texas 76301.
59
>o."
. Al Alfred
G:t,T
c" n I fI Pr 181
Wanting a refreshing
change of scene?
AUSTRALIA
STATE OF VICTORIA
MELBOURNE
"""
Hospital
. "
opD It 1"1
prl nr A
willi
VVd.d
be
expaos.
Tn
1 R n 'C e
2 Cardlt.... thoracIc c e
3 Acu 1e resp,' "y carP
AI ed Hospl II IS a scho I nu ..1"9 admlnor I
240 studl 11 annud It
1he Monash UnnterSlty
be 1119 respons.t- e f
'" "".
SALARIES 1 r Q
SA 7987 20 dn d S6684 """h,
annually SA938080 Canada S78...G
Penal1y ra re palr1 Unll rms e pi
and laundered At Immocla n IS éI\
close to the HosPlta. which IS WI1hln 15 mlnu1e
01 rhe C.rv centre For prospectrve nllgranrs
the Hospl1al IS v 109 t act as sponsor
apphcant IS appOln1ed
Apphcatlons rogether with d recent photo raph
and the names and addresses o' ,"...,) referees
and/or requests 101 IUI her Int Irma 111 be
directed to MIss I\: Sewe 01
ALFRED HOSPITAL Comrnercld'Rd
"- VICro..-.
, 3181 Austr<> 20
../
THE REGISTERED NURSES r ASSOCIATION OF ONTARIO
invites applications and nominations for the position of
EXECUTIVE DIRECTOR
RNAO enters its second fifty years of service with a new focus geared to
optimizing the effectiveness of the nurse In contributing to the quality of life.
The position of Executive Director of the Association has tremendous scope for
challenge, creativity and innovation and affords opportunity for an exciting and
enriching experience.
The Executive Director, as the executive officer of the Association, has overall
responsibility for carrying out poliCIes, established by the Board of Directors,
pertaining to the management and administration of the affairs of the Association
The applicant should have university preparation at the Master s level, a broad
nursing background and administrative experience
Written applications or nominations, accompanied by a resumé of qualificaltons
and names of referees, will be received in confidence by.
The Chairman
Search Committee
Box 31, Islington, Station B
Etobicoke, Ontario M9C 4X9
60
Dr. Everett Chalmers Hospital
Hôpital Dr, Everett Chalmers
Rue Pnestman St
POBox. C.P 9000
Fredencton, N.B. E3B 5N5
Tel. 506-454-0710
Patient Care Co-Ordinator - Psychiatry
C, Ordinator required to direct the Nursing programme for a
Psychiatric Unit of a modern 485 bed hospital. opening in
September 1976.
The Psychiatric programme will service an In-patient Unit of
33 beds, as well as an Out-patient-Day Care facility
This offers a unique opportunity for a self directed individual to
assist in the organization of a new clinical service.
Jualification
Graduate Nurse, eligible for New Brunswick Registration.
Broad clinical background in Psychiatric nursing, some
experience at the senior level.
Baccalaureate degree in nursing desirable.
Salary
Commensurate with experience and qualifications.
Send resume to:
Director of Staff Relations
Dr. Everett Chalmers Hospital
P.O. Box 9000
Fredericton, New Brunswick
E3B 5N5
The CanadIan Nurse September 1976
Director of Nursing Opportunity
at
The Clarke Institute of Psychiatry, Toronto
The Institute IS internationally known and highly regarded for
research. education and service in mental health. Its 153
in-patient beds tell only part of the treatment story which
includes investigation into causes of mental illness while
integrating research into in-patient and out-patient clinical
programs.
The Director of Nursing should be an administrator, teacher,
researcher, consultant, coordinator who enjoys influencing
and shaping care in a multi-disciplinary environment.
Requirements include a Masters level from recognized course
instruction or above and registration in Ontario. Salary and
fringe benefits are In line with the key nature of the
responsibilities.
The Institute is university affiliated and cross-appointments
may be arranged.
Applications will be received by the Executive Director
until October 15, 1976.
Clarke Institute of Psychiatry
250 College Street
Toronto, Ontario
M5T 1 RS
The Montreal
Children's Hospital
The Nursing Department of
the Rehabilitation Institute
of Montreal will present a
four week intensive course
on rehabilitation care, from
October 18th to November
12th 1976.
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
This course is opened to experienced
registered English speaking nurses who
are specially interested in education and
in the care of convalescent, handicapped
and long term patients.
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.
For further information and details of
the course, apply immediately to:
The Director of Nursing
Rehabilitation Institute of Montreal
6300 Darlington Avenue
Montreal, .:Iuebec
H3S 2J4
Tel.: (514) 735-3741, ext. 262
Interested qualified applicants should
apply to the:
Director of Nursing
Montreal Children's Hospital
2300 Tupper Street
Montreal, Quebec, H3H 1P3.
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 1E2
.
\ -1
#
( Occupational
Health Nurse
Consultant
The Nova Scotia Department of Public Health, Occupational
Health Division, Health Englneenng Services invites
applications for the above position for Nurses registered or
eligible for registration with the Registered Nurses Association
of Nova Scotia.
.Jualifications:
The successful candidate will have an Occupational Health
Nursing Certificate or its equivalent by examination and not
less than ten years vaned experience in occupational health
nursing In Industry of which five years should be at the
supervisory level. Travel throughout all areas of the Province.
Training in audiometry, advanced preparation in Occupational
Health Nursing, and some knowledge of basic industnal
hygiene would be an advantage
Duties:
A comprehensive occupational health program is now being
developed and a O.H. Nurse Consultant will be a key member
of the consultant team, responsible to the Director of the
Occupational Health Division for a major segment of the total
program.
Salary:
Commensurate with qualifications and experience
Full Nova Scotia Civil Service Benefits.
Competition IS open to both men and women.
Please quote competition number 76-525.
Application forms may be obtained from the Civil Service
Commission, J.W. Johnston Building, P.O. Box 943, Halifax,
Nova Scotia, B3J 2V9, and from the Provincial Building,
Sydney, Nova Scotia, B1P 5L1.
Rehabilitation for the Ostomy Patient
The Continuing Education Programme of the Faculty of Nursing,
University of Toronto in co-<>peration with the Canadian Cancer
Society will offer a two day seminar on the Rehabilitation of the
Ostomy Patient.
Purpose of the Programme
1. To assISt nurses to develop a practical philosophy concerning the
rehabilitation of the ostomy patient
2. To assist nurses to update their basIc knowledge concerning the
physiological and the psychological components of the care of the
ostomy patient
3. To make available, to nurses current literature and current
resource personnel.
Course Co-<>rdinators
Mrs. M. Barter, R.N.
Research Associate
Continuing Education Programme
Faculty of Nursing
University of Toronto
Miss Enid Wilson, R.N., E.T.
Clinical Coordinator
Sunnybrook Medical Centre
Toronto, Ontario
Student Population
Registered nurses and allied health professionals.
Registration will be limited to 100. Early registration is suggested.
December 9 and 10, 1976
$30.00 for two days. Lunch and coffee will be provided
The Debates Room
Hart House, University of Toronto.
For further information please contact:
Mrs. Dorothy Brooks, Chairman
Continuing Education Programme
Faculty of Nursing
University of Toronto
50 St. George Street
Toronto, Ontario M5S 1A1
Telephone: 978-8559
Date:
Fee:
Place:
The CanadIan Nurse Seplember 1976
61
SENECA
Bursary for Post Basic Education
Registered nurses who are graduates of the Yor1\ Regional School of
Nursing or the Nursing Programme of Seneca College are reminded
of the bursary available to assist with the expenses of post diploma
nursing education
Applicants must have two years of graduate nursing expenence and a
final acceptance from the Institution offering the post basic
programme.
Direct enquiries to:
Seneca College, Leslie Campus
1255 Sheppard Ave. East
Willowdale, Ont. M2K 1 E2
Student Services
York Regional Scholarship
&
Assistant Director of
Nursing
With preparation and/or experience in
Rehabilitation Nursing and activity programming
for Chronic patients.
Will be required to work closely with Rehabilitation
Staff of adjacent Centre in assessing and
determining patient programmes.
Qualifications
B.Sc, in Nursing or equivalent preferred plus 2 - 5
years experience in Rehabilitation Nursing.
Salary
Salary commensurate with qualifications and
experience
Apply to:
Administrator
The Shaver Hospital for Chest Diseases
541 Glenridge Avenue
P.O. Box 158
St. Catha rines, Ontario
L2R 6S5
62
I j
......
"\
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 adjoins.
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
experience.
Post-Graduate Education: RP A 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 RP A 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
Hospital
Camperdown, NSW 2050
Tel: Sydney 51-0444.
Australia.
'- -*--:- \.
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The Cenadlan Nurse
""
Two Head Nurses
Two Head Nurses with preparation
and lor demonstrated competence in
Psychiatric Nursing and
Management functions.
One to be responsible for
participation in the organization,
initiation, and the management of a
New Psychiatric In-Patient Unit.
The other to be responsible for
participation, organization and
management of an existing
Psychiatric Day Care Unit.
Forward complete resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
City of Winnipeg
Health Department
requires
Director of Nursing
The successful applicant will be responsible for
the integration ot the Nursing Division program
within the Civic Service and other community4
agencies. Will exercise considerable
judgement and carry out programs of
evaluation, planning, research, education, and
counselling with respect to Public Health
Nursing.
Applicants must possess a Bachelor'sdegree in
nursing. At least five years' experience in the
public health nursing field, some 01 which must
have been at a supervisory, administrative or
teaching level.
Salary: $19,916.00 to $24,063.00 per annum-
1975 Rates.
<
,.ìt4 .
.cl
. ,
Apply In writing to:
Mr. J.W. Woodward
Maneger of Employment
Personnel Department
Main Floor - 510 Main St.,
Winnipeg, Manitoba
R3B 1B9
Nursing Education
& Research
Position: Coordinator
Department: Nursing Education &
Research
Responsible to: Director
Quellflcatlons: graduate from a
recognized School 01 Nursing, Operating
Room experience, bilingual (French &
English) teaching experience, degree in
Nursing Science or equivalent.
Apply to:
J.F. Roger Brunet
Recruiting Officer
Ottawa General Hospital
58 Bruyere St. Ottawa, Onto
K1 N 5C8
September 1976
l
MANIT
BA
CIVil SERVICE COMMISStQN
This position Is open to both
men and women
Public Health Nurses
Department of Health
& SocIal Development
Various Locations in Manitoba
Opportunity awaits you in Sunny
Manitoba where the people are friendly
and our innovative health care program is
second to none.
Positions at the field and senior level in
both rural and northern areas are
available for B.N. 's with three or more
years related experience. Salary
commensurate with qualifications,
experience and location,
For further Informetlon write enclosing
complete resume to:
Civil Service Commission
904 . 155 Cerlton Street
WINNIPEG, Manltobe R3C 3H8
Director of Nursing
Director of Nursing required for a
32-bed active treatment hospital
situated in Southern Alberta,
Experience and post graduate
training helpful but not required.
Apply, forwarding complete
resume, to:
Administrator
Macleod Municipal Hospital
Fort Macleod, Alberta
TOL OZO
Footnills 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)
Beqinning: March, September
Limited to 8 participants
Applications now being accepted
For further Information, please write
to:
Co-ordinator of In-service Education
Foothills Hospital
14032951. N.W. Calgary, Alberta
T2N 2T9
e"ìpecially\dlen your job is litè.
You already knO\\' that. .-\nd that's probably one
of the reasons you chose to be a nurse.
:'\ow, wc'd like to oiler you another choice, The
opportunity to come to the {'nited States, To lhoe
and work in Little Rock. .-\rkansas at the Baptist
Iedkal Center.
Life is what Buptist
Icdical Center System is
all about. Our three hospitals offer you an ... : 1'. -
,- -' '
:....:: .- ":--
opportunity tu choose both a hospital size and r
nursing style suitable to you. Central Baptist . ,/ ...J
Hospital, 150 beds,
Iemorial IIospital, 18ï .'
beds. and Baptist
Iedical Center, 58ï beds i
....
offer starting salaries beginning at S9,880 1
day shift,
10,ïïO e\'ening and night shift}}
for new graduates, with additional .::3i
salary paid for experience. ,
31: t
.-\ir fare tu Little Rock \\-ith a one ,/' jþ}
yet
r.c
)nll11itm
nt, temporary housing lr:
faCllItIes. all nsa anangements. and 1
liberal benefits are all a I mrt of our offer to -;'"à
,(
nm. The .\rkansas State Board of ]
Xursing will recognize your Canadian ,.-,:,Jt1
education and license without an\' 'k ',.-
.. 0".
..
eXaIl1inations here. ....:,:
_.-.-.
Life in Little Rock is great. The city
is modenl, progressive. \\'ith a wide
\"ariety of entertainment, cultural,
recreationaL religious oppurtunities.
You \\'ill be a welcomed member of the
conul1unitv.
\re hope you will find out why this
opportunity means more than ajob and
\\'ill choose Baptist
Iedical Center
System. .-\fter all, your life should be more
than ajob
Especiall1T"TIen
}üUr job is Life.
Life s110tùd be
tnore than a job
Write or call:
Linda Barnes
Baptist Medical Center System
9600 West 12th, Little Rock, Arkansas 72201
Phone (collect) 501-227-2260.
Equal Opportunity Employer
The Canadian Nur.. September 1976
63
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...to the Canadian North in fact!
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Canada's Indian and Eskimo peoples in the North
need your help. Particularly if you are a Corrrnunity
Health Nurse (with public health preparation) who
can carry more than the usual burden of responsi-
bility, Hospital Nurses are needed too... there are
never enough to go around.
And challenge isn't all you'll get either- because
there are educational opportunities such as in-
service training and some financial support for
educational studies.
For further information on Nursing opportunities in
Canada's Northern Health Service, please write to:
........,
Medical Services Branch I
Department of National Health and Welfare
Ottawa, Ontario K1A OL3
I
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I . .. Health and Welfi!! e Santé et Biell-être social
Canada Canada
,........
P'OV.
The Canadian Nurse September 1976
Index to
Advertisers
September 1976
Abbott Laboratories Cover 4
The Canada Starch Company Limited 52
Canadian Pharmaceutical Association Centre Insert
The Clinic Shoemakers
Designer's Choice
EqUity Medical Supp ly Company
Hollister Limited
House of Appel Fur Com pany Limited
Kendall Company
L'eggs Products International Limited
The C.V. Mosby Company limited
Nordic Pharmaceuticals Limited
Parabec Lim ited
Posey Company
Reeves Company
w.s. Saunders Company Canada Limited
Uniform Specialty
Uniform World
2
5
43
47
57
13
7
54, 55
16
58
53
9
1
Cover 3
15
White Sister Uniform Inc.
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.
BE:]
o 76
I
/
The Canadian Nurse
E
7502868935
1217
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FASHIONS
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CAREFREE
J
B Style No. 7538
Sizes 12 -20
Pristine Royale
White only
. . . . . . about $24.00
,
Style No. 7839
Sizes 12-20
Royale Seersucker
10CJ>1o Woven Polyester
White. Yellow
. . .. about $29.00
\
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-
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'.Ð SISTER
CAREER APPAREL
\
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---.
-
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,1
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.
-
The Canadian Nurse October 1976
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:
o The 'Littmann' stethoscope line
o The Group Purchase Package
o The 'Littmann' Series portfolio
o A list of selected 'Littmann'
dealers
MEDICAL PRODUCTS
m
3m r:ANADA LImITED
.I.I.
2
The Canadian Nurse October 1976
KeelJS
him drier
Instead of holding
moisture, Pampers
hydrophobic top sheet
allows it to pass
through and get
<<trapped" in the
absorbent wadding
underneath. The inner
sheet stays drier, and
baby's bottom stays
drier than it would in
cloth diapers.
,
Saves
,'ou till1e
....
Pampers construction
helps prevent moisture
from soaking through
and soiling linens. As a
result of this superior
containment, shirts,
sheets, blankets and
bed pads don't have to
be changed as often
as thev would with
conve
tional cloth
diapers. And when less
time is spent changing
linens, those who take
care of babies have
more time to spend on
other tasks.
..k
-
..
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P&
eJ:'s
"
"\
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----
'ROCTER . CAMBLE CA"-3U
10 76
Input
News
Names and Faces
Books
What's New
Library Update
Calendar
The Canadian Nurse
The official Journal of the Canadian
Nurses Association published
monthly in French and English
editions.
Volume 72, Number 10
15
18
20
J. Goerzen, S.D. Abbott
22
6
10
13
48
50 Reader Survey:
How Do You Feel About Working Nights?
54 Changes - Part II
54 Over and Over P. Jessop
Blood Pressure:
Physiologic Controls
Blood Pressure Measurement:
Guidelines to Accuracy
Seven Steps to a Successful
Hypertensive Screening Program
What Patients Want to Know
About Their Pacemaker
Waiting for Cardiac Surgery
An Affair of the Heart
Self-concept of the
Myocardial Infarction Patient
The Transfer Process
Plan of Care:
The Young Child on Dialysis
Through the Looking Glass
J. Goerzen, S.D Abbott
24
D.S. Silverberg, M.D.
25
R. Gorrie
M. Rakoczy
J. Duffle
27
30
36
C.I. Cook
B. Lethbridge, 0 Somboon,
H.L. Shea
M.A. Irwin, J. Young,
D. Matthews, L. Christensen
G. Gitterman, P. Goering
37
39
41
44
-
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This month's cover photo, highlighting
the theme of the second in the
three-part series on the
cardiovascular system in t>ealth and
disease, was obtained "om
Sunnybrook Medical Centre,
Coronary Care Unit which also
supplied the photo on page 38. Photos
by Pearce Audio Visual Presentation.
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,
1:'1 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 I
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.
eCanadian Nurses Association
1976
4
The Canadian Nurse October 1976
I......HI)(.(.. iy...
Will the real nurse please stand up?
It is just a year now since I directed a
special appeal to all of the nurses who
care about what's happening to their
profession to share their experiences
with their fellow nurses. The fact that
you do care became evident almost
immediately as the number of really
good submissions rose by leaps and
bounds.
As editors, we complain loudly
because the pile of unpublished
manuscripts grows higher each day.
At heart though, we cannot help but be
pleased,
Our problem is more fundamental
than an embarrassment of riches.
What we have to ask ourselves
now is: "Is this really what nursing is all
about?" Sure, we betieve in continuing
education and better teaching
programs and more research and
psychological support and
understanding for patients but what's
happened to good "old-fashioned"
nursing care based on sound
knowledge of things like the etiology,
incidence, signs and symptoms of a
disease? What's wrong with talking
about the diagnosIs and treatment of
these diseases - the drugs,
equipment, and lab tests involved?
What's wrong with a straightforward
description of necessary nursing care,
including the teaching program that is
needed?
That's not to say that Canadian
nurses never write this kind of clinical
article. In the past few months, we've
received several - many of them
excellent. What worries us is the fact
that articles of this type make up only
the tiniest fraction of all those that
cross the editor's desk.
This week we carried out a hasty
and unofficial inventory of "clinical
articles" carried by the journal in the
past five years. We were, to put it
mildly, distressed. Would you believe
that we found only one clinical article
on cancer? only one on
gastro-intestinal disorders? only four
on drugs? Where are the nurses who
care for patients suffering from
arthritis and rheumatism, burns,
allergies and anaphylactic shock?
Where are the nurses who know the
signs, symptoms, diagnostic tests,
treatment and nursing management
involved in caring for the kidney
transplant patient? the patient with
hemolytic disorders? the dermatolog'
patient?
The Canadian Nurse is
a "professional journal. . As such, I
believe it reflects the tendency of the
profession, in the past, to direct its
major efforts towards improving
methods of preparation for nursing
practice, attracting enough workers
into the profession and encouraging
administrators and teachers to studll
administrative and educational
problems etc.
In doing so, I believe that
members of the profession have
shortchanged themselves. They
have forgotten or overlooked the facll
that, at Ihe root of
therr "professionalism" is the speda
body of knowledge and skills that onl\
the members of their occupational
group possess. It is this knowledge
that determines the quality of their
performance. And it must be
developed and shared by all nurses if
the profession is to advance and gl0Y
in wisdom and public stature.
-MAH
Ile..ei'l
We have many authors to thank for
their contributions to our three month
series on the cardiovascular system.
Among them is Penny Jessop, who
---
\-
)
not only helped in the planning stages
and theme development of the series,
but also contribuled one article to each
of the three 'cardiovascular' issues of
The Canadian Nurse.
Since 1974, Jessop has been
Director of Public Education of the
Ontario Heart Foundation, a position
involving responsibility for the
Foundation's education program
directed toward the general public, the
school population, industry and
paramedical personnel in the
province. She also acts as liaison
through the Canadian Council of
Cardiovascular Nurses, Ontario
Interagency Council on Smoking and
Health, and Canadian Health
Educators' Society. Jessop, a
graduate of St. Mary's School of
Nursing, Kitchener, Ontario, and the
University of Ottawa, has had a wide
range of experience in a number of
teaching settings. This September
she participated in the IXth
International Conference on Health
Education held in Ottawa.
Editor
M. Anne Hanna
Assistant Editors
Lynd a Ford
Sandra LeFo rt
Product ion Assist ant
Mary Lou Downes
---
Circulatio n Manag er
B eryl Darling
A dvertising Manager
Georgina Clarke
CNA Executive Director
Helen K Mussallem
GENEROUS NEW GROUP DISCOUNTS on .11
items shown. for IP"OUP Durchases. graduation giftS, favors. etc
6-11 Same Items, Deduct 10%; 12-24 Same Items, Deduct 15%
25 or More Same Items, Deduct 20% K
MØ
7Z,v...p...em
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IT'S EASY TO ORDER REEVES NAME PINS FOR YOURSELF OR FRIENDS! I
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6
The C..n..di..n Nurse October 1976
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.
111))tlt
Quality of life in the North
The nurse in the North can and
does playa vital role in helping people
help themselves towards
independence by preventing disease,
prolonging life and learning healthful
living.
We all know that involvement is a
powerful motivation. Our community
health representative program in
which a native person receives
training to work on his/her reserve,
with the nurse, has been successful.
The community health representative
as well as interpreting programs
offered by Medical Services, acts as
liaison and is a key person on the
health team. The community health
representative also serves as an
example to the people.
On some reserves the commun ity
health representative has been
successful in forming a health
committee at which meetings the
nurse and the community health
representative take an active part,
giving information and guidance and
encouraging the people to examine
their health picture to realize their
needs and to help find solutions.
We do not overlook the
importance of education in helping to
change attitudes and actions. The
nurse and the community health
representative work together as
teachers, advisors and, most
important, as good listeners.
meet the people in many different
settings and situations. On home
visits, we see each member of the
family on a "one to one" basis, from
the infant to the elderly.
. We work closely with the teachers
in the schools, not forgetting that these
children will be the future parents and
leaders.
. We have well baby clinics every
month and periodically plan others i.e.
diabetic etc. Whenever possible we
hold workshops where we make use
of various consultants from both
Medical Services and other outside
agencies.
. When invited, we attend band
council meetings where we discuss
health matters and encourage
feedback from the chief and council.
. We work closely with Indian
Affairs who are responsible for the
education, housing, roads, water,
garbage disposal and social welfare
on the reserve.
. We maintain contact with the
Native Alcohol Council and the
Provincial Alcohol Commission.
. In our work we also meet with the
school committee, with native
women's groups, with native leaders
(including the subtle), with people
outside the reserve such as doctors,
R.C.M.P., Provincial Public Health
and Welfare and the clergy.
In spite of disappointments and
drawbacks, there are many
compensations and and many
successes involved in working in the
North. Some of these are: more
people taking advantage of early
prenatal care, earlier seeking of
medical help and hospital care,
improved attendance at child health
clinics, regular checkups for the
chronically ill, more responsibility
towards taking prescription
medications at home including long
term anti-tuberculosis chemotherapy,
more seeking and using family
planning, more taking advantage of
gOOd dental and eye care.
In most instances it is
encouraging that the nurse and the
community health representative
have been well accepted by the
people. Better still, the people are
becoming more interested in their own
health picture and are demanding
better standards.
We can learn much and denve
satisfaction and pride from our native
history and culture which is most
essential in our pursuit of self esteem
and self actualization but there is no
going back to "the good old days," we
must look ahead! Basically, Indian
people are a happy people and the
fortunate nurse, no matter her color or
creed, who has a sense of humor and
who strives to attain the qualities of
empathy, compassion, patience and
perseverance, can go a long way
towards helping the native people take
the initiative in finding a better quality
of life.
- Irene Desjarlais, PHN, Nurse in
Charge, Medical Services
Health Centre, Fort Qu'Appelle, Sask.
The above is excerpted from a report
prepared by the author for delivery at
the last CNA annual meeting. Due to
the air strike, she was unable to
address the delegates in person and
has asked the Journal to share her
thoughts with readers.
A safety lesson
Statistics show that many
children under the age of four are
killed or injured annually in automobile
accidents. This number could be
reduced if proper restraints were used
while traveling. Children riding in the
cargo area of trucks or station
wagons, sitting on mother's knee or
unrestrained in a vehicle are common
practices that endanger a child's life
on the highway.
Why, with all the evidence
supporting the benefits of child
restraints, do we ßtill see young
children jumping about in cars as they
travel down the highways? Who is
responsible for their safety? Most
people would agree that parents are
responsible for their children's safety
and the majority of parents take this
responsibility seriously. Why then are
so many children traveling unsafely?
Perhaps it is because parents do not
realize the dangers of a child playing in
the rear of their station wagon. It may
be that in our fast-paced society
parents haven't the time to secure
their child before taking off.
Safety restraints should be
regarded as "preventive medicine" in
the same context as immunization and
to a child no doubt less painful.
Children should be taught by their
parents that safety belts are a part of
traveling as blankets are a part of
sleeping. Teachers, beginning in
nursery school, should reinforce what
a child already knows about auto
safety and fill in the gaps left by
parents.
Since motor vehicle accidents
pose the greatest single threat to a
child's life following the neonatal
period, this is surely one area of health
prevention that needs to be stressed.
It has too long been neglected in our
child care books and by government
agencies, safety organizations, health
workers, schools and parents.
- Geraldine Brooks Walsh,
Framingham Umon Hospital Nursing
School, Framingham, Mass.
A change for the better
Recently, I received the August
and September editions. I see that
your format is changing. Good! I, for
one, like it. I found several articles
interesting, well worth reading '"
- Gerardina van Baal Philp,
Senneville, P.Q.
A stand against cutbacks
I have never felt any need to
write "The Canadian Nurse" for I fel
that the people that edited the
magazine were very competent, but
since reading the June and July issue
I thought I would like to write my !wI
bits worth.
The magazine is improving all thE
time. The varied updated nursing
topics are certainly worth sharing witt
all nurses.
I agree with Maxine Enderton
(Input, July 1976) that it is about timE
we lethargic, apathetic nurses took,
stand. But if we do. what then? Man)
of us would have our front teeth I
knocked in for speaking up against
the "cutbacks in budget." I
I feel that anti-inflation measure
like these are only hitting at the
defenceless sick and handicapped
public. Shutting down wards, cutting
down staff, replacing competent staf
with lay help is certainly not the
answer. All it does is make for a
disgruntled staff and patients. Yes, let
us take a stand and protest but
remember we are only a small group
compared to the millions in Canada.
Have we got enough of the renegade
in us to stand up to this tyrannical
government? You know what usually
happens to renegades; they are shot
down.
-Hope Nowlin, R.N., Calgary Nurses
Private Duty Registry, Calgary, Alta.
The universal language
Like so many other nurses'
husbands I read The Canadian Nurse
and find it a rather good publication.
like your new layout.
..For the last few months there
has been labor unrest in the nursing
field here in Quebec.
It has been stated by doctors thai
some young children have died due to
this labor trouble. ... Now we read that
there is a pool of nurses that could
help out and save lives but since they
do not speak French they cannot
work. I ask - does a three-year-old
child care what language a nurse
speaks? For that matter do you think
parents care if the nurse speaks
French?
- Lome Ulley, Verdun, Quebec.
The Canadian Nurse
October 1976
7
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B
The Canadian Nurse October 1976
A SPECIAL OFFER OF INTEREST TO
CANADIAN NURSES
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The Can..dlan Nurse October 1976
9
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If what you have.
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Its rust away and
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Tlaturity, it is a
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used pre-surgically to reduce the bulk
f tumor and make surgical removal
feasible. In cases of inoperable breast
::ancer, it can be the treatment of
:hoice and in this instance has a cure
ate of some 30 percent. Palliative
adiotherapy is used to control spread
nd particularly to treat metastatic
ony deposits for assoCIated pain.
The basic premise for many years
as been that most breast cancers
: rise in a single focus. spread at an
ndeterminate time to the regional
- tation of lymph nodes and then later
. nter the blood strea m. Logically then,
he pnmary therapeutic attack has
onsisted of mastectomy with surgical
emoval and/or irradiation of the
orimary lymphatic drainage.
This basic premise is now being
-hallenged on two points
1) Pnmary cancer of the breast may
.xist in multiple foci In almost half of
he patients
') Lymphatic and lymph n3de
oermeatlon does not necessarily
o recede blood-borne dissemination of
oreastcancer.
For these reasons, the patient
ith breast cancer and nurses must
ot feel that because the patient is
eceivlng radiotherapy, she has a
opeless future or that radiotherapy
only has a palliative role. Indeed, in
o st cancer centers the treatment of
breast cancer IS a multidisciplinary
-pproach in which surgical removal.
adiotherapy, chemotherapy and
-- - - -- ,...-
--- - - - -----
of youth but you have gained
perspective. Maturity is a stage of life
with special significance. It is a time for
you to put into effect the wisdom that is
unattainable at any preceding age.
Some doors are closed by illness and
the loss of friends, but new doors have
been opened by your maturity.
Not everyone will turn in
retirement to the same source for
satisfaction.
Having something to do, not
necessarily as a means to supplement
your livelihood, will add purpose to
your life but you show poor Judgement
if you seize upon the first
post-retirement position that offers
Itself.
Retirement is not meant to be a
dead stop, but a change of direction.
You will be happy to get up every
morning if you will have something to
do. Much of the unhappiness of
retirement is caused by people who
really want to be up and doing, but
have no idea what they ought to be
doing.
All dUring your working years you
followed a narrow path. You will find
that what you get out of retirement
depends on the investment you make
in it ahead of the deadline - friends,
hobbies, and so on. One precept will
apply to whatever you choose, keep it
simple, have fun and don't make it a
burden that is pointless or irksome.
While you were working you were
doing something everybody else
around you had an interest in. Now is
your chance to develop different
Ottawa, Ontario
ve nursing
The nursing profession must
relentlessly search for new avenues
for its members to demonstrate their
knowledge and skill while
professionally and gainfully
employed. In fact. it should use some
of the more ethical techniques
employed by big business and
corporations to find new markets for
their products. It must look beyond
hospital walls, public health nursing
practice. and classrooms of schools of
nursing, colleges, and universities
Massive unemployment is
looking nursing In the face and,
instead of looking for scapegoats, the
time would be better spent looking for
new and meaningful roles for
unemployed and future nurses. It does
not suffice to blame government
cutbacks or to evaluate the two-year
nursing program, or even to mention
wage levels.
One area that maybe has not
been fully tapped is preventive care
How does Social Preventive Nursing
(SPN) sound? We have had SOCIal
Preventive MediCIne for decades why
not SPN?
We have the expertise in Canada
and the nursing profession to make it
work. SPN could be everything that
relates to the understanding and
Improvement of the delicate balance
between man and his environment. It
could involve not only agents of
ill-health and disability, but also
individual and social patterns of
behavior that make man more
susceptible to those agents. It could
be concerned with the effectiveness
and efficiency of the system of nursing
care and particularly with improving
the outcomes of the care.
SPN could be defined as dealing
wIth problems of public health and
their solutions. This Includes studies
of the distribution and behavior of
disease in human populations:
definition of the agents responsible for
the patterns observed: consideration
of the modifying effect of social and
environment conditions on disease
evolution: and the assessment of the
health and efficiency of people
exposed to various external
circumstances Linked with these
subjects is the design of measures
intended to control or prevent disease
and the field assessment of their value
in public health practice SPN would
also encompass the objective study of
the organization and functioning of
nursing services with particular
emphasIs on the measurement of their
efficiency.
Readers should thoroughly
assess this proposal. Maybe one day
we will have nurses practising SPN rn
public libraries and, instead of
bandaging cut fingers in school yards,
nurses will be teaching in classrooms.
Who knows?
- Mohamed H. Rajabally, R.N..
Ed. M., Kelowna. B.C.
We stand corrected
As the author of "Understanding
the Patient in Emergency,' July 1976.
I would like to point out that the
wordrng of one sentence in thiS arlJcle
dId not appear in print as it was
originally submitted. The sentence I
refer to concerns the importance of
psychological support for the
emergency patient In pain and should
read as follows: "If the doctor orders
an analgesic for the emergency
patient, the administration of it is most
important. But, very frequently in an
emergency situation, analgesics are
contraindicated. as with head-injured
patients or until definitive diagnosis is
made, because they may mask the
patient's symptoms. Consequently.
emotional support of this patient is
important to reduce the level of fear
and anxiety and in turn perhaps
reduce the level of associated pain.
- Wendy McKnight. R.N.. Ottawa.
Onto
B
The Canadian Nurse October 1976
A SPECIAL OFFER OF INTEREST TO
CANADIAN NURSES
-
- -
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THE new ENC
Now available ê
1. TO GET AT THE FACTS QUICKLY
AND EASILY. This need is served by
the 10-volume Ready Reference and
Index which contains 102,000 right-to-
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The CanadIan Nurse October 1976
9
I II I) lit
Radiotherapy has many uses
Ada Butler's article. ' Breast
::ancer,"(June, 1976} was one oflhe
:Jetter articles to appear in nursing
ournals and has good teaching value.
However, I would like to suggest that
ner statement "radiation may be used
:0 manage palliation of symptoms to
mprove the quality of the person s
Ife," while valid, may lead to serious
'llisconceptions, as this is not the only
ole for which radiation therapy is
Jsed.
Radiation therapy in breast
:ancer was used in Edinburgh in the
ate 1940's with reduced surgical
Jroædures and adopted in many
:ancer centers throughout the world. It
s used in conjunction with surgery to
:over areas beyond that which the
>urgeon can operate and has been
,hown to improve the cure rate. It is
Jsed pre-surgically to reduce the bulk
Jf tumOr and make surgical removal
'easible. In cases of inoperable breast
'ancer, it can be the treatment of
:hoice and in this instance has a cure
-ate of some 30 percent. Palliative
adlotherapy is used to control spread
,lnd particularly to treat metastatic
Jony deposits for associated pain.
The basic premise for many years
las been that most breast cancers
,lrIse in a single focus. spread at an
ndeterminate time to the regional
3tatlon of lymph nodes and then later
enter the blood stream_ Logically then,
he primary therapeutic attack has
:onsisted of mastectomy with surgical
emoval and/or irradiation of the
:mmary lymphatic drainage.
This basIc premise is now being
hallenged on two points:
) Primary cancer of the breast may
XISt in multiple foci in almost half of
he patients.
) Lymphatic and lymph n:Jde
ermeation does not necessarily
recede blood-borne dissemination of
reast cancer.
For these reasons, the patient
ith breast cancer and nurses must
lot feel that because the patient is
eceiving radiotherapy, she has a
lopeless future or that radiotherapy
jOnly has a palliative role. Indeed, in
'most cancer centers the treatment of
Ibreast cancer is a multidisciplinary
!approach In which surgical removal,
adiotherapy, chemotherapy and
hormone manipulation are all
considered and used as appropnate to
improve, not only the cure rate, but the
quality of life.
- M.M. Freeze, R.N., B.S.N..
HospItal Unit Supervisor, Cancer
Control Agency of B.C., Vancouver.
B.C.
Thoughts on retirement
Don't look on retirement as
though you had been deprived of
something, but in the spirit of having
something fresh added to your life.
You are not starting out
empty-handed, but from the point at
which you have assimilated the
lessons of ha If a century. Those years
should be a crown, not a burden.
By retirement time you have lost
some of the plagues and insecurities
of youth but you have gained
perspective. Maturity is a stage of life
with special significance. It is a time for
you to put into effect the wisdom that is
unattainable at any preceding age.
Some doors are closed by illness and
the loss of friends, but new doors have
been opened by your maturity.
Not everyone will turn in
retirement to the same SOurCe for
satisfaction.
Having something to do, not
necessarily as a means to supplement
your livelihood, will add purpose to
your life but you show poor judgement
if you seize upon the first
post-retirement position that offers
itself.
Retirement is not meant to be a
dead stop, but a change of direction.
You will be happy to get up every
morning If you will have something to
do. Much of the unhappiness of
retirement is caused by people who
really want to be up and doing, but
have no idea what they ought to be
doing.
All during your working years you
followed a narrow path. You will find
that what you get out of retirement
depends on the investment you make
in it ahead of the deadline - friends,
hobbies. and so on. One precept will
apply to whatever you choose, keep it
simple, have fun and don't make it a
burden that is pointless or irksome.
While you were working you were
doing something everybody else
around you had an interest in. Now is
your chance to develop different
Ideas, and do unusual things. In other
words, do what you want.
Writing has much in its favor as a
hobby. It is a lonely one, but
convenient, as it can be carried on
anywhere without burdensome
equipment. It is worthwhile because it
can contribute to human knowledge
and wisdom and will live long after
one's life is over.
Make the most of what you have.
Wherever you go, go with a whole
heart, keep your eye on what is new.
Do not let the moments rust away and
remember - beauty in youth is an
accident of birth, in maturity, it is a
creation.
-Dorothy Dent, RN, Ottawa, Ontario.
Social preventive nursing
The nursing profession must
relentlessly search for new avenues
for its members to demonstrate their
knowledge and skill while
professionally and gainfully
employed. In fact. it should use some
of the more ethical techniques
employed by big business and
corporations to find new markets for
their products. It must look beyond
hospital walls, public health nursing
practice, and classrooms of schools of
nursing, colleges, and universities.
Massive unemployment is
looking nursing In the face and,
instead of looking for scapegoats. the
time would be better spent looking for
new and meaningful roles for
unemployed and future nurses. It does
not suffice to blame government
cutbacks or to evaluate the two-year
nursing program. or even to mention
wage levels.
One area that maybe has not
been fully tapped is preventive care.
How does Social Preventive Nursing
(SPN) sound? We have had Social
Preventive Medicine for decades. why
not SPN?
We have the expertise in Canada
and the nursing profession to make it
work. SPN could be everything that
relates to the understanding and
improvement of the delicate balance
between man and his environment. It
could involve not only agents of
ill-health and disability. but also
individual and social patterns of
behavior that make man more
susceptible to those agents. It could
be concerned with the effectiveness
and efficiency of the system of nursing
care and particularty with improving
the outcomes of the care.
SPN could be defined as dealing
with problems of public health and
their solutions. This Includes studies
of the distribution and behavior of
disease in human populations;
definition of the agents responsible for
the patterns observed: consideration
of the modifying effect of social and
environment conditions on disease
evolution: and the assessment of the
health and efficiency of people
exposed to various external
circumstances. Linked with these
subjects is the design of measures
intended to control or prevent disease
and the field assessment of their value
in public health practice. SPN would
also encompass the objective study of
the organization and functioning of
nursing services with particular
emphasis on the measurement of their
efficiency.
Readers should thoroughly
assess this proposal. Maybe one day
we will have nurses practising SPN in
public libraries and, instead of
bandaging cut fingers in school yards,
nurses will be teaching In classrooms.
Who knows?
- Mohamed H. Rajabally, R.N"
Ed. M., Kelowna, B. C
We stand corrected
As the author of "Understanding
the Patient In Emergency," July 1976,
I would like to point out that the
wording of one sentence in this article
did not appear in print as it was
originally submitted. The sentence I
refer to concerns the importance of
psychological support for the
emergency patient in pain and should
read as follows: "If the doctor orders
an analgesic for the emergency
patient. the administration of it is most
important But, very frequently In an
emergency situation, analgesics are
contraindicated, as with head-injured
patients or until definrtive diagnosIs is
made, because they may mask the
patient's symptoms. Consequently,
emotional support of thiS patien1 is
important to reduce the level of tear
and anxiety and In turn perhaps
reduce the fevel of associated pain.
- Wendy McKnight, R.N, Ottawa.
Ont.
10
The Canadian Nurse October 1976
Xe\,.s
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Nurses from 70 nations around the
world were among more than 1,000
delegates to the Nmth International
Conference on Health Education in
Ottawa. The theme of the conference,
which took place from August 29 to
September 3, was "Health Education
and Health Policy in the Dynamics of
Development." Approximately 100
nurses were among the
representatives of health professions
and voluntary associations, as well as
government agencies, who attended.
Above, nurses from several
Canadian provinces are pictured
during the conference with their
international counter parts. Countries
represented in the group include in
addition to Canada, the United,
States, the United Kingdom, Australia
and South Africa.
Two key issues that emerged
from the six-day meeting were the
need to make more effective use of
.
preventive measures in health care
and the need to tailor health
education to the specific environment
and culture of the people receiving
these services. Conference
partIcipants agreed that it is
imperative that health education be
demystified and that ways be found of
helping the consumer and provider of
health care to work together. The
terms used when dealing with the
consumer of care should be simple
and concrete. Self-help should be
encouraged with the assistance of
paramedical workers comparable to
the barefoot doctors of China. With
minimal training, these people could
act as catalysts to lay people and help
demystify medicine. Participants also
agreed on the need for government
support of health education.
ICN Proposes
Primary Care
Conference
The International Council of Nurses
has proposed to the World Health
Organization that a joint conference or
seminar on the subject of nurses
vis-a-vis the provision of primary
health care be held next year.
ICN President Dorothy Cornelius
initiated discussion of such a
conference at a meeting with Dr.
Halfdan Mahler, Director-General,
WHO, in March. "Since the aim of both
ICN and WHO is to improve health
care for all people," she said, "ICN's
purpose in initiating this meeting with
WHO was to explore how to
accomplish mutual goals. .
On July 20, ICN and WHO staff in
Geneva met for preliminary
discussion of the setting up of a JOint
working party to plan the organization
and conduct of the conference,
projected for 1977.
Commenting on the purpose of
the proposed conference, ICN
Executive Director Adele Herwitz said,
"One of the major objectives of ICN is
the full and effective participation of
nurses in the provision of both
qualitative and quantitative health
care to the people of the world. In this
present age of new and growing
knowledge in health care, a joint
WHO/ICN international seminar or
conference on this subject would be
supportive to the nurses' effective
functioning within the health care
delivery team."
One ofthe goals shared by ICN's
84 member associations, grouping
close to a million nurses around the
world, is to ensure maximum
utilization of nurses' services in the
provision of health services within
each country.
Grant teaches nurses
to aid retarded
A $68.000 grant from the Atkinson
Charitable Foundation will help
produce a film series to teach
graduate and student nurses about
current approaches to mental
retardation. A series of five half-hour
films containing a course of eight
lectures will be made for The Hospital
for Sick Children , Toronto. The course
is designed to give general duty
nurses a more complete
understanding of the special problems
of the mentally retarded.
The Canadian Nu
October 1976
11
Jurses at ILO
;onference
ontribute to world code
fficlal preparation of an international
strument on the conditions of work
d life of nursing personnel got under
ay during the 1976 International
bour Conference in Geneva, last
ne. A total of 48 nurses from 34
untries attended the conference as
elegates or advisers to government,
orker or employer groups. or as
bservers.
"The nurses made outstanding
ntributions to the discussions of the
'ommittee on Nursing Personnel and
ad a tremendous impact on the
leeting .. said ICN Executive Director
dele Herw,tz in reporting on the
leeting to the presidents of ICN s 84
lember associations.
"Nurses expressed their opinions
ery clearly and were able to bring
ther delegates to a clearer
nderstanding of the special problems
.cing the nursing profession. This
nference was a perfect illustration of
Ie need for nurses to attend such
leetings in order to speak
uthoritatively for their profession and
b defend their rights. '
The proposed conclusions
cÎpted in June will be sent by ILO to
overnments for their comments. A
f!port will then go to the 1977
"lternational Labour Conference,
hich will hold a second and final
iscussion on the subject.
The preliminary conclusions
iawn by this year s conference
,clude the statement that nurses
hould be able to refuse to perform
peciflc duties where performance
ould conflict with their religious,
,ora) or ethical convictions, provided
['ley inform their supervisor in good
me and are satisfied that nursing
are IS ensured. If this clause is
dopted by next year's conference,
ays ILO, it will be the first time that
uch a conscience clause has been
atured in an ILO standard.
Other significant
!ecommendations include two relating
e career development and
emuneration. It was agreed that
easures should be taken to give
ursing personnel reasonable career
rospects by providing for a
ufficiently varied and open range of
possibilities of professional
advancement. leadership positions in
administration, education and
research, and that remuneration
should be commensurate with nurses'
"needs. qualifications,
responsibilities, duties and
experience." Remuneration should
take account of the constraints and
hazards inherent in the profession and
should be fixed at levels likely to
attract persons to and retain them In
the profession.
The proposed conclusions
adopted this year cover the following
specific subjects: policy concerning
nursing services and nursing
personnel: education and training:
practice of the nursing profession:
participation, career development,
remuneration: working time and rest
periods: occupational health
protection; social security: special
employment arrangements, nursing
students and international
cooperation.
ICN is asking its member
associations to contact government
authorities in their respectivE'
countries to voice the nursing
profession's support of the proposed
conclusions, with a view to ensuring
adoption of an international
instrument next year by (LO Member
States. National associations will also
seek to have nurses included in
government, worker and employer
delegations again next year.
NLN forecasts
zero growth rate
After nearly ten years of
unprecedented expansion, the
number of basic nursing education
programs in the United States and the
number of students admitted to those
programs, appear to have peaked and
now are stabilized at a virtual zero
growth rate.
That is the conclusion of the
National League for Nursing's 1975
Annual Survey of State-Approved
Schools of Nursing. The report
surveys programs preparing for
registered and practical nurse
licensure, graduate programs leading
to masters and doctoral degrees in
nursing, and baccalaureate nursing
programs for registered nurses only.
According to NLN Director of
Research, Dr. Walter L. Johnson, the
most significant question arising from
the projected zero growth rate is:
"Assuming the current rates of growth,
to what extent will supply and demand
for nursing personnel match up over
the next few years?"
Despite the importance of this
question, he explains, it cannot be
answered at this time because a
quantitative analysis of requirements
for beginning practitioners according
to type of preparation has not yet been
done. Thus, there is no projected
demand curve against which to
evaluate supply trends.
The report cites another trend of
major significance to the future of
nursing-the tendency toward
increasing part-time rather than
full-time attendance in graduate
programs. Because many part-time
students defer dates of completion of
their work, sometimes with no firm
target date in mind, the report
suggests this could lead to declining
graduation rates despite increasing
enrollments in graduate programs.
"This kind of trend should not be
ignored," warns Dr. Johnson, "in the
light of the prevalent notion that the
shortage of nurses prepared at the
graduate level is one of the most
serious problems of supply today."
The current leveling off in growth
he points out, is at the end of a marked
expansion that began in the late
1960's for RN education and in the
early 1950's for PN education. "The
rates at which numbers of programs
and admissions of students were
increasing," Dr. Johnson states,
"could not be sustained for an
indefinite period."
The declining rate of growth
applicable to basic nursing education
does not appear to apply as yet to RNs
who were prepared in diploma or
associate degree programs and who
now are seeking baccalaureate
degrees. The number of these
graduations this year increased by 26
percent.
There was a minimal increase In
the number of graduations from
masters programs. However,
enrolments continue to show
substantial increases, with a 22
percent increase this year.
Doctoral graduations rose more
than 60 percent this year from 46 to
74, but enrolments increased only
slightly from 192 to 199.
Reviewing admissIons,
enrolments, and graduations of men
and minority students, the report cites
modest changes between 1972 and
1975, except for a drop in proportions
of Blacks in associate degree and
practical nursing programs. These
decreases, however, are
counter balanced by the increases in
Blacks admitted, enrolled, and
graduated from baccalaureate
programs.
In 1975, men repesented seven
percent of the RN graduates, Blacks
nine percent, Hispanics six percent,
and American Indians/Orientals three
percent. For that same year, men
represented five percent of the PN
graduates, Blacks 16 percent,
Hispanics 19 percent. and American
Indians/Orientals five percent.
Pregnancy...
or Proteinuria?
Recent studies conducted in the
Health Protection Branch
laboratones. Health and Welfare
Canada, have found that some
pregnancy tests show a false positive
result In women who have proteinuria
Manufacturers of the commercial
test kits used in the study have been
asked to label their kits to indicate the
exact extent of protein interference to
be expected. In the meantime. health
personnel are advised to take into
account the possibility of protein
inter1erence in pregnancy tests
Did you know?
Allergic contact dermatitis from poison
ivy, poison oak or polson sumac is
caused by a toxic substance called
3-pentadicylcatechol (commonly
known as urushiol or toxicodendrol)
Symptoms include: burning,
itching and reddening of the skin
within 10 days after exposure. Rash
and edema follow rapidly.
In mild cases. cold compresses
and calamine lotion may suffice.
Newer drugs for treating
mild-to-moderate dermatitis are
topical corticosteroids
12
The Cllnadi3n Nurse October 1976
X'P\,-s
CIDA releases new
health care guide
The Canadian International
Development Agency (CIDA) has
published the second of a series of
sectoral guidelines for Canada's
development assistance program for
the nex1 five years. Entitled "Social
Development and Community
Services," the Guidelines deal with
education, population, housing, social
communications and cooperatives.
In the field of health care, CIDA
points out that: "It should be
remembered that while Canada
spends close to $400 per capita per
year on health, in many developing
countries the health budget is as little
as two to three dollars per person, and
in some of the least developed
countries less than one dollar. The
challenge for developing countries is
how to use the limited resources at
their disposal to alleviate the
tremendous waste of human
resources resulting from the
overwhelming burden of disease,
extremely high infant death rates and
their exploding populations."
The guidelines suggest that top
priority in the health sector be given to
integrated training and curative and
preventive programs in rura I areas, for
instance:
a training of health auxiliaries and
para-medical workers;
a provision of clean water,
environmental sanitation;
a health education;
a provision of simple, basic
equipment for the treatment and
prevention of disease;
a construction of simple buildings
suited to communal uses;
a Canadian projects must be a part
of national or regional health
programs;
a CIDA projects must be developed
within the financial scope of the
recipient country;
. emphasis should be on applied
research and pure research projects
avoided;
. health projects in which CIDA
participates bilaterally or through a
non-gouvernmental organization
(NGO) should rely on available or
potential local resources.
Health happenings
in the news
Occupational health received a
strong shot in the arm recently when
the Ontario government released its
"Report of the Royal Commission on
the Health and Safety of Workers in
the Mines," prepared by James Ham
of the University of Toronto.
The report contains a strong
indictment of provincial and federal
governments and mining corporations
for failing to protect the province's
30,000 mine workers from hazardous
conditions that result in death,
accidents an d lives ruined by disability
and disease. The author of the report,
Professor James Ham, points out that
"the problems of the health and safety
of the mine workers as discussed in
the report are probably not peculiar to
the mine industry." He criticized
industry and government for "a
serious lack of openness on matters of
the health and safety of workers in the
mines."
Ontario New Democratic
Party leader Stephen Lewis.
commenting on the Ham report said:
"If the Government moves on the
inspection recommendations, opens
up information and makes (radiation)
threshold limits law, then, boy oh boy,
it will be another world in occupational
health."
The Natonal Cancer Institute in
the United States has come out with a
new set of guidelines covering the use
of X ray techniques in the detection of
breast cancer. The Institute
recommends that the techniques not
be used routinely on women between
the ages of 35 and 50 unless they
show specific symptoms or are
otherwise classified as "high risk."
The guidelines are contained in a
letter circulated to physicians at 27
U.S. centers participating in a national
breast cancer demonstration project.
Next year could see the beginning of a
"new war on sexually transmitted
disease, expecially among young
people," according to federal health
spokesman, Dr. Maureen Law. The
latest federal study describes the
incidenæ of reported cases of
gonorrhea as "reaching epidemic
proportions" with 215.8 cases per
100,000 population.
The proposed program for
detecting, treating and preventing
sexually transmitted diseases hinges
on agreement among federal and
provincial health officials. The basis
for their agreement is to be
recommendations contained in a
report by a committee set up in 1974
and headed by Dr. Russell Manuel of
Dalhousie University.
The committee's final report was
submitted to a conference of depu1y
health ministers last Spring but
disagreement on the resolutions has
prevented action..on its
recommendations. The contents of
the report are still not available to the
public.
The federal provincial advisory
committee on community health, to
which the report was referred, IS
scheduled to wrestle with the
committee findings and come up with
a proposal for minimum standards in
the area next November.
Communicable diseases still pose a
very real threat to Canadians,
according to Dr. Harding Ie Riche,
professor of epidemiology at the
University ofT oronto. Dr. Ie Riche, in a
recent interview with Toronto Star staff
writer Marilyn Dunlop, accused the
federal government of being
"short-sighted and stupid" in failing to
set up measures to better protect
Canadians against imported disease.
"About 1955, people began to
believe that all communicable
diseases were under control" Ie
Riche says. "We assumed the
millenium had come. Penicillin had
solved all our problems. It is not at all
true."
Dr. Ie Riche cites six diseases as
an example of the gamut of infections
that could threaten Canadians,
including: Lassa fever, "Legionnaires'
disease," Swine flu, St. Louis
encephalitis, diphtheria and polio. He
believes that "sinæ 1967, the
reservoir of diseases has increased in
Canada" and cites the results of a
recently completed study in which he
found that between 20 and 30 percent
of all hospital patients have infections
unrelated to the reasons they are in
hospital.
There is no eVldenæ that a Swine Flu
epidemic is even remotely likely to
occur, according to Ontario's
controversial government health critic
author and former coroner, Dr. Mortor
Shulman. He points out that
"practically all of the deaths in the
1918 flu outbreak were not from the
virus but from secondary bacterial
complications which today are
routinely cured with antibiotics that
were unknown in 1918."
He suggests that the reason for
governments giving the go ahead to é
mass vaccination program boils dowr
to the profit some people, including
drug companies, stand to make and
"the favorable publicity a few
politicians hope that they will get for
their excellent work in the public healtt
field."
Kidney transplants
up at U of A Hospital
The weeks between July 25 and
August 20,1976 were busy weeks fOr
the University of Alberta Hospital's
kidney transplant team. with a total 0
seven transplants being done in less
than a month.
Four kidneys from two donors
were transplanted in a series of
operations on the weekend of Augus.
7th and 8th.
By mid-August, 1976, 13
successful transplant operations had
been done at the University hospital in
Edmonton, a number which
approaches the 1975 total
A transplant team spokesman
says he is hopeful that this is an
indication of increasing public interest
in kidney donations, an encouraging
sign, as there are more than 40
patients at the University hospital who
would benefit from a transplant
operation. Kidneys that can't be
matched at the University hospital can
be taken to another center to be
transplanted.
Serving as the kidney transplant
center in Northern Alberta, the
University hospital receives notice of
available kidney donations from other
hospitals. These are generally cases
where the donor had previously
completed a donor card, or the relative
of the deceased provided
authorization
The CanadIan Nurse October 1976
13
Xil111PS
ill)(1
I
ilees
:NJ talks to...
:Iura Barr, the nurse who has guided
1'9 collective destiny of Ontario s
IJrsing profession for the past 16
,'ars, leaves the RNAO next month
1e leaves with regret; she says she
110WS she 11 miss the particular nurses
ld student nurses she has worked
'h and that she has enjoyed her term
I; executive director.
But she leaves wl1h the
Itisfaction of having seen organIZed
Jrslng make remarkable advances in
e past decade and with the firm
)nviction that the profession today
ands on the brink of even greater
::complishments in the immediate
ture.
,
"
....
I
L
"
,
'-
''I'm more excited about nursing
ow than I was 16 years ago," she
ays. She feels that nurses, having
I-.ared some of their traditional
,ctions with other health care
lorkers, have now assumed a unique
lentity as "a helping profession" and
hould capitalize on th is asset. "We're
here everyone else says they want
be. We have created a network of
ccess to the people and now we can
oncentrate on being where these
eople spend most of their lives - in
eir homes, at work, in schools and
dustry "
Barr feels that nurses spend too
ttle time caring for each other and too
.uch time worrying about
ving up to
eing "that thing called nursing. " She
ays: "The essence of nursing is
resence, because nursing doesn't
10 on if she's not there. This is the
ling we need to protect."
She worries about the popular
tendency to downgrade the two-year
graduate rather than to recognize that
dIfferences in education and
experience can enrich a profession.
"We have created our own problems
by trying to make the diploma nurse all
things to all people instead of allowing
them to contribute in their own way.
The (professional) Association has an
important role to play in offering
support and recognition to all of its
members and teaching them to
cherish these differences."
For the RNAO, Barr sees an
important decade coming up when the
Association comes to grips with "The
New Reality." She believes that, as a
group, the profession has built up a
fund of knowledge and self-esteem
that will go a long way towards
preparing its members to help people
cope and adapt wherever they are.
"Even though we never appeared to
fight very aggressively for It, nurses
have been the major influence on
current health policy. We began to talk
about prevention and promotion long
before anyone else thought of it. Now
we can say to people We'd like to
meet you where you are,' and, that
way, people will spend less time in
institutions and more time where they
want to be."
"The world is our oyster," Barr
concludes, 'if we can just appreciate
and enjoy what we have now and set
our sights on where our future lies."
CNF Scholars
Eight Canadian nurses will receive
scholarships from the Canadian
Nurses Foundation for the coming
academic year 1976-77. The awards
are used for graduate studies in the
field of nursing.
ConstanceJan Becker, lecturer
at the University of Mamtoba SchOOl 01
Nursing, has been awarded $3000. to
study for a Master's degree in clinical
nursing with a major in maternal health
at the University of Texas System,
School of Nursing in Austin, Texas.
Donna Jean Roe, formerly
Educational Cooronator at St.
Joseph's Hospital, Hamilton, Ontario,
receives $3000. to study for a Master's
degree in Community Nursing at the
University of Toronto.
Cora Marie Price, Community
Health teacher at Sault Ste. Mane
College In Ontario, receives the Agnes
Campbell Memorial Award which is
provided by the NurSing Sisters of
Canada and is administered by CNF.
Price plans to study for a Master of
Science in Nursing degree at Wayne
State University with a major In
Community Heallh.
Wendy Lynn McKnight, lecturer
at Queen s University. Kingston.
Ontano, plans to study for a Master s
degree in emergency nursing at
McGill UniverSity with her CNF
scholarship of 53000.
Helen Bernice Garry of
Vancouver, B C. has been awarded
$3000 to study for a Master s degree
at the University of Bntish Columbia
Her major field of study will focus on
research into nursing practice and
health care organizations and
delivery
Mary Louise McSheffrey of
Oromocto, New Brunswick has been
awarded a 53000. White Sister
Incorporated Scholarship 10 finance
her second year of graduate study in
maternal-child health at McGill
University. This IS the second year
McSheffrey has received a CNF
scholarship.
Ann Shepherd Fenwick of
Montreal has been awarded 53500.
from the Helen McArthur Canadian
Red Cross Fellowship for Graduate
Studies. Fenwick plans to complete
her Master s degree In Nursing at the
University of British Columbia.
Jane Buchan of Vancouver will
receive $3000. to study for a Master's
degree in Community Nursing at the
University of Bntish Columbia.
Buchan has recently completed a
two-year contract with CUSO where
she served in Malaysia as midwife and
Public Health field worker.
The Canadian Nurses
Foundation was established In 1962
by the Canadian Nurses Association
to receive funds and administer
fellowships for the preparation of
nurses for leadership pOSitions. A total
of 137 nurses have been awarded
scholarships under the program to
date. CNF funding is voluntary and
dependent on gifts, donations and
bequests from individuals and
organizations.
Appointments
Phyllis Craig (B-Sc.N.. M.H.SA.
UniverSity of Alberta) has been
appointed a full-time researcher wl1h
the Edmonton Local Board of Health
She says Administration and
research in health disciplines should
be Interrelated The research program
need not be large but at least
decisions are based on some
statistical flndmgs. '
Craig s nursing career has
included two years with Health and
Welfare Canada at Norway House,
Manitoba; short-term nursing
assignments In Australia: and work as
a public health nurse and nurse
practitioner in Alberta. Her recent
studies in health services
administration were m part supported
by the Canadian Nurses Foundation
Susan D. Smith {R.N., Nightingale
School of NurSing, Toronto: B.A. and
B.Sc.N., Queen s University,
Kingston, Ont.) has been appointed to
the position of Nursing Practice
Cooronator for the College of Nurses
of Ontario. Smith is responsible for
activities related to the development of
standards and improvement of
nursIng practice for regIstered nurses
and registered nursing assistants.
She will also monitor nursing practice
to identity trends in health care
delivery. Smith has been head nurse
at the Sunnybrook Medical Centre and
nurse-teacher at the York Regional
School of Nursing, Toronto.
Valerie Hooper (R.N. Grace Hospital
School of Nursing, Winnipeg, Man'
B Sc.N., U B.C.) has been appointed
assistant registrar of the 18,000
member RNABC.
Hooper will be Involved in
assesSing candidates for nurse
registration in B. C. and In interpreting
registration policies of the association.
She has previously held positions
as nurSing Instructor In two Ontano
schools of nursing and has practiced
nursing in B.C. and Quebec. She also
served as the official head of a nurSing
delegation sponsored by the RNABC
to the People s Republic of China In
April. 1976.
14
The Canadian Nurse OctoÞer 1976
In this high pressured world of caring and doing and bending and reaching,
walking miles of aisles and wondering whether anybody out there cares... We
do. Barco backs every stitch of every look, every day.
Barco Backs "iúu, Bab
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Please look for Barco at the store nearest you.
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The Canadian Nurse Octobar 1976
15
UPSIDE-DOWN
HOW DO YOU
FEEL ABOUT...
.
.
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Recently The Canadian Nurse has published articles on the difficulties
many hospitalized pa1ients have in sleeping. These are 'patient'
problems that the nurse on night shift may have te deal with. There are
other problems - what might be called 'nurse' problems, - associated
with night duty.
Contemporary experiments concerning physical and mental
functions indicate a noticeable fluctuation in performance depending on
the time of day or night of an individual's activity. Studies on circadian
rhythms have led one author to write, "We are all more or less inept
during the nighttime hours.--
Most nurses are called upon to work night shift at some time in
their career. At The Canadian Nurse we are interested in finding out
how you feel about working nights. Please fill in the questionnaire on
the following pages and mail it to:
The Canadian Nurse,
50 The Driveway,
Ottawa, Canada,
K2P 1 E2.
We hope to draw some interesting observations from your
answers so that we can share them with you at a later date The
questionnaire is simple and could be fun. If you have any further
comments about night duty, or any suggestions, feel free to add them at
the end of the questionnaire. We hope to hear from you.
16 The Canadian Nurse October 1976 l
:-:.
. 1. Night shift h) Do you generally feel well- 0 1. yes
rested while working nights 0 2. somewhat tired
a) Do you work nights? 0 1. yes 0 3. no, very tired
0 2. no.
b) Have you ever worked nights? 0 1. yes . 3. Eating habits
0 2. no
a) Do you experience a change in 0 1. yes, always hungry
c) Do you work 0 1. on a ward your appetite while working nights? 0 2. yes, feel nauseated,
r:J 2. in a spedatty care unit not hungry
(I.C.U., PAR., Emerg.) 0 3. no
r:J 3. other (specify). . . 0 4. other (spedfy)...
d) Do you work 0 1. full-time b) Do you eat regular meals 0 1. yes, three regular meals
0 2. regular part-time while working nights? 0 2. yes, two regular meals
0 3. casual part-time 0 3. yes, one regular meal
0 4. no, snacks
e) Do you work 0 1. three eight-hour shifts
0 2. evenings and days c) Would you describe your eating 0 1. unchanged
0 3. nights and days habits while working nights as 0 2. improved
0 4. twelve-hour shifts comparatively o 3. adequate
r 5. permanent days o 4. poor
evenings
nights d) Do you experience significant 0 1. no
weight fluctuation while working 0 2. yes, weight gain
f) Do you work 0 1. short periods of night duty nights? 0 3. yes, weight loss
(up to seven days)
r:J 2. blocks of nights . 4. General activity
(two weeks or more)
g) Do you prefer to work nights in 0 1. short periods a) Do you find it difficult to carry on 0 1. yes, very difficult
0 2. blocks such funcfions as shopping, 0 2. moderately difficult
0 3. not at all banking, keeping appointments, 0 3. no problem
because you want to etc. while working nights?
h) Do you work nights 0 1. b) Do you... 0 1. interrupt sleep to
0 2. because you would rather
work nights than evenings maintain such
activities
0 3. out of necessity 0 2. sleep and ignore such
(e.g. hospital policy)
r:J 4. other (e.g. family) (specify)... functions
0 3. other (spedfy)...
. 2. Rest c) Do you keep in touch with friends 0 1. frequently
and acquaintances during periodsO 2. sometimes
a) Do you have difficulty sleeping 0 1. no of night shift? 0 3. rarely
after night shift? 0 2. no more than usual 0 4. never
0 3. yes, sometimes Does working nights interfere 0 1. not at all
0 4. yes, most of the d)
time with your family life? 0 2. not too much
0 3. yes, significantly
b) If yes, do you have difficulty 0 1. getting to sleep 1. as well as usual
0 2. sustaining sleep e) How do you feel that you interact 0
0 3. both of the above with friends and family 0 2. not as well as usual
while working night duty?
c) Do you sleep 0 1. less than four hours On your 'off' hours do you feel 1. yes, usually
r:J 2. more than four hours, f) 0
less than eight hours isolated or lonely? 0 2. sometimes
0 3. more than eight hours 0 3. no, never
g) On your 'off' hours would you 0 1. cheerful
d) Is it easier for you to sleep 0 1. in the mornings describe your mood as 0 2. balanced
r:J 2. afternoons comparatively o 3. slightly low
0 3. evenings o 4. depressed
e) Do you sleep for 0 1. one long penod
0 2. one short period . 5. At work
0 3. two short periods
0 4. in "snatches"
a) Do you feel comparatively 0 1. most of the time
f) Do you ever take medication 0 1. regularly alert while working nights? 0 2. some of the time
to sleep? 0 2. sometimes 0 3. not at all
r:J 3. rarely
0 4. never b) Do you find it difficult to stay 0 1. no, never
awake while at work on night shift? 0 2. sometimes
g) Do you take medication to 0 1. regularly 0 3. yes, espedally at
sleep while working nights 0 2. sometimes
0 3. rarely (specify time)
0 4. never
The Canadian NUrM October 19711
17
c) Do you feel physically comfortable 0 1. yes
while working nights? 0 2, no (specify). . ,
d) Would you descnbe your 0 1. quick, clear
thinking process as. . . o 2. adequate
while working nights o 3. sluggISh or foggy
e) Do you feel that your reflexes are D 1. quick
D 2. jumpy
0 3. slowed somewhat
D 4. slowed considerably
f) On night shift, would you describeD 1. confident
your reaction to stress situations D 2. less confident than usual
or problems as 0 3. shaky
g) In relation to patients' emotional 0 1- more empathetic, caring
needs, how would you descnbe than usual
your reactions on night shift? o 2. unchanged
D 3. less empathetic than usual
D 4. uncaring
h) Working nights, do you feel D 1. as competent as ever
D 2. less competent than usual
0 3. incompetent
i) Working nights, do you D 1. bored
generally feel 0 2. lethargic
0 3, content
D 4. anxious
0 5. other (specify)...
j) Working nights. do you D 1- euphoric
generally feel 0 2. lightheaded
C 3. balanced
D 4. slightly depressed
0 5. miserable
k) Working with others on nights D 1. open, communicative
shift do you feel D 2. relatively quiet
D 3. easily annoyed
D 4. withdrawn...
I) Do you feel that D 1- productive
communication with day or D 2. adequate
evening staff is 0 3. lacking
D 4. other (specify) ...'
m) On 'quiet' nights, do you feel D 1. talk to wakeful patients
incined to D 2. tidy the ward
0 3. read patients' charts
o 4. knit
D 5. other (specify)...
n) Do you feel that most of your 0 1. necessary
nlQht duty functIons are 0 2. filling time
0 3. ur,necessary
0) When you finish a night shift. 0 1- worthwhile
do you generally feel that your o 2. satisfactory
work has been D 3. pointless
p) When you return home after a 0 1. cheerful
night shift, do you feel D 2. content
o 3. letdown
o 4. other (specify)...
Other comments and suggestions are welcome.
We look forward to sharing the
response of other nurses with you.
Thank you for your
participation. .
At Last...
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The Canedlan Nurse October 1976
Gb9D
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second in a three part series on the cardiac surgery... the MI patient whose
cardiovascular system. Two and one half life-style must change? W ho helps them
million Canadians suffer from cope wIth these changes?
hypertension and only one in four are
receiving treatment Whose
responsibility is it to create a climate of
awareness?
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The Canadian Nurae October 11176
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Arterial Blood Pressure
The normal blood pressure fluctuates
constantly, varying with environmental stimuli
and personal response. Arterial blood
pressure is regulated by intrinsic and
secondary factors,
o intrinsic components include: blood
volume, viscosity, arterial wall elasticity,
cardiac output(referring primarily to left
ventricular function) and peripheral
resistance.
o secondary regulators include: the
autonomic innervation of blood vessels
through controls in aortic and carotid
sinus moderator nerves, central and
peripheral reflex centers, chemical
mediators (epinephrine and
norepinephrine), effects of respiration,
venous return to the heart, and
venopressor mechanisms.
For the details of these regulator
mechanisms see Table 1. Normally, arterial
pressure exists at its maximum level in the left
ventricle during systole with a gradual lowering
in left arteries, capillaries and veins until it
reaches subatmospheric levels in the large
veins during diastole. These fluctuations,
known as arterial pulse pressures, can be
indicative of the efficiency of the cardiac cycle,
the mean atrial pressure, and arterial wall
elasticity.
Blood pressure has a direct relationship
with the cardiovascular system and other
major body systems. Understanding arterial
blood pressure involves the consideration of a
number of physiologic variables. Unless our
conditions of measurement are accurately
defined, interpretation of hypertension may be
imprecise.
Hypertension
Arterial hypertension can be defined as
the elevation of blood pressure to a level which
requires investigation and treatment. A
relationship has been established between
hypertension and left ventricular hypertrophy,
aortic dissection, renal insufficiency, cerebral
vascular diseases, and coronary artery
disease.
Hypertension itself, whether essential or
secondary, often carries with it no specific
symptoms. An elevated blood pressure is itself
a symptom of another problem. Headache,
I
dizziness, fainting, tinnitus, and epistaxis may
mark the more advanced development of I
hypertension. But diagnosis often occurs as a
result of complications arising from I
hypertension. If it remains undetected,
untreated, or if patients do not comply to
treatment, it can progress to cardiac failure, I I
cerebral thrombosis, and massive cerebral
hemorrhage.
Essential Hypertension
Essential hypertension (primary,
idiopathIc) accounts for 90 percent of all cases
of hypertension. The cause of the disease is
not known, but research hints that it is not I
merely a result of the aging process. I
The arterioles of the hypertensive person
are narrowed. As arterial pressure mounts I
gradually to push blood through narrowed
arterioles, hypertrophy of the smooth muscle
of these walls will occur. In the cycle that
follows, further narrowing develops thus
increasing peripheral resistance and
increasing cardiac work load. Narrowing also
OCCurS in the vascular bed, with the resuh of
impaired nutrition to the vital organs I
particularly the myocardium, kidneys, and I
central nervous system.
In advanced phases of accelerated
hypertension there is widespread
degeneration of the arteriolar wall - this is
known as MALIGNANT hypertension, and is
manifested in the ocular fundi as papilledema
Papilledema rarely develops without the
presence of an underlying pathologic process.
Secondary Hypertension
Secondary hypertension accounts for ten
percent of all known cases of hypertension,
and is due to a known and generally
manageable cause. Underlying etiology may
arise with the following problems:
1. disturbances in the central nervous system
a) increased intracranial pressure i.e.
neoplasm, inflammation
b) brain stem and spinal cord disease i.e.
poliomyelitis
2. disturbances in adrenal tissue
a) pheochromocytoma
b) Cushing's syndrome
c) primary aldosteronism
3. disturbances in the renal system
a) renal artery obstruction
b) acute renal ischemia
The Canedl.n Nuru October 1Ø111
21
Improved detection of individuals with hypertension over the past twenty years has had little
effect on the mortality rates associated with the disease. For health professionals, an
understanding of the dynamics of hypertension is only the beginning - the challenge lies in
creating a climate of overall public awareness, and in setting up comprehensive programs for
I the detection and follow-up of people who have hypertension. Two of the following articles
focus on a review of the pathophysiology of hypertension and of blood pressure recording; a
Ithird illustrates the implementation of a successful screening and follow-up program for the
detection and treatment of hypertension, and tells how nurses got involved.
-
c) acute and chronic glomerulonephritis
I d) pyelonephritis and others
I
4. toxemias of pregnancy
5. coarctation of the aorta
In these cases, treatment of the specific
cause of hypertension results in its control.
Factors Affecting Hypertension
Treatment of hypertension is directed
I towards decreasing the patient's blood
pressure as soon as possible. The nature of
medical management depends on the
I evaluation of the patient. Certain factors must
I be kept in mind in the assessment and
management of the patient with hypertension:
. the patient's age, sex, and race
. the degree of atherosclerosis
. any familial history of hypertension
. the degree of psychologic stresses and
emotional lability
. any pre-existing damage to major organs
i.e. congestive heart failure, uni- or bi-Iateral
renal ischemia, cerebral ischemia
. the degree of overweight Or obesity
. the patient's smoking habits
The treatment and follow-up of patients
with hypertension is a matter of great concern;
untreated hypertension can result in serious
cardiovascular. cerebral vascular and renal
vascular complications.
Bibliography
1 Levine, SA Clinical heart disease. 5ed.
Philadelphia, Saunders, 1958.
2 Mahon, WA Etiology of hypertensIon.
Toronto, College of Family Physicians of Canada-
I Medifacts Audio Service, 1971.
3 Peart, W.S. Arterial hypertension. In Beeson,
Paul B. Cecil-Loeb textbook of medicine, ed. by...
I and Walsh McDermott. 13ed, Philadelphia.
I Saunders, 1971.
4 Sackett, D. L. Hypertension in the real world.
(Unpublished paper)
! 5 Sackett, D.L. Screening for earty detection of
disease: to what purpose? Bull. NY Acad. Med.
51:1 :39-52, Jan. 1975.
6 Shane, S.J, Management of hypertension.
Parts I and II. Toronto, College of Family Physicians
of Canada - Medifacts Audio Service, 1975.
7 Wilkins, G.E. Correctable hypertension.
Toronto, College of Family Physicians of Canada-
Medifacts Audio Service, 1975.
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22
The Canadian Nurse October 1m
Table 1
Major determining factors
Cardiac Output
(heart rate and stroke volume)
Peripheral resistance
(blood viscosity and arteriolar
diameter)
Blood volume
(changes in blood volume alter
cardiac output and arterial
pressure)
Blood Pressure: Physiologic Controls
Mechanisms
1 sympathetic nervous system (SNS) impulses predominate in the Vasomotor center (VMC).
The VMC is located in the pons and medulla oblongata and the lateral portion responds to
stimulation by increasing heart rate, peripheral resistance and adrenal medulla secretions,
2 baroreceptors (pressure receptor cells):
.
aortic pressure stimulates baroreceptors in aortic arch
. impulses from aortic arch sent to VMC via vagus nerve
. impulses from baroreceptors in carotid sinus sent to VMC via Hering's nerve then
glossopharyngeal nerve.
. when these impulses reach the VMC, they stimulate the cardiac center in the medulla to
increase SNS impulses thereby increasing the heart rate.
3 cerebral stimuli ego emotions: propably stimulate the hypothalamus which acts on thE
medulla and autonomic neurons to increase
eart rate and hence blood pressure.
4 neurotransmitters ego catecholamines such as epinephrine and norephinephrine alter
heart action.
5 a multitude of factors which affect stroke volume and cardiac rate exist.
1 SNS vasoconstrictor action predominates in the VMC.
2 baroreceptors (as above) respond to an increase in arterial pressure cy sending impulses
that decrease SNS vasoconstrictor action, thereby allowing for relaxation of the arterioles.
3 chemoreceptors: aortic and carotid arteries contain sensitive structures (chemoreceptors)
that respond to low oxygen concentrations in the blood and alterations in blood pH. They
stimulate the VMC to cause vasoconstriction, leading to an increased heartbeat and a rise
in arterial blood pressure.
4 cerebral medullary ischemic response: At very low blood pressures, localized
deoxygenation and elevated C02 stimulate vasoconstriction.
5 viscosity is determined by the number of red blood cells and plasma proteins found in the
circulating blood,
6 vasoconstriction occurs through the renin-angiotensin mechanism. (See diagram 1).
1 osmoreceptors located in the hypothalamus are nerve cells that respond to the osmotic
state of the fluid surrounding them. In high extracellular fluid concentrations of sodium, fluid
moves out of the cells and the osmoreceptors shrink, This increases their rate of firing to the
posterior pituitary gland and increases the release of antidiuretic hormone. An increase in
ADH results in water retention and therefore, increases the blood volume and results in an
increased blood pressure.
2 restoration or alteration of fluid volume occurs also through the renin-angiotensin
mechanism. Recent evidence suggests that an altered renin-angiotensin mechanism may
be a factor in primary hypertension. (See diagram 1).
Source: Janice Goerzen and S. Darlene Abbott
The Canedlan NUrM October 11176
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24
The Canadian NUrM October 1976
Blood pressure measurement:
Guidelines to accuracy
Janice Goerzen,
S, Darlene Abbott
Environment:
. quiet with the least stress possible.
. wait 10-15 minutes if patient has smoked.
Patient Position:
. BP taken after patient has been supine for 5
minutes, sitting for 5 minutes, immediately on quiet
stand;ng and again 2 minutes later. Postural differences
may occur in accordance with physiologic
compensatory reflexes.
. for initial readings, both arms and legs are used
because of the possibility of vascular disease or
coarctation of the aorta.
. for arm readings, place arm at heart level. If the
artery is above the heart level, false low pressures may
be obtained. If the artery is below the heart, false high
pressures may be recorded.
. palpate brachial artery and apply the stethoscope
firmly but with minimal pressure.
. for leg readings, the patient is prone with leg bent,
and stethoscope applied over the popliteal fossa.
Cuff Size:
. it is important that the cuff is the proper size.
. if cuff is too small (i.e. if cuff width does not equal
2/3 of arm diameter or if the compression bag (bladder)
is too small to encircle the arm adequately) then, a false
reading as great as 60/30 can occur.
BP recording:
. inflate rapidly to 30 mm Hg above systolic (check
radial pulse to be sure),
. deflateatthe rate of 2-3 mm Hg per second. Do not
stor> and never reinflate without totally deflating and
waitlnç 'wo minutes, The artery needs time to recover
from tt, , previous pressure.
. the first sound heard is the systolic. The diastolic is
the last sound heard. If the artery is compressed by the
stethoscope, the diastolic may be heard all the way to
zero. Compression may also alter Korotkoff sounds.
These sounds are the tappings and murmurs heard
while taking a BP. They are also useful in diagnosing
certain cardiovascular diseases.
. controversy exists over the use of the muffle or end
point as best representative of the true diastolic, If both
points are distinct they are recorded ego 120/80/70,
Experimentally, the end point has been shown to be
more reproducible.
Equipment maintenance:
. stethoscope ear inserts should be clean, cuffs
repaired, aneroid manometers calibrated against
mercury manometers and mercury manometers also
checked for accuracy at least every three months,
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Korotkoff sounds:
If there is difficulty hearing Korotkoff sounds, try
the following measures to increase sound intensity:
. check that the stethoscope is located properly, that
the cuff size is appropriate and the manometer is
working.
. inflate the cuff more quickly
. have the patient open and close his fist about 10
times after the cuff has been inflated above systolic
. drain the arm of blood by elevating the arm for a few
seconds before the pressure is taken.
. be aware that individual differences in hearing
acuity exist. ..
Janice L. Goerzen, (R.N., Galt School of
Nursing; B.Sc.N., U. of Alberta) is a Master of
Medical Science student studying
hypertension at the University of Calgary. She
is co-author of Review of Maternal and Child
Nursing, C. V. Mosby.
S. Darlene Abbott. (R.N., University of
Saskatchewan) is a staff nurse with extensive
cardiovascular nursing experience. She is the
coordinator of the Foothill's Hospital
hypertension clinic in Calgary, Alberta.
Bibliography
Guy1on, Arthur Clifton. Textbook of medical
physiology. 4ed. Philadelphia, Saunders, 1971.
Kaplan, Norman M. Clinical hypertension. New
York, Medcom Press, 1973. (Medcom medical
update series).
Meyer, Philippe. Summary of current studies on
angiotensin -induced aldosterone release. Circ.
Res. 38:6:Supp. 2:127-128, Jun. 1976.
The Canadl.n NUIM OçtOber1976
..
1
It has been estimated that two and a half million Canadians have hypertension, Finding them can be a
pro
l.em - their treatment, educa
ion and follow-up becomes a sizable task to those in a professional
positIon to be able to do something to control the disease. Sizable, but not impossible....
Many people with hypertension go either
undiagnosed or untreated, Over the past three
years. in Edmonton and six small Alberta
towns we have been successful in screening
63,000 people for hypertension, and in
detecting and treating those in this group
found to have elevated blood pressures. We
have used volunteer nurses and a variety of
community resources to create an active
awareness of the existing problem. The
following is a step-by-step account of our
program for the detection, treatment and
follow-up of those with hypertension. The
results speak for themselves.
Donald S. Silverberg, M.D.
Alerting the medical community
. At the beginning of our program,
we obtained the support of the
Alberta Medical Association. This
strategy proved beneficial when
individual physicians became
antagonistic at our "storefront"
medicine.
. We distributed to all physicians a
summary of recent advances in
hypertension, including guidelines
for investigation and treatment.
. We arrar.lged conferences on
hypertension at all the Edmonton
hospitals and we went out and spoke
to the physicians and nurses in the
small towns.
Finding volunteers
. We spoke to nursing
associations, nursing alumni and
public health nurses, both in
Edmonton and in the six small towns.
and had an excellent reception.
Hundreds of nurses volunteered their
time. Our training programs for these
nurses included lectures on
hypertension and a review of the
technique of blood pressure
measurement. The nurses were
required to pass a test for accuracy of
blood pressure measurement before
they could participate in the project.
Finding places for screening
. Shopping center managers
were most cooperative in finding us
busy places in their shopping malls
(I
(I
I1r(l'
to a Successful Hypertensive
Screening Program
and in obtaining free booths for various associations (Rotary,
taking blood pressures. They also Kiwanis, etc.), spoke on
advertised the project in their hypertension, and took the blood
monthly newsletters to their pressures of all those attending.
customers and on radio and . In one small town, a mobile van
television. was used for screening. This was
. After we addressed the local moved from one location to another
pharmacy association in Edmonton, during a three-week screening
30 pharmacists set up blood program.
pressure detection booths in their
drug stores. Only three manned th
Creating public awareness
booths themselves. The remainder . Throughout the past three
had nurses do the screening. years, over 40 articles on
. We approached occupational hypertension have been published in
health nurses in various businesses the Edmonton newspaper. Similar
and in the Provincial Government. advertising took place in small-town
These nurses helped to find suitable newspapers.
areas for our screening program and . Hypertension experts spoke on
advertised the project among their several "talk" shows on TV and
employees. This included placing radio. Posters were set up
announcements about the project in throughout the towns and the city,
employee's pay envelopes. advertising the project and
. We approached Edmonton high explaining hypertension.
schools and colleges and received . Community meetings about
their permission for screening. In hypertension were extremely
high schools, lectures and well-attended in Edmonton and in the
demonstrations about hypertension small towns. At those meetings,
were given by nurses to each senior doctors and nurses spoke about
class, and pamphlets were hypertension, answered people's
distributed to all the students. We questions and took blood pressure
screened 15,000 high school measurements of those attending.
students. about two-thirds of the total . 80th in Edmonton and in small
high school population. towns we contacted members of
. In the small towns, sports local and provincial governments.
arenas were used for hypertension Such community leaders came, with
detection clinics, as well as drug press fanfare. to have their pressures
stores and shopping malls, taken and at the same time, made
. Nurses attended meetings of public statements encouraging
25
The C.nadlan Nur.. October 1878
r
I
participation in our project.
Organizations such as the Rotary
Club, the Chamber of Commerce,
etc., were contacted, and they
encouraged their members to attend
the screenings, Blood pressure
teams visited many of these groups
(including the Provincial Cabinet) to
take blood pressures at the meeting
itself.
. In one town, volunteers
telephoned people on the voters' list
to announce the project and tell
people what hypertension was; in
response, 60 percent came for the
screening. In another town where
this was not done, only 30 percent
came. In the first town, those 40
percent who did not come to the initial
screening were called again, and
another 16 percent of the town came
to a second screening,
. At the time of screening, two
blood pressures were taken, five
minutes apart, and a short
questionnaire was filled out. There
was ample time for people to ask
specific questions about
hypertension. Several pamphlets
on hypertension (both Merck,
Sharpe & Dohme and Sear1e
pharmaceutical companies have
excellent pamphlets, as do the
Kidney and Heart Foundations)
were handed out free of charge.
. Those screened were handed
one of two cards . Those whose blood
pressures were normal, were
handed a card which said so and
showed them their values as well as
the normal values for their ages.
Everyone whose systolic or diastolic
pressure was elevated on both blood
In Edmonton, we have screened 55,000
people of a population of 500,000; 8,000
people from the six Alberta towns have been
tested. In both Edmonton and the rural areas,
six percent of the people screened were found
to have elevated blood pressures and were not
being treated at the time of detection.
Evaluation ofthe results of our program can be
seen clearly in the figures that follow:
. 90 percent of the group found to have
elevated pressures went to see their doctors
as a result of our screening program
. 40 percent of those who went to see their
doctors were started on treatment
. eighteen months after treatment was
begun, 90 percent of those who were to stay
on treatment have done so
. of those who stayed on treatment, 65
percent have aChieved blood pressures of <
160 and/or < 95 mmHg, and 15 percent of
160-169/95-99 mmHg.
Age
Systolic
Diastolic
under 40
;. 155
;. 95
Figure I
40-64
;. 160
"" 95
over 6-1
;. 16
;. 10('
I
pressure readings, received a card to
this effect, which indicated the
specific reading as well as normal
values. This card explained that the
high reading at this time did not
necessarily mean the pressure was
permanently elevated. However it
requested that the individual visit a
physician for further checking,
Maintaining a follow-up program
. Volunteers telephoned those
who had been found to have elevated
pressures at the time of screening.
They called 3 months, 6 months, 12
months and 24 months later to check
whether or not a physician had been
consulted and, if so, what he had
done. If medication had been started,
the volunteers asked whether
treatment was being continued and,
if not, why not. One and two years
after the screening the physicians
were cpntacted by letter to find out
how well the individual's blood
pressure was being controlled.
Perhaps through these contacts
physicians became more concerned.
Recognizing problems
. For our criteria for hypertension
see Figure 1.
(þ Generally physicians did not treat
systolic hypertension or diastolic
blood pressures of 95 to 99 mmHg.
Several studies throughout the world
are currently investigating whether
treatment of these groups is, in fact,
worthwhile. It is the author's opinion
Why have we been so successful? We don't
really know, but maybe some of the tactics we
used have helped to contribute to our success.
Donald S. Silverberg (M.D., M.Sc.,
F.R.C.P.(C)) is assistant professor of
Medicine at the University of Alberta, in
Edmonton, Alberta. He is presently working
with the Department of Nephrology, Chaim
Sheba Medical Centre, Sackler School of
Medicine, Tel-Hashomer in Israel,
Bibliography
1 Silverberg, Donald S. Use of shopping centres
in screening for hypertension, by ... et al. Canad
Med. Assoc. J. 111:8:769-774, Oct. 19, 1974.
2 Silverberg, Donald S. Screening for
hypertension in a high school population, by ... et al.
Canad. Med. Assoc. J. 111:2:103-108, July 26,
1975.
3 Silverberg. Donald S. Long-term follow-up of a
hypertension screening program. Canad. Med.
Assoc. J. 114:5:425-428, Mar. 6,1976.
at the present time that a diastolic ,
pressure of;. 95 mmHg at screening
should be used as the criterion for
hypertension. I
. Physicians generally used cuff
,
of only one width. This is a practiCE'
that needs to be questioned since
standard cuffs may result in
falsely low readings for those with
thin arms and high readings for
those with wide arms. In our
screening program we used blood
pressure cuffs of different widths,
depending on the width of the
person's arm. I
7! Considering other possibilities I
. We undertook a survey of many.
medical specialists in Edmonton.
The majority of them
(opthalmologists, otolaryngologists,
dermatologists, psychiatrists,
surgeons, etc.) did not routinely take
their patients' blood pressures. An
educational drive directed at them
and nurses working in their offices
might produce an excellent source
for hypertension detection.
. Only one of SIX adults admitted
to the Emergency department of the
University Hospital in Edmonton has
his blood pressure taken. It is the
author's personal belief that
hospitals should require that the
pressures of their emergency
patients be routinely taken and that
patients be informed if pressures are
elevated. Those that do not routinely
do so should lose accreditation.
. In a study we did of 500 adults
screened in dentists' offices in
Edmonton, two percent had
pressures of ;. 160 and/or;. 100
mmHg. When they were referred to
their doctors, the dentists' readings
were verified by the doctors' readings
in almost every case and several
patients were put on treatment.
Dentists have a high stake in
detecting hypertension. If they
should use vasopressors for tissue
retraction or do any type of dental
treatment for someone with
uncontrolled hypertension, they
could precipitate a vascular
catastrophe.
. Public health nurses,
occupational health nurses, blood
bank technicians, phvsiotherapists,
chiropodists, chiropractors, firemen
and other groups could also take
blood pressures. We are now
working with unions to get their
members checked for hypertension,
hat patients
want to know
about their
PACEMAKER..,
Authorities estimate that there are close to 300,000 people in
the world today whose lives depend upon the "electronic heart
stimulation" supplied by an implanted pacemake:-. For these
people, their electronic pacer is the key to living a f",11 and active
life. It is only natural for them to have many questions about the
device that enables them to lead a normal life. The Ontario Heart
Foundation has published a booklet that answers many of
these questions. It is called "You and Your Pacemaker" and is
available from the Foundation. Excerpts are reprinted here with
their permission to help you as a nurse become more aware of
these concerns and to be able to offer informed support and
encouragement.
The concept of electrical stImulation of the heart was f"st
introduced in Toronto by Dr. Wilfred G. Bigelow and his associates
in 1950. It was not until 1 960, however, that the first miniaturized,
self-contained electronic pacemaker was Implanted in a human
being. Since then new pacemaker models with improved circuitry
have helped both adults and children with a wide range of heart
problems. .' . .
The normal heart is regulated by a natural tIming deVIce whIch
sets the rate of the heart by producing an electrical signal, causing
the muscle of the heart to contract and relax, pumping the blood
and setting up waves of pressure which can be felt at various parts
of the body as a pulse.
Not every heart, however, functions properly. If the pathway
carrying the natural pacemaker signal is blocked either
intermittently or permanently, we have a conditIon known as "heart
block. "
If the heart block is complete, the natural pacemaker signals
are not transmitted in the heart and the pumping rate may slow to 30
to 40 contractions per minute. This low rate continues because the
lower half of the heart does generate some signals of its own. In
intermittent heart block, a fraction of the natural pacemaker signals
are transmitted,making the pulse slow and irregular.
To restore normal pacing to the heart and overcome either
intermittent or complete heart block, an art'ficial pacemaker
(sometimes referred to as a pacer) is implanted and takes over the
work of the natural pacemaker by sending an electrical signal into
the heart muscle, çausing contraction and relaxation in the same
manner as a naturål pacemaker. For patients who have a complete
heart block, a "fixed rate" (or asynchronous) pacemaker system is
often implanted. This pacemaker sends a steady fixed electrical
signal to the heart at a rate pre-selected for the patient by his doctor
- for example. 70 beats per minute.
For patients with intermittent heart block, who do have some
normal heart pacing, a "demand" (or inhibited) pacemaker system
is implanted. This pacemaker remains inactive as long as the heart
rate is normal. If however, the heart rate drops below the pre-set
rate, the demand pacemaker takes over and maintains an
adequate heart rate.
a. What are the components of a pacemaker?
A. An electronic pacemaker consists of two parts, 1) the pulse
generator (or battery pack) which contain the circuitry and batteries
that generate the electrical signal, 2) the lead(s) (or electrodes)
which carry the electrical signal from the pulse generator to the
heart.
a. Where is the pacemaker implanted?
A. There are normally two sites for the implanted pulse generator. 1)
When the leads are attached directly to the outside of the heart, the
pulse generator is usually implanted in the abdominal wall. This is
referred to as an "epicardial" or "myocardial" implant. 2) When the
leads are inserted through a vein in the neck or shoulder to theinside
of the heart, the pulse generator is usually implanted under the skin
just below the collarbone. This is referred to as an "endocardial" or
"transvenous" implant.
a. When is the pacemaker replaced?
A. Since the batteries in the pacemaker will run down with time,
mechanisms have now been established to determine when the
power source must be changed. This is done by a
ntinuo
s
follow-up of the patient by visits to a Pacemaker C
InIC. or hl
personal physician or cardiologist where electrocardiograms will be
taken and compared to those taken on previous visits. Initially, after
implant, patients will be checked every three to six months. As .t
e
time increases and nears the predicted life of the battery cells, VISitS
will be scheduled more frequently. A fairly recent innovation is
telephone monitoring whereby a patient can telephone a Pacemaker
Clinic and, using a special transmitter, can send an
electrocardiogram by telephone. This is recorded by a tape recorder
and then read by the physician or cardiologist and compared to
previous electrocardiograms. Such telephone monitoring can be
used by patients when on holiday and at a distance from a
Pacemaker Clinic ortheirdoctor. Similarly, it can be used by doctors
and patients in outlying areas by calling a centralized or local
Pacemaker Clinic, Careful monitoring assures the patient that the
pulse generator will be replaced before failure occurs, thus
preventing a recurrence of fainting spells and a very low pulse rate.
The time between initial implant and replacement is being constantly
lengthened Pacemaker manufacturers are continually striving
through research to obtain longer life from the pacemaker.
....
NATURAL PACEMAKER
a, What is the power source in the pulse generator?
A. The power source, necessary to provide the electrical signal to the
heart is provided by battery cells. There are four main types of cells
presently in use. Mercury-zinc cells last on the average of about 30
months. Nickel-cadmium cells may last from 5 to 10 years but must
be recharged by the patient every few weeks. The lithium cells are a
recent development and it is hoped will also last 5 to 10 years, but not
enough data has been accumulated as yet The nuclear cells of
plutonium could possibly last a lifetime.
a. How does a surgeon or cardiologist know what type of
pacemaker to use and what manufacturer's product is most
suitable for the patient?
A. This decision is based on the physician's knowledge of (i) the
patient s heart condition and general health, (ii) the various
pacemakers available and their use, and (iii) his experience and the
experience of other physicians regarding the reliability and
performance of these products.
a. How are the battery cells replaced?
A. The battery cells are sealed in the pulse generator and when the
batteries must be changed, a complete new pulse generator is
implanted This is a relatively simple operation. An incision is made
over the pulse generator, the old unit is removed, the new pulse
generator connected to the existing leads and re-implanted in the
pocket formed by the previous unit. The wound is then stitched. This
operation is usually performed under a local anesthetic and should
not require more than one or two days stay in hospital.
a. Should I feel any discomfort with my pacemaker?
A. At the outset, you will feel the discomfort of the incision and
stitching and will be aware of the pacemaker in your body. When the
wound heals, you should feel little discomfort and will lose your
awareness of the pacemaker.
a. What physical activity may I now enjoy?
A. In general, your level of activity is determined by your particular
heart condition and can be only improved by a pacemaker implant. In
the first few months the patient should avoid sudden stretching or
reaching with his arms to prevent dislodgement of the leads from his
heart. This does not apply to younger children or to those who have
the electrodes attached directly to the heart from an endocardial
implant. After this initial period and insofar as the pacemaker is
concerned, you can bathe, swim, fly, drive a car. golf. curl, play
tennis, lawn bowl, dance, run or jog - whatever activity you have
I ne (;8n8018n Nurse October 1976
EPICARDIAL APPROACH
TRANSVENOUS APPROACH
enjoyed. It is suggested that heavy body contact sports be avoided
as this could damage the leads or pulse-generator. 00 consult your
doctor if you wish to engage in such sports.
a. What is an "Implanted Device Identification Card?"
A. After the surgeon has implanted the pacemaker, he will advise the
manufacturer of the type and senal number of your pacemaker, the
type of leads, yoúr name and address, your physician's/surgeon's
name and address, and date of the implant of the pacemaker.
Shortly thereafter you will receive a card from the manufacturer
with all the above information recorded. This card is an "Implanted
Device identification Card" and should be carried with you at all
times, to identify you as a pacemaker patient.
a. Should I avoid various types of electrical equipment and, if
so, which ones would cause the main problem and why?
A. No. Electrical interference is not a major problem with modern
pacemakers. A demand pacemaker is designed to sense the natural
electrical activity of the heart, but it may, under unusual
circumstances, also sense other types of electrical energy.
Theoretically this electrical interference could possibly alter the
performance of the pulse generator, and you could feel faint or dizzy.
Simply moving away from the electrical equipment will restore the
pulse generator to normal operation without harm to the pacemaker.
This problem has become negligible with proper shielding and
improved pulse generator designs. Standing close to microwave
ovens, arc welders. and large electrical generators may still provide
potential hazards to pacemaker wearers. Standard household
appliances, electric shavers, hair dryers, electrical lawn-mowers
and power tools can be used with safety.
a. Can I continue normal sexual activity?
A. Yes, in most cases.
a. Should I avoid weapons detectors at airports?
A. According to a recent study, weapons detectors used at major
airports will not affect the operation of a pacemaker. They will detect
the presence of the pacemaker. You should be prepared to show
your Implanted Device Identification Card. This card, too, will usually
allow you to bypass the walk-through weapons detector if you ask to
be scanned by a hand scanner.
a. What drugs should be taken or avoided?
A. This should be fully discussed with your doctor and cardiologist.
The Canadian Nurse October 1876
29
Q. Is it necessary to take my pulse daily?
A. It is suggested that you take your pulse at regular intervals. You
will be advised of your pulse rate after you have had your implant and
before you leave the hospital. Should you detect a change,
particularly a drop in rate, immediately call your doctor, cardiologist
or the Pacemaker Clinic that you attend. If they cannot be reached,
go to the hospital. To be sure that there is a measurable change in
rate, rest for about five minutes and take your pulse again. If your
pulse rate should nse, again recheck your pulse, and if it remains at
this rate follow the procedure outlined above.
,
I Q. How do you take your pulse?
A. Place the fingertips of one hand on the inside of the wnst of the
other hand above the thumb. Avoid squeezing the wrist. Press just
hard enough to feel your pulse. Count the pulse beats for a full
minute using a watch or clock with a sweep second hand. This will
give you your heart rate. In babies or small children, it may be
necessary to use a stethoscope to listen to the beat of the heart and
count the heart rate. This is something parents can easily learn to do,
Q. Whom should I advise that I have an implanted pacemaker?
A. When admitted to a hospital for other than a pulse generator
change, inform your doctor, surgeon. anesthetist and/or nurses that
you have a pacemaker. You should also advise your dentist as they
too use equipment generating large electrical fields. If he has any
concern, ask him to put a lead blanket over the pacemaker. Many
patients who have pacemakers wear a Medic-Alert bracelet or
necklace or similar identification in case of an accident. In Canada.
these identification bracelets may be obtained from the Canadian
Medic-Alert Foundation Inc., 174 St. George St.. Toronto, Ontario
M5R 2M9.
Q. What is the function of a Pacemaker Clinic?
A. The function of a Pacemaker Clinic is to follow pacemaker
patients by regularly scheduled visits to the Clinic for
electrocardiographic, electronic and x-ray analysIs and companson
of data with previous records. Results of your visit are sent to your
doctor and cardiologist. The Clinic is not a substitute for visits to your
doctor or cardiologist. but rather supplies additional informatIon
concerning the function of the implanted pacemaker system.
Q. Do I need the service of my physician and my cardiologist as
well as the Pacemaker Clinic?
A. Yes. It is suggested that you regularly visit your physician for your
general health and perhaps visit your cardiologist annually. Results
of your scheduled visits to a Pacemaker Clinic will be sent to your
physician and your cardiologist.
Q.1f I move to another city or town and have to change doctors,
what do I do?
A. Once you have selected a new doctor and have advised him that
you have a pacemaker, ask him to request all the information from
your former doctor or Pacemaker Clinic.
Q. What other symptoms related to problems with my
pacemaker implant should I be aware of?
A. If you experience difficulty In breathing, blackouts. dizzy spells.
prolonged weakness or fatigue, swelling of limbs, palpitations or
chest pains. do advise your doctor. Also. if you have a fever with
tenderness. redness, swelling and/or discharge at the surgical scar,
immediately contact your doctor.
Q. Can the pacemaker be rejected by the body?
A. A pacemaker is enclosed in a plastic or metallic case which has
been shown to have minimal reactions to body tissues. However,
just as some people are allergic to some specific external materials
or products, so some people have a reaction to the plastic or metal
casing of the pacemaker. It is emphasized that such a reactIon is
minimal.
Q. A great deal has been written about nuclear-powered
pacemakers. What are the advantages and disadvantages of
this pacemaker system?
A. Plutonium, the nuclear power source for this pacemaker has the
potential to power a pulse generator for 40 years or more. However.
it is not known how long the electrical circuitry and other components
in a pulse generator will last; nor is the full effect of nuclear radiation
yet known. The cost of the nuclear pacemaker is three to four times
that of conventional battery cell powered pulse generators. PatIents
who have had nuclear pacemaker implants must also register with
the Canadian Atomic Energy Commission and any country outside
Canada that they may wish to visit. Nuclear pulse generators are
designed to be used for the youngest patient due to the added
duration of power which this source offers, Because of the above
reasons, the Ontario Department of Health and the medical
profession are proceeding very carefully in the implanting of
nuclear-powered pacemakers,
Q. Can my pacemaker fail?
A. Any man-made device can fail. but many precautions are taken to
prevent failure. Pacemaker manufacturers carry out stnngent testing
procedures both during and after production of their product. In
addition. checking by your physician. cardiologist. or Pacemaker
Clinic alerts them to possible early failure such as breaks .n the
leads. electronic malfunction or premature battery failures.
Q. Some companies have had a recall on their pacemakers.
Why?
A. It was previously stated that any man-made instrument can fail. If
a significant number of failures occur in any model of a pacemaker
then a recall can be ordered by the Bureau of Medical Devices,
Health and Welfare Canada, or can be initiated by the manufacturer.
There is excellent cooperation between the manufacturers, the medical
profession, and the hospitals and when a fault does appear with any
pacemaker, the manufacturer sends out word to the medical profession
that they should be on the lookout for faults in specific models. On the
other hand, if the doctors or hospitals find faults occurring, they then
alert the manufacturer.
You and your Pacemaker was published with the medical,
educational and financial support of the Ontario Heart Foundation's
Public Education Committee. The booklet was developed and
researched by Ron Gome, a member of the Toronto General
Hospital's Pacemaker Club, and an active volunteer with the
Ontario Heart Foundation's Public Education Committee. Gome,
himself a pacer wearer, based the work on information he gained
from research into commonly asked questions of pre- and
post-insertion pacemaker patients His own experience as a
pacemaker patient has enabled him to recognize the many areas of
concern for those depending on pacemakers. '"
30
The Canadian Nurse October 1976
Mary Rakoczy
Waiting for Cardiac Surgery
Z .1-
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Investigation indicates that patients
who are waiting for cardiac surgery
react according to an identifiable
pattern as the appointed day draws
closer. Understanding these thoughts
and feelings makes it easier for the
nurse to communicate with the
candidate for cardiac surgery at each
stage in the waiting period.
Historians call this the age of space, For
surgeons it is the age of cardiac surgery.'
Improved diagnostic tests, safer methods fo
delivering anesthesia, and mechanical
devices that substitute for heart and lungs
enable the surgeon to perform more
sophisticated procedures in an attempt to
correct cardiac disease. 2 Today, thousands
are alive as a result of such procedures.
Unfortunately, however, most patients find
their admission to hospital an unfamiliar,
stressful, and sometimes frightening
experience. A patient facing heart surgery ma
see it as a devastating blow to himself and tc
his family.3
This paper, attempts to identify the nature
of the thoughts and feelings of patients in thE
waiting period prior to cardiac surgery and the
subsequent implications for nursing care.
The study
Preliminary foci were established by
interviewing the eleven patients in this study.
In general, the content areas that were not
mutually exclusive encompassed the patients
descriptions of their response to the idea of
cardiac surgery and knowledge of it, their
concerns, adaptive behaviors, and method 01
coping with the period of physical preparation
Patients considered their situation in a
seemingly identifiable sequence during the 7,
hours prior to surgery. The emerging
composite profile showed that particular type!
of thoughts and feelings predominated at
different points in time relative to the day of
surgery. Their nature and the order in which
they appeared were reflected in the four
The Canadien Nurse October 1976
31
hases, or periods, identified in the model
;onfrontation, self-reflection, resolution and
ountdown).
This model (Figure 1) permitted a
omprehensive description of the thoughts
nd feelings of patients, but not every patient
.rogressed through all the phases identified.
Confrontation refers to the period when
,atients came face-to-face with the reality of
ihe impending cardiac surgery.
I They made four identifiable types of
tatements referring to this period: reasons,
oncerns, knowledge and support. Patients
lave reasons to justify or explain Ihe
3rthcoming surgery and expressed concerns
!nal revealed their interests and engaged their
Ittention. Some included the amount and type
I)f information they had about the impending
;urgical procedure. And lastly, patients
aferred to the assistance or support provided
)y individuals that had been helpful in dealing
, 'th the impending threat of cardiac surgery.
Self-ReflectIon describes the period
,vnere patients contemplated their situation
Figure 1
I
Confrontation
and tried to explain or justify the cause of
their heart problem. They also talked about
personal losses engendered by their problem
for example, they referred to having been
depnved of something they had had
previously.
Resolution refers to a penod where
statements made by patients focused on the
process of Internalizing the meaning of the
surgery and Incorporating this into their
self-concept. Patients indicated they had
resolved to go through with the surgery and
stated their belief that what is desired is also
possible.
Countdown refers to the day prior to
cardiac surgery when the time remaining was
counted off in fixed units.
The patient
Mr. Linder, a 52-year-old airline
executive, was the father of four teen-aged
children. He had had "heart trouble" for 18
years and stated that, "by June of this year I
had alii could take." When I met him during the
The Waiting Period
I I I
Self-Reflection Resolution
"waiting period' he felt he was gettmg worse
and said that in February he had been "almost
wiped out' by a serious heart attack. Mr.
Linder progressed through all the phases
identified in the study.
Confrontation
Mr. Linder had no difficulty expressing
himself. Confronted with the reality of the
impending cardiac surgery, he verbalized both
his anxiety and disbelief'
I'm anxious about the Idea of open heart
surgery. (silence) So, now, I m going to
have heart surgery. (sigh) That's a pretty
difficult pill for me to swallow but It'S
something I'm going to have to get used
to... and fast.
Mr. Lmder gave reasons for needing
surgery and seemed to try to justify or explain
it. He saw himself as having no alternative: his
medical condition was such that this was the
"last resort."
Patients expressed concerns In four
areas. They verbalized their feelings of
helplessness and/or fear of impairment. the
I
The Countdown
Table 1
Summary of Expressed Concerns
Concern No of Patients Who Expressed Concerns
First Interview Second Interview Total
(Time 1) (Time 2)
. Feeling of 11
Helplessness 10
. Fear of
Impairment 8 2 10
. Seriousness
of the Surgery 6 3 9
Fear of Dying 4 4 8
.
Concerns are those expressed by patients during the first and second interview. Time 1 refers to the first mterview. Time 2
refers to the second interview. Most patIents were in the "confrontation" phase at Time 1 and "countdown" at Time 2
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'
CLINICAL GERIATRICS
1
This timely, cross-disciplinary work provides a
comprehensive account of the diagnosis and treatment
of the older patient within the framework of the biological
process of aging. All organ systems and their diseases are
completely covered from the preventive, diagnostic, and'
therapeutic aspects.
Such problems as osteoporosis and fracturÐ5; dimin-
ished hearing and vision; the threat of vertigo; the rising
incidence of postural hypotension; the impairment of
homeostasis; etc., are explored in depth. Recent advances
in various fields applicable to geriatric patients are fully
covered - psychotropic drugs; rheumatology; diabetes;
anesthesia; orthopedic joint replacement; cardiovascular
disturbances; etc,
Basic material In aging, from the anatomical to the
molecular to the genetic, has been included. A most valu-
able section discusses the psychologic, psychiatric and
environmental aspects of the aging patient,
Edited by I. Rossman, Ph.D.(Anat.), M.D.
Lippincott 525 Pages Illustrated 1971 $26.00
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THE DYING PATIENT:
A SUPPORTIVE APPROACH
.
Written specifically for the many hundreds of thou-
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compassionate solutions to the difficult problems they
encounter. It provides nurses with both the psychological
foundations necessary to understand the varying meanings
of death and dying, and straightforward, thoroughly
practical guidelines for coping with the actual clinical
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particular problems of adults facing death, and death in
acute care settings.
Edited by Rita E. Caugh"I, R.N., M.S.
Little, Brown 228 Pages 1976 $6.95
PSYCHIATRIC DISORDERS
IN OLD AGE
3
Americal edition of a British handbook for the
clinical team, to help untrained personnel recognize
psychiatric conditions in the aged and to assess their
importance. An introduction and a chapter, "Two Old
Ladies," are followed by discussions of particular disorders,
the family and community, treatment and the therapeutic
team, services, and other topics.
By j. A. Whitehead, D.P.M.
Springer 128 Pages 1974 $5.95
.
SPECIAL NEEDS OF
LONG-TERM PATIENTS
This informal and delightfully written book is a
"must" for all nursing personnel who are directly involved
in the care of long-term patients in any care setting. Draw-
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with families; nursing tips for common treatments, tests
and medications;
elationships with confused or disoriented
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patients and an extensive chapter on death and dying.
By Carolyn B. Stevens, L.P.N.
Lippincott 288 Pages Illustrated
1974
$5.90
PRACTICAL MANAGEMENT
OF THE ELDERL V
5
This book describes the medical, social and psycho-
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the patient as a complete person is elaborated.
By W. F. Anderson, Q,B.E., M,D., F.R.C.P. (Glasg.,Edin.)
Blackwell 392 Pages Illustrated 1971 $12.75
AGING AND BEHAVIOR
Up-to-date comprehensive, in-depth study of the
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special area is being accorded increasing priority, the book
offers a welcome source of introductory reading on the
subject. Topics Include: Who are the aged, factors in
longevity and survival, sexuality, turning inward, processing
sense information, problem solving, memory theory, issues
in research, and more.
By j. Botwinick, Ph.D.
Springer 336 Pages 1973 $12.50
7
NURSING CARE OF THE
LONG-TERM PATIENT r 2nd Edition
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patient, Now updated in the light of advances and inno-
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By Jeanne E. Blumberg, R.N., P. H.N. , M.S., and Eleanor
E. Drummond, R.N., P.H.N., Ed.D.
Springer 154 Pages Illustrated 1971 $5.50
CARING FOR AND CARING
ABOUT ELDERL Y PEOPLE
.
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By Janet M. Long, R.N., M.S. With 13 Contributors.
Lippincott 127 Pages 1972 $3.90
ABOUT BEDSORES
11
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By Martan E. Miller, R.N., M.S.N., and Marvin Sachs, M.D.
Lippincott 45 Pages Illustrated 1974 $5.40
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By Robert Kastenbaum Ph.D., and Ruth Aisenburg, Ph.D.
Springer 446 Pages 1976 $9.95
CARE OF THE OLDER ADULT
9
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Lippincott 228 Pages 1973 $4.75
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34
Tha Canadian Nu...e October 1976
seriousness ofthe surgery, and/or their fear of
dying. (Table 1)
Mr. Linder talked about his fear of dying.
He said:
You know, I'm really concerned with the
whole dying aspect of it. I feel very
positive, but I still think anybody In my
position thinks about it. Every operation
has its risks. I figure I might die and that's
it. It can happen to anybody anytime
but...
He said that he had put his will in order
before coming to hospital and often mentioned
that his family still needed him.
The knowledge patients had about their
impendmg surgery varied from minimal to
extensive; only two patients had detailed
information. Mr. Linder was one of them. He
said:
The doctors propose to do a bypass on
me. They are going to strip a vein out of
my foot and then bypass the diseased
area... One of the arteries has lost 95
percent of its efficiency. The maior
problem in my case is near the iuncture of
the left anterior descending and the
circumflex. The one affected is the left
anterior descending. Now that one is
operative. They can tell from the
angiogram that this one can be done...
The bypass will be done straight from the
aorta to at least an inch beyond the
diseased area. The other maior artery
affected is the right coronary and that is
affected in several areas. That one
caused the original infarct and whether
that bypass can be done is
questionable... But the heart is going to
develop its own bypass system and the
circumflex will be feeding the muscle
tissue.
Mr. Linder was often aggressive in that he
would control the conversation, and it was
difficult to keep him on topic. He expressed his
lack of confidence in the doctors and nurses
several times and said he enjoyed "stumping
them with questions" and he was
sometimes "flabbergasted by their answers.'
In referring to support during
the "confrontation," eight patients expressed
confidence in their doctor. This was
conceptualized as supportive in nature. Mr.
Linder, was representative of this group:
The doctors here are good and I know I'll
get good backup. Knowing that, well,
that makes me feel good.
His confidence in the technology also
helped him face the idea of surgery.
Family members played a supportive role
for Mr. Linder and he appeared to have a close
relationship with them; his expressions were
loving and he smiled when he talked about
them.
Mr. Linder also made reference to a
successful patient, one who had had cardiac
surgery and was "better off now than he ever
was . This seemed to be yet another means of
support, as this person was "living proof" that
the surgery was, in fact, successful.
Self-Reflection
Mr Linder tried to explain or justify the
cause of his heart problem. He attributed it to
being overweight, to high blood pressure, and
to stress associated with his work. He stated:
I have some theories about my own case
I cannot speak for anybody else. I had my
first infarct in 1966. I had no previous
history of a heart condition. There were
no symptoms except that I was
overweight by about 14 kilograms and I
have always been so. Also, my blood
pressure tended to be on the high side.
And last but not least... commitments to
the iob. That, I think, is responsible for
most cardiac problems. I hear a lot of talk
about dietary things but I question that. I
believe stress has more to do with it than
diet. Diet may be a contributory factor,
but stress is a maior factor because
stress changes the electrolytes in the
systems.
Resolution
In the 'resolution" period Mr. Linderwas
"talked out" and said;
I can't ask any more questions because
it's all been explained to me (pause) so I
just sort of sit and wait for tomOrrow. "
Countdown
Time passed almost unbearably slowly
for Mr. Linder during this "countdown" period,
He often checked his watch, and once said:
Well, that's my life up to 9:03... My God,
how the time drags.
Mr, Linder restated his confidence in his
doctor during this period:
Dr. Myles is good... I'm glad I have him.
The day prior to cardiac surgery, he also
sought out a successful patient to converse
with. He recounted the following:
Yesterday I went to visit Peter Price, He
had surgery five days ago... I iust wanted
to talk to him ... to see how he was doing.
He did more for me than 10,000 chief
surgeons and all the documentation in
the world, because that was living proof.
In the "countdown," routine procedures
were important to Mr. Linder:
Today is going to be one of those days
that goes on and on and on, but I
suppose they will keep me busy. I
appreciate that because I know it won't
be done in a haphazard way... that gives
confidence... this routine.., this logical
sequence.
Implications for nursing
Mr. Linder, as one of the eleven patients in
the study, illustrates a number of points
important to nursing.
. During the confrontation period, when
patients realize with shock the seriousness of
having cardiac surgery, the nurse may help
maintain hope by allowing them to express
their feelings.
. When patients feel they have no
alternative but to undergo surgery - "a last
resort" - many are bolstered by a feeling of
confidence in the doctor. The nurse may
further support them by expressing her own
confidence in the medical team and the
technology involved.
. When expressed concerns center around
the patients feelings of helplessness and fear
of impairment, the nurse may indicate her
confidence in the medical team .
. The amount of knowledge about the
impending surgery varies from patient to
patient. Only two in this study had detailed
information and only one patient asked fOI
more detail, particularly about the surgical I
procedure. This suggests that not all patients
require or desire a great deal of information in I
the preoperative period. I
As nurses, we need to reexamine our
teaching plans. Is our teaching still based on
what we think patients should know, or on the I
needs of individual patients? Is it crucial, for
example to teach deep breathing and
coughing? If so, how and when? We need to
find out how patients learn in the preoperative
period when they think and feel as they do.
. In the confrontation period, when patients
talk about their families and show an interest in
having them present, the nurse needs to be
aware of the importance of families to patients.
Supportive relationships can help minimize
anxiety by reducing a patient's feelings of
alienation from those who are meaningful to
him. For example, rules for visiting hours may
be appropriately bent or discarded,
. When patients in the confrontation period,
refer to the Importance of seeing or hearing
about similar cases, the nurse can instill a
sense of confidence by providing examples of
her former patients who have had successful
operations. Later, in the countdown-, patients
themselves actually search out these
successful patients without the aid of the
nurse. The nurse can best assist by being
aware of this and allowing patients to do this on
their own.
. As patients move on to self-reflection,
they indulge in what appearS to be self-pity or
grieving, suffer feelings of guilt, and mourn
their loss of control. The nurse needs to
recognize the importance to patients of this
period of grief. She can assist by encouraging
patients to verbalize the felt losses and their
causes since it has been demonstrated that
talking does help and that "if grieving is
blocked. the patient then has to adopt some
defensive sort of adaptation rather than clear
the site to reconstruct the ego. "4
. The resolution period is characterized by
expressions of hope of recovery, rebuilding of
confidence and self-esteem, and the decision
to go ahead with the surgery, Patients move
quickly from this phase to the countdown.
The Canadian Nurse October 1976
35
. In the countdown patients are still
interested in having their families visit them.
However, as they are "talked out," the
presence of the family seems sufficient. The
, nurse should inform families that, as the day of
I the operation approaches, their presence,
rather than verbal discourse, may be what
patients need. The nurse must remember that
families, too, need her support as the surgery
IS often frightening for them.
How can the nurse best help families
while they support patients? Are families
allowed time to talk with the nurse? Do we, as
nurses, need to identify more clearly what
families do to support patients so that we can
assist them?
. The most important statements made by
patients in the countdown are simply, ''I'm all
talked out" and ''I'm not going to change my
mind." The nurse needs to be aware that
talking is no longer useful, but her actions are
evidence that she can be trusted to be in
control of the patient's life.
Sometimes, baby gets
more air than formula.
Conclusion
This study was prompted by the apparent
isolation of patients awaiting cardiac surgery.
in an attempt to understand more about the
limited nurse/patient interaction that
characterizes this period. Is this
I communications breakdown caused by the
I fact that the nurse does not fully understand
the needs and feelings of the patient during
this time? If so, reading about the concerns
expressed by the patients in this study as
represented by Mr. Linder may offer some
enlightenment.
The data suggest that the feelings of
cardiac surgery candidates are worked
through chiefly on a verbal level and that these
patients therefore urgently need psychological
support. Effective nursing care demands
recognition of this requirement as well as
attention to the physical needs of patients
waiting for cardiac surgery. ..
""---..
---
That's why we make soothing,
peppermint-flavoured Ovol
Drops.
Ovol is simethicone. an
effective but gentle antiflatu-
lent that relieves trapped air
bubbles in baby's stomach and
bowel without irritating gastric
mucosa.
Ovol works fast. And that's a
relief for baby. And for mother.
Also available In adult-strength
chew8Þ1e t8Þ\ets.
OVal DROPS
FOR INFANT COLIC
--
Mary Rakoczy, (Soganich) (R.N., St.
Elizabeth's School of Nursing, St. Joseph's
Hospital, Sudbury, Ontario: B.A., Laurentian
University; M. Sc. (Appl.), McGill University) is
assistant professor of nursing at Queen's
University. She collected data for this article
while a student at McGill University, Montreal.
O Võl
.. .
.7 .....
References
1 James, Edwina E. The nursing care of the
open heart patient. Nurs. Clin. North Am. 2:3:543
-558, Sep. 1967.
2 Rogoz. Barbara. Nursing care of the cardiac
surgery patient. Nurs. Clm. North Am. 4:4:631-644,
Dec. 1969.
3 Ibid.
4 Shands, H.C. An outhne of the process of
recovery from severe trauma. AMA Arch. Neurol.
PsychIatry 73:4:403-409, Apr. 1955.
H HORnER
36
The Canadian Nurllll October 1976
An Affair of the
Like most people, I always thought a heart
attack was something that only happened to
somebody else, like a car accident. Then I had
one of my own, 3,000 miles from home on the
third day of what was to be a three-week
holiday, The doctor called it a myocardial
infarction, a term which appealed to me
because it seemed to add a little class to the
whole affair.
The event had many bad effects. It kept
me in hospital for six weeks, creating a lot of
work and nuisance for SOr.1e exceptionally nice
people. It ruined my holiday, scared the
stuffing out of me, and brought a great deal of
worry to my wife and family. On the other hand,
there were benefits. It forced me to take a long
rest. something I should have had sense
enough to do of my own accord. And of course
my heart attack has given me an entirely new
subject for boring my friends, acquaintances,
and even casual passersby.
Much of the initial attack is hazy in my
memory. I can remember a terrible crushing
feeling, as though a pro linebacker were
kneeling on my chest and a severe pain,
incredibly like a toothache, in both jaws. I
say 'incredibly' because I have reached the
stage where, if my teeth ache. I drop them in a
glass of water and tell them to go ahead and
ache.
I also recall the ambulance ride - feeling
that I was taking part In a rerun of Emergency
on TV I was disappointed that the attendants
didn"t call Ramparts and give my vital signs to
Bobby Troup, but was sustained through the
ride by the thought that I would wake up to find
that delicious morsel, Julie London, hovering
over me as she soothed my fevered brow. The
bearded intern who met me at the hospital was
quite a let-down.
The next morning I woke up to find six
electrodes glued to my chest, all feeding into a
little TV set over my head. There were also two
intravenous needles stuck in my arm, their
tubes leading to two bottles of clear liquid
hanging from what looked like a small
hangman's scaffold. I remember asking a
John Duffie
nurse if she could fill one bottle with gin and the
other with vermouth, but she paid no attention
other than to remark that they didn't have any
olives. All the electronic gear brought a feeling
of déja vu. Then I realized that my TV
conditioning had again betrayed me - in my
imagination I saw myself as none other than
the six million dollar man, give or take a dollar
or two.
The electronic monitoring system caused
one minor crisis. I woke up one morning to find
that in thrashing about in the night I had pulled
three of the wires out of the tiny six-holed plug
that fed proof of my existence to the
oscilloscope. Without giving the matter too
much thought. I plugged the wires into the first
three sockets that I happened to see. The
resulting pattern on the screen brought the
staff on the run, all certain that I was not only
dead, but had risen.
A good mental attitude is important in
heart therapy. I was lucky because I was
looked after by people who were not only
capable and efficient, but were blessed with
enough sense of humor to bring a few laughs
into an otherwise grim situation. For example,
there was an occasion when a pleasant young
nurse was trying to insert an IV needle in my
arm. Unfortunately I am cursed with small,
elusive veins -a technician once told me they
were known as "rollers" in the trade - and my
nurse was jabbing away, like a housewife with
a broomstraw testing a cake for 'doneness'.
After a little of this I asked, "What's going on?
Are you playing 'pin the tail on the idiot' or
something?" She looked at me scornfully and
replied, "Don't snarl at me. You rethe one with
the substandard veins."
One night the same nurse asked me if I
would like some orange juice - when I
accepted she ran into trouble finding a way to
open the can. I heard her mutter to a
colleague, "With the price of scalpels being
what it is, all the can openers are down in
surgery. "
Adding to the carnival air of the place was
the jolly lab technician who appeared every
day to collect blood samples, announcing her
arrival with the cry of "The vampire strikes
again!"
I have many more pleasant memones.
Heart patients work their way through a
number of levels of activity, and I had reached
the point where I was required to walk up and
down a short flight of stairs three times a day.
One night I dozed off about 9.30, about a half
hour before official 'lights out'. only to be
shaken awake at 9.40 to take my sleeping pdl.
(I know this is a cliché but, so help me, it
happened). I had barely dropped off to sleep
again when another cheerful soul woke me up
a second time, suggesting that it would be a
good opportunity to do my stair climbing.
I am not foolish enough to claim that a
heart attack is a good thing. But if you manage
to survive, it can have the beneficial effect of
scaring you into living a slower, less frantic and
more sensibly-paced way of life. Years ago, in
Toronto, I saw graffiti which read, "Death is I
nature's way of telling us to slow down:' A
heart attack, while less drastic, can deliver the
same valuable advice.
John Duffie (Victoria, B. C,) is a member ofthe
American Association of Retired Persons, the
National Council on Aging, International
Federation on Aging, the B.G. Old Age
Pensioners, the Canadian Authors'
AssocIation, and numerouS other groups.
Retired from his position of Property Tax
Manager WIth Canadian Pacific, Duffie has
channelled his energies into other areas:
"Believing strongly in varied interests for
retired persons, I am trying to develop a sort of
second career as a free-lance writer,
specializing in the field of aging and
retirement." His work has appeared in several
weekly papers in the Victoria area, and he has
had some speaking engagements and a
couple of T. V. appearances, all concerned
with problems of the elderly. ..
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of th e
myocardial
infarction patient
The treatment of myocardial infarction patients has changed substantially in the past decade but, for
many patients, a heart attack still spells the end of a normal, productive life. Nurses can do a great
deal to combat this attitude and help patients maintain a positive self-concept. Successful nursing
intervention starts at the time of admission and continues until the patient is ready to resume his
normal living patterns at home.
-
Patient study
Ten years ago, at the age of fifty-nine,
Mrs. Adams first experienced chest pain.
Her doctor advised her to "take it easy'
and Mrs. Adams promptly retired from
her job. With each succeeding episode of
chest pain, Mrs. Adams curtailed her
activities more and more. She now only
washes her dishes and makes her beds
"if I feel like it." Because she is afraid that
"something might happen," Mrs. Adams
never goes for a walk. She has confined
herself to her home, spending her time
reading and watching television.
Mrs. Adams feels that she had not
been healthy "since my heart started up ..
She believes that her health is
deteriorating daily, even though there
has been no rapid progression in her
coronary artery disease.
Mrs. Adams views herself as a
chronically sick person, unable to
participate in any physical activity. She
feels that she must always be careful
because any excitement or exertion
might "be bad for my heart." Mrs. Adams'
vIew of her heart and of herself have led
her to become a cardiac cripple.
Carrolliwasiw Cook
The symbolism that surrounds the human
heart has a direct bearing on the attitude of the
myocardial infarction patient towards the
event that results in his admission to hospital.
If he is like most of us, he regards the heart as
the center of life, the seat of his emotions. A
threat to this vital organ constitutes a threat to
his personal identity. Within the space of a few
short minutes, his attitude towards himself as a
living. breathing individual changes
drastically. Unless the health professionals
canng for him take steps to prevent it, hIs
self-concept is almost certain to suffer
permanent damage.
Self-concept is a person's total view of
himself and his appraisal of what he sees. It
includes his attitudes and beliefs about his
abilities, his occupation, his successes and
failures, his body shape, his relationships with
others, his personal expectations, and his
sexuality. A person s self-concept is
influenced by the reactions of other people
towards him, and by his perception of their
behaviors.
The heart attack victim 10 years ago
A decade ago, the treatment of patients
with myocardial infarctions was considerably
more conservative than today. Members of the
family were often told, "It's a miracle he lived
through this," Having "lived through it," the
heart attack victim was not allowed to do
anything for himself.
Bedrest for three to six weeks was
common. The nurse fed the patient and did
passive range of motion exercises on his limbs
for at least two weeks. Progression to a
bedside chair meant being lifted into it from the
bed. Walking was Introduced into the
rehabilitation program at about eight weeKS
postmyocardial infarction. Discharge home
might have been in an ambulance to minimIze
exertion during the tnp.
Vague discharge orders to "take it easy'
and "don't ove
do it" offered no gUidelines
about an acceptable activity level The patient
was often left with the feeling that the quality of
his life was severely altered.
It IS not surprising that many myocardial
infarction patients developed an image of their
hearts as fragile organs. Fear of sudden death
was common among these patients If health
personnel in the hospital were afraid to let
them be active, then surely something terrible
would happen If they resumed their usual
patterns of living,
The heart attack victim today
Times have changed and now It IS
recognized that most myocardial infarction
patients are physically capable of returning to
their usual activities, or, under medical
-
supervision, even increasing their physical
activity. Active leg exercises and perhaps
chair rest are begun in the Coronary Care Unit.
Ambulation may begin within two weeks
postmyocardial infarction.
Coronary Care Unit
It is in the Coronary Care Unit that the
groundwork is laid forthe patient and his family
to develop a positive attitude towards his
illness. Attitudes conveyed to the patient and
his family in the CCU are likely to be reinforced
by the crisis situation of the patient/family unit.
The nurse's first task is to listen to the
feelings expressed by the patient and his
family. This will give her insight into how they
perceive a myocardial infarction and what
changes they expect in their lives.
While the patient is in the Coronary Care
Unit. the nurse can allow him some
independence. Choices are possible within
the routines of daily care. For example, the
patient can choose to have his bath before or
after breakfast.
The coronary care nurse is in a unique
position to prevent overprotection of the
patient by his family. By outlining future activity
steps, she can demonstrate her belief that the
patient will not always experience pain and
fatigue. If she takes the time to describe the
progression in activity he will experience after
transfer from the Coronary Care Unit, the
nurse can offset the feelings of dependency
the patient is experiencing.
While he is still in the Coronary Care Unit,
the nurse can help the patient maintain his
concept of himself as an independent,
responsible adult. She can emphasize to the
patient that he has some control over what
happens to him. She can help him become
sensitive to his bodily sensations - the
location, character and intensity of his pain.
She can also help him begin resuming
responsibility for his body and health by letting
him participate in the decision to try
nitroglycerine and oxygen or an analgesic
injection to alleviate the pain.
One of the most important ways in which
the nurse can help the myocardial infarction
patient maintain his self-concept is to
emphasize his areas of competency. This can
be done only when the nurse knows her
patient and which aspects of his life are
important to him.
The Ward
Nursing intervention designed to help the
patient maintain his self-concept is continued
on the ward Here the medical goal is for the
patient to reach the level of self-care required
when he goes home. The nursing goal is to
help the patient and his family continue to
develop a healthy attitude towards himself and
his illness.
During his program of gradually increased
activity, the nurse conveys an attitude of
confidence in the patient's ability. Her relaxed
attitude as the patient assumes more
responsibility for his self-care, does much to
dispel the fears of sudden death associated
with activity. If she includes the family in the
Ill'll \,tanGU11U1 .,un." VC10uer JW/D
-.-
,.
activity program this will help to alleviate their
apprehension and to promote family
interaction. It is important that activity be
alternated with periods of rest to prevent
undue fatigue and feelings of helplessness.
Emphasis on signs of improvement help
the patient to see himself as progressing
towards health. It will engender in both patient
and family an expectation that usual life
patterns may again be possible.
Planning for discharge
Successful readjustment to life at home
after his hospital stay requires careful planning
on the part of the health care team, the patient
and his family. Areas that should be reviewed
together before discharge include:
- a warning that a feeling of fatigue once he
gets home is normal and is due partly to
attempts to resume more activities and partly
to deconditioning in hospital. Knowing that
this "weakness" is normal and temporary can
prevent feelings of depression and
hopelessness.
- concrete information about medications
(name, dosage, desired effects and possible
side effects) as well as information about what
to do if chest pain recurs. These add to the
patient's feeling of competence and control
and help to bolster his self-concept.
-desirable modification of smoking and
eating habits and information on the amount
and type of permitted exercise, sexual activity,
the need forfollow-up visits to a physician, and
the ability to resume normal working habits.
A definite plan of activity and continuing
support from the health team can go a long
'\
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.
.
.
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way towards preventing disruptive family
arguments that assault the self-concept. It can
also reinforce the steps already taken in
hospital to ensure that the myocardial
infarction patient does not become a cardiac
cripple. ..
The author, Carroiliwasiw Cook, R. N. is a
graduate of the University of Manitoba
(B.N.) and received her M.Sc.N. from the..
University of Western Ontario. Her
experience includes work as a staff nurse
on a general medical ward at
Northwestern General Hospital in
Toronto and in the Coronary Care Units of
the Vancouver General Hospital and the
Victoria General Hospital, London,
Ontario. She is now lecturer in
Medical-Surgical Nursing in the Faculty
of Nursing, University of Western Ontario.
Bibliography
1 Carnes, Giles D. Understanding the cardiac
patient's behavior. Amer. J. Nurs. 71 :6:1187-1188,
June 1971.
2 Epstein, S. The self-concept revisited. Or a
theory of a theory. Amer. Psychol. 28:5:404-416,
May 1973.
3 Klein, Robert F. The physician and
postmyocardial infarction invalidism, by ___ et at-
JAMA 194:2:143-148, Oct. 11, 1965.
4 Smith, Catherine A Body image changes after
myocardial infarction. Nurs. Clin. North Amer
7:4:663-668, Dec. 1972.
5 Wenger, N. Rehabilitation of the myocardial
infarction patient, by... and C. Gilbert. In Hurst, J.
Willis. The Heart, ed. by... and Bruce R. Logue. New
York, McGraw-Hili, 1974. P.1140-1149.
an . an ',ae .. .....
!III I
!litlllFlit PitDlll1
The crisis that precipitates admission of
the MI patient to the Intensive Care Unit
and the stress that these patients
experience in this hospital setting has
been well documented. What is less
generally recognized is the extent of the
psychological adjustment involved in the
subsequent transfer of.these patients
from the ICU to a general medical ward
The authors set out to learn more
about the transfer process and its
implIcations for nursing care Their
subjects were 26 cardiac patients who
were observed during their stay in ICU
and for a period of 24 to 72 hours on the
wards after the transfer took place.
When the critical phase of the MI patient's
recovery is over and he no longer needs
the intensive care provided within the
ICU. he is transferred to a general medical
ward. This transfer involves transition
from a state of total dependence to a state
of relative independence. The patient
leaves an open setting in which there was
a high nurse-patient ratio. constant
presence of the nurse, and where his
heart activity was carefully monitored. He
moves to a medical ward where there are
fewer nurses not always in sight and
where assessment is made by the
patient's symptoms, placing greater
responsibility on the patient. The
nurse-patient relationship that fosters
dependence withm the ICU ends abruptly
and the patient must adjust to a change in
doctors, nurses and physical
environment. As a result, transfer causes
a break in the continuity of care and
Betty Lethbridge, Orranun Somboon, Hattie Lee Shea
frequent inconsistencies of care. Patients
are likely to experience a sense of loss.
abandonment, fear and Insecurity that
one investigator has described as
"separation syndrome."
Because of the particular
psychological problems of cardiac
patients in the ICU and the added stress
of the transfer process, it was anticipated
that patients would experience anxiety
and physiological complications following
transfer. The staff of the hospital where
the study was conducted confirmed this
observation. The Head Nurse on a
medical ward that received many of the
patients from ICU stated that problems
such as chest pain, anxiety, fear,
insomnia, and demanding behavior
frequently occurred within 72 hours of
transfer. She suggested that the time of
transfer might also contribute to patients'
problems of adjustment and pointed out
that patients are usually moved to the
ward early in the afternoon when beds
become available. This is a very busy time
of day for the nurses who are completing
their day's assignment and preparing
reports for change of shift. As a result, the
number of nurse-patient contacts are
reduced. especially in comparison to the
ICU.
In order to carry out the study, the
authors interviewed patients directly and
also studied current and past patient
records. Information was collected on;
mode of admission, diagnosis, time of
transfer, expressed feelings and
complaints, behaviors exhibited, medical
(doctor's orders for recheck EKG and
CPK) and nursing intervention within
24-72 hours of transfer.
Admission by Emergency
Twenty-five of the 26 patients studied
were admitted to ICU from the Emergency
Department. One author has observed that
this involves a psychological as well as
physiological crisis. The patient has no
altemative but admission and complete
dependence on others, and there is no time
for preparation. The patient within ICU has no
control over what is happening to him, He
feels helpless and tends to overevaluate the
power of the helping staff. As a result, he
becomes increasingly dependent upon the
doctors and nurses and the complicated
equipment to which he is attached.
Transfer
The patients stayed an average of
five days in the ICU. and then they were
transferred to a general medical ward.
Sometimes they were moved rather
abruptly when a bed in the ICU was
needed for a new patient. Patients were
disconnected from the monitor just prior to
transfer. Immediately following transfer,
new interns and nurses were assigned to
the patient.
Within 72 hours of transfer. close to
half of these patients (42 percent) voiced
specific physical complaints such as
chest pain, headache and dizziness.
Eight of these eleven complained of chest
pain. In four cases, the physician
responded by ordering an EKG and CPK
Three of the four test results showed no
evidence of further pathological change.
The pain and discomfort suffered by these
40
patients was thought to be related to
anxiety following transfer.
Mr. G., a 47-year-old married man, was
admitted to ICU from Emergency with
severe chest pain. He was diagnosed as
having an acute myocardial infarction. His
physical condition stabilized within four
days and he was transferred at 1700 hours
to a medical ward. Shortly after transfer,
Mr. G. complained of chest pain and
nitroglycerin 0.6 mg was administered
which brought relief. On the second and
third days following transfer, Mr. G.
continued to complain of chest paul, An
EKG and CPK were ordered to investigate
the possibility of an extension of his M.I.
The results indicated no further
pathological change. Through interviews it
was learned that Mr. G. was wOrried
because his condition required restricted
activity and he expressed considerable
anxiety about the possibility of these
limitations being permanent.
Fourteen of the 26 patients studied
exhibited behaviors indicative of anxiety
such as restlessness, tearfulness,
insomnia, poor appetite, refusing care
and/or demanding attention.
Mrs. S., a forty-two-year-old married
woman, was admitted from the
Emergency Department with an acute
M.I. Six days later, she was transferred
rather abruptfy during the evening
because a bed was needed in ICU. The
first night on the ward she complained of
chest pain and insomnia. The next day
she became very upset, refused care
and was perceived by the staff as being
an uncooperative patient. However,
during an interview with Mrs. S., she
expressed considerable anxiety related
to her condition. She was afraid of dying
suddenly, as had several of her family
members in the recent past.
Time of Transfer
Twelve of the 26 patients were
transferred in the afternoon and evening
(1300-2400 hours). Of these patients, 10
(83 percent) complained of chest pain or
exhibited behaviors indicative of anxiety.
Ten of the patients studied were
transferred in the morning (0700-1300
hours). Of these, less than half, (40 percent)
complained of pain or exhibited behaviors
indicative of anxiety. (Time of transfer was
not available in four cases).
These results would seem to indicate
that transfer during the afternoon is more
frequently associated with the
development of patient problems in
adjustment than transfer during the
morning. One seemingly important
difference between morning and
afternoon transfers is the number of
nurse-patient contacts Reduction of
The Canadian Nur.. October 1976
nurse-patient contacts is to be expected
following transfer because of the change
in physical environment the patient
moves from the open area of ICU to a
room on the ward. However, contacts are
further reduced in the afternoon þecause
of the preparation of reports for change of
shifts and because the actual number of
nursing staff is reduced in the evening.
Nursing Implications
How a person responds at a given
time will depend upon how he perceives
the situation. If it is perceived as
threatening to his identity, sense of being
or personal security, he responds with
anxiety.
Although the patient may understand
that his transfer is a sign of improvement
and an indication that the critical phase of
recovery is over, emotionally he may not
be ready for the move. Many demands
are placed on the patient at this time. He
must adjust to a new environment, new
staff, less intensive care and become
more independent when emotionally he
may be very concerned about what a
heart attack may mean to his survival and
future lifestyle. Thus, it is not surprising
that the patient's anxiety increases at this
time and if left unresolved, can interfere
with his recovery.
If the nurse is to be effective in
meeting the patient's needs, she must be
aware of how the patient is perceiving his
condition and how he interprets what is
happening around him. The patient will
respond to his own perception of a
situation, not the overt reality of it. The
nurse must seek to understand the
meaning of the patient's feelings and
behavior from his point of view and then
validate her interpretation of his needs by
talking with him. Only then can
appropriate nursing intervention and
planning of care take place.
Understanding what is happening
between herself and the patient is central
to nursing practice and comprises the
basic framework for the help she gives.
For example, a few days following
transfer from the ICU, Mr. K., a post-M.1.
patient, asked the nurse for information
about heart attacks. Because he did not
appear to be anxious, the nurse assumed
Mr, K. was not anxious and was only
asking for information. Responding
literally to his request, she gave him
booklets to read. The following day, Mr. K.
became extremely anxious about his
condition and had to be calmed with
tranquilizers administered
intramuscularly. Had the nurse talked with
Mr. K. to find out how he felt about heart
attacks and any concerns he might have
had, the anxiety attack which occurred
might have been averted.
In conclusion, with a change of stan
and a reduction in the number of
nurse-patient contacts in the new
environment of the medical ward, the post
transfer period is indeed a vulnerable time
for the patient. Knowing this, the nurse
can predict that the patient will feel
anxious following transfer even though he
may not give overt indications of this
concern and she can then give him the
extra support he needs. The
establishment of a helping nurse-patient
relationship requires collaboration of
nursing staff from both the ICU and the
medical ward. Working together, they can
do a great deal to counteract the stress
felt by the patient in his new environment.
..
Authors Orranun Somboon and Betty
Lethbridge were fef/ow students in the
Master's program of the School of
Nursing at Dalhousie University when
they wrote this paper. Their professor in
Medical-Surgical Nursing was Hattie Lee
Shea who is a graduate of Methodist
Hospital in Dallas, Texas and obtained
her BSN Ed. and MSNfrom the University
of Texas.
Orranun Somboon, who has since
returned to work in Thaifand, is a
graduate of the Royal Thai Army School
of Nursing and obtained her BN from
McGifl University in Montreal. Betty
Lethbridge, RN, Grace General Hospital
School of Nursing, St. John's
Newfoundland, and BN, McGif/
University, is now assistant director of
nursing at the Victoria General Hospital in
Halifax
Bibliography
1 Cassem, N.H. Reactions of coronary
patients to the CCU nurse, by. . et al. Amer.
J. Nurs. 70:2:319-325, Feb. 1970.
2 Deal, Jacquelyn. It's a big move.
Bedside Nurse 4:7:16-20, Jul. 1971.
3 Hayes, Joyce Interacting with patients,
by . . . and Kenneth Larson. New York,
MacMillan, 1963
4 Houser, Doris. Safer care for the M.I.
patient. Nursing 74 4:7:42-45, Jul. 1974.
5 Klein, R.F. Transfer from a coronary care
unit. Some adverse responses, by . . . et al.
Arch. Intern. Med. 122:8:104-108, Aug. 1968.
6 Orlando, Ida Jean. The dynamic
nurse-patient relationships; function, process
and principles. New York, Putnam's, 1961.
7 Reichle, Marian J. Psychological stress
in the intensive care unit. Nurs. Digest
3:3:12-15, May/-Jun. 1975.
8 Reiser, Mortan F. Psychology of
cardiovascular disorders, by . , . and Hyman
Bakst. In Arieti, Silvano ed. American
handbook of psychiatry, vol. 1, New York,
Basic Books, 1959. p. 659-677.
9 Robinson, Lisa. Uaison nursing;
psychologIcal approach to patient care
Philadelphia, Davis, 1974.
10 Shannon, Valerie J. The transfer
process: an area of concern for the CC U nurse
Heart Lung 2:3:364-67, May/Jun. 1973.
The Canadian Nurse October 1976
41
............................................................
Plan of care:
the young child on dialysis
Until recently, children with kidney
disease who were under five years old
were not routinely accepted into a
dialysis - transplantation program.
The multidisciplinary approach now
used by the staff of the dialysis unit,
Hospital for Sick Children,
demonstrates that very young children
can be maintained on dialysis until
successful renal transplantation is
Figure 1 achieved.
VISIT TO FAMILY DOCTOR AUG 1973
ADMITTED TO HOSPITAL OCTOBEP
TENCKHOff CA THETER .DECEMBER
'Home lor 2 wk \ .._m..JAN 1974
NASOGASTRIC fEEDING TUBE__
APRIL
BILA TERAL NEPHRECTOMY
UNSUCCESSfUL TRANSPLANT
(Renal vein ,hrombosls)
__.MAY
TENCKHOfF CATHETER INfECTED
AUGUST
OSTEOPOROSIS_ . ,moom.....oo..SEPTEMBER
,No rickets or 2 hyperpara,hyro,d,sm
SURGICAL INCISION To draIn
Inlechon and Tenckholl ca,he'er
__END SEPT
SUCCESSfUL KIDNEY TRANSPLANT.--END OCT
LEFT HOSP1T AL
END NOV 1974
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MA Irwin, J. Young. D Matthews, L
Christensen
The number of children with kidney disease
being accepted into the
dialysis-transplantation program at the
Hospital for Sick Children, Toronto is growing
larger each year. In its annual summary for
1975, HSC s dialysis unit reported that from
1967 to December, 1975, a total of 63 children
entered the program; a total of 71 transplants
were performed over seven years. As of
December 31, 1975, there were still nine
children waiting for transplants.
Technically. no child is too young for
dialysis and transplantation. However. the
physical. psychological and social stresses
these procedures placed on the very young
child and his family led the
dialysis-transplantation team to develop a
unique plan of care for each child. Members
of the planning group included physician,
surgeon, dialysis head nurse, ward head
nurse. dietician, social worker, recreationist.
consulting psychiatrist and the patient's
family.
The following case study is an example of
how a multidisciplinary approach can foster
normal growth and development and help to
maintain the quality of life for both child and
family.
Jane
Jane SmIth had always appeared healthy
but was small for her age. weighing only 10 kg
at 2 '/2 years of age. Because of her poor
appetite and failure to gain weight. her parents
took her to the family physician In August
1973. Routine diagnostic tests detected
protein in the urine and a renal biopsy revealed
glomerulonephritis. Two months later. she
was admItted to The Hospital for Sick Children,
in acute renal failure, with a serum creatinine
of 1o.2mg/dl. (Normal value 0.4 - 1.2 mg/dl).
Emergency treatment was given in the
intensive care unit and Jane was started on
peritoneal dialysis.
As shown in Figure 1. Jane's clinical
course was stormy. Multiple problems and
infections from two to thirteen months after her
initial admission necessitated frequent
changes in the dialysis regime during her long
stay in hospital. Persistent problems included
anorexia. vomiting, and diarrhea. After a brief
stay at home. readmission was necessary
because of high fever dyspnea, mild
42
The Canadian Nurse October 1976
pulmonary edema, and right lower lobe
pneumonia.
Patient-care plan
The dialysis-transplant team formulated a
patient-care plan, assigning specific roles to
key disciplines. Nursing carried the
responsibility for day-to-day continuous direct
care. One nurse in the dialysIs unit and one on
the ward coordinated the plan. They
implemented new approaches as problems
were identified, and advised other team
members of changes in plans and
management suggestions. Approaches which
proved successful were identified and a daily
routine was designed for Jane. (Figure 2) The
team members met regularly for conferences,
induding one Or both parents if possible, to
discuss current difficulties and make plans for
the coming weeks.
DUring the formulation of the patient-care
plan, Jane's physical as well as psychological
needs were discussed. The need for
mothering and for consistent management
was recognized from the outset as being of
primary importance in Jane's care, Her age
and stage of development were also kept in
mind, particularly as she tended to regress
when very ill and under stress.
Initially, Jane's care was extremely
difficult for the staff and for her family.
Everyone experienced frustration and despair
at some time. Gradually, however, with Jane's
acceptance of the dialysis regime and
hospitalization, and with consistent care, she
began to respond to the staff. Her behavior
changed: a sense of humor and a distinct.
endearing personality emerged.
In addition to the many medical problems,
the patient-care plan focused on three major
issues;
. maintaining a normal level of
development,
. providing adequate nutrition, and
. offsetting maternal deprivation while
maintaining family stability.
Development
The recreationist, trained in behavior patterns
and developmental needs, set the pace and
goals for the nursing staff in play discipline and
in general interaction with Jane. Every day. a
certain time was set aside for Jane to play with
the recreationist.
During the first six months, Jane showed
many signs of emotional disturbance: she
twirled her hair continually, was withdrawn,
rocked constantly in a rocking chair, and clung
desperately to anyone who picked her up.
Jane's concentration span was very limited -
most of her brief play periods ended in
frustration with Jane throwing her toys on the
floor. Gradually her concentration span
increased and she began to respond Planned
activities included: play with toys such as
blocks, puzzles and articles that she would be
exposed to in hospital e.g. tubing, syringes,
and tapes; creative play: and physical activity
in the outdoor playground with her parents and
staff. When the recreationist was not available,
the ward and dialysis unit nurses applied the
same approaches, using the patient-care plan
as a guide.
Creative play proved to be Jane s favorite
activity, especially painting and molding
play-dough - activities that retained their
popularity after she returned home. The
recreationist developed Jane's play skills to
the point that her response to play became an
accurate indicator of her well-being:
furthermore, the daily play routine helped to
stabilize her attention span, which tended to
fluctuate with her health
Nutrition
Jane was a very poor eater. Her mother and
the dietician tried many ways of preparing
dialysis
.
;g;
:
,
l
9.00 ploy therapy
foods and varying menus, but Jane did not eat
enough to meet her nutritional needs.
Mealtimes became a battleground She woul(
break up her food into tiny morsels and pick a
her meal for hours.
Five months after admission it was
decided that one person (the recreationist)
should deal with mealtime and that no other
staff should interfere. This approach, which
was continued for one week, proved
unsuccessful. Other approaches were tried
such as quiet play before meals and sitting
Jane at the table with her parent(s) and brothe
but nothing improved her eating habits.
To offset her nutritional imbalance, the nurse
frequently offered her drinks of high caloric
content. Fortunately, she was always thirsty
and so received some of her nutritional
requirements from them.
In April 1974, six months after her I
admission, the team reassessed the dialysis
regime and tried to replan Jane's diet. .
However, even with the new regime, she was
still unable to keep her food down.
Consequently, a nasogastric feeding tube wa
inserted.
The feed concentration was started at 3/ A
calorie/ml offluid. When this was increased b
1/4 calorie/ml, Jane either vomited or had
diarrhea. For three weeks, the stafftried giving
feeds - both continuous and intermittent -
but with no success.
In May, Jane had a bilateral nephrectom1
and an unsuccessful transplant. Post-surgery,
nasogastric tube feedings were resumed. A
major problem was getting enough calories in
a small volume, since fluid overload was a
concern. To compound the problem, the
caloric value of the feedings could be
increased only every two weeks, since a morE
rapid increase caused diarrhea. By
September, Jane was receiving 2 calories/m
of feed in 75 ml q3h together with 'treats' suct
as soft cheese, biscuits, and 30 ml aliquots of
cola by mouth, To avoid the very high
phosphorus content of the cream-based
formula, which could not be cleared by -
dialysis, soybean protein was substituted.
Jane was now able to go home for short
intervals, and despite brief periods of vomiting
could continue with nasogastric feedings
given by her mother.
After a successful kidney transplantation,
in October, Jane's appetite improved rapidly.
Now, the main objective was to teach her to
take food by mouth and to consume enough
calories for growth. Intake while in hospital
consisted mainly of baby food, but after Jane
returned home, her mother began to introduce
foods of a more normal consistency, and
within a month Jane was eating a normal diet.
Family
To prevent significant maternal deprivation
and to keep Jane in touch with her family, Mrs.
Figure 2 - Chart of Jane's daily routine which was mounted on the
wall opposite her bed. By using color-coding, Jane was able to
Identify the activites of individual members of the health team and
her family,
The Canadian Nu.... October 1976
43
'ruth was encouraged to spend two days a
eek with Jane during dialysis while her father
Id brother spent time with her on weekends.
r. Smith had to rearrange his work shifts to
ive his wife to and from the hospital which
3S 60 miles from their home. Jane's
n-year-old brother was forced to become
ore independent and self-reliant. The Smiths
eded help to maintain their functional
ld emotional stability during Jane's long
ess. The social worker was primarily
'sponsible for family counseling with the help
the staff psychiatrist.
On first learning about Jane s diagnosis,
3r family was shocked and grieved. Mrs.
mith became silent, almost immobile while
r. Smith was more verbal, expressing his
lxiety through criticism and a frantic search
'r alternatives. Gradually with further
, scussion, they were able to explore their
elings and bring them into perspective, The
lysician and social worker talked with the
uents about the decisions they would have
make. The realities of suffering, growth
fficulties, transplant failure and numerous
Jerative procedures, maternal deprivation
ld overall effects on the family were
asoned through carefully for several weeks.
e outcome was a decision that Jane
t Jntinue dialysis and await a transplant. (In
ctober 1974, Jane did undergo a successful
anspfant operation).
During the thirteen months that Jane was
the dialysis-transplantation program, there
, ere many emotional "ups and downs" for her
mily. There were many frustrations. changes
'ld disappointments for them to cope with.
owever, the Smiths responded well to
Jpportive counseling and they participated
15 members of the team in helping to plan
ne's care.
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Bibliography
1 Bernstein, D, After transplantation - the
child's emotional reactions. Amer. J.
Psychiatry 127:1189-1193, Mar. 1971.
2 Ciske, Karen L. Primary nursing; a
organization that promotes professional
practice,J. Nurs, Admin. 4:1 :28-31, Jan./Feb.
1974.
3 Erikson, Erik H. Childhood and society.
Rev.ed. New York, Norton, 1964. p. 269-272.
4 Fine, R.N. Second renal transplants in
children, by... et al. Surgery 73:1-7, Jan. 1973.
Conclusion 5 Fine, R.N. Renal homotransplantation in
The example of this young family was a children, by... et al. J. Pedatr. 76:347-357,
velation to the team. Jane would not have Mar. 1970.
_en able to surmount the physical or 6 Freud, Anna Normality and pathology in
lotional difficulties if her family had not childhood: assessments of development,
lared in the responsibility for her care. New York, lI1tl. Univs. Press, 1966.
Now, two and a half years since her first 7 Grushkin, Carl M. Hemodialysis in small
dmission to hospital, Jane's vocabulary and children. JAMA 221 :869-873, Aug. 21, 1972.
lay habits are normal for her age although 8 Korsch, B.M. Kidney transplantation in
iscipline is still a problem at times. She is children; psychosocial follow-up study on child
ating normally and is consuming sufficient and family, by... et al. J. Pediatr. 83:399-408,
Irotein and calories for her nutritional needs Sep. 1973.
nd growth. Now, with a successful kidney 9 Peterson, Grace G. Role of the health
, ansplant, her serum creatinine is within team and the nursing team in patient care. In
ormallimits. Peterson, Grace G. Working with others for
As a result of this experience with Jane patient care 2ed. New York, Wm. C. Brown,
I nd her family, children underfive years of age 1973. (Foundation of Nursing Ser.)
re being more readily accepted into the 10 Rapaport, Felix T. ed. A second look at
iafysis-transplantation program at this life New York, Grune and Stratton, 1973.
ospital. Children over one year of age are 11 Van Leeuwen, J.J. Comprehensive
ow maintained on peritoneal or hemodialysis mental health care in a pediatric
ntil the time of successful kidney transplant. dialysis-transplantation program, by... and
he team continues to use the planned D.E. Matthews. Canad. Med. Ass. J.
pproach to care, involving each team 113:10:959-963, Nov. 22, 1975,
lember as outlined, in the belief that this 12 Bakke, Kathy. Primary nursing:
tproach offers both the patient and team perceptions of a staff nurse. Amer. J. Nurs.
I embe,. some vo'Y demonstrable benefits... 74:8:1432-1434, Aug. 1974.
-1
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Photo: OfItce du film du Ouébec
"
M.A. Irwin (above) R.N., R.M.N,. B.Sc.N., c.P.
is head nurse of the dialysis unit; J. Young, R.N.,
B.Sc.N., is a ward head nurse; D. Matthews,
M.S. W is a social worker; and L. Christensen,
Dip. E. C. S. (Recreavonist) are all members of
the dialysis-transplant team at The Hospital for
Sick Children, Toronto.
The authors extend their thanks to Dr G.
Arbus, Director and Dr. R. D. Jeffs, Surgeon of
the dialysis-transplant program.
...........................
44
Through the
Looking
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The Canadian Nursa October 1976
11111'1
I I
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Gail Gitterman
Paula Goering
Nursing education and practice tend to run along parallel paths, functioning
side by side, but split rather arbitrarily into two separate worlds. These 'worlds'
have much to offer to one another in the reciprocal process of learning-teaching,
and both share the goals of professional development and quality patient care.
The authors here describe their way of bringing the two wor1ds into closer touch.
.
.
.
.
.
.
.
.
.
.
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Gail
After teaching psychiatry for two semesters.
I decided that I needed professional clinical
upgrading, and with a fury stemming from some
unmet driving need, I attempted to get it ...
I was pretty uneasy at getting involved again in the
clinical setting. Heading for a third semester as a
teacher in psychiatric nursing, I hadn't been actively
involved in a nurse-psychiatric client relationship
since my student days. When I began teaching, I had
naively hoped that expertise in the clinical setting
would gradually come upon me, but after two
teaching semesters, I decided that I needed to take
more immediate steps to upgrade my clinical skills.
My goals were to increase my skills in a one-to-one
relationship, to improve my first-hand knowledge of
community resources, and to use my experience for
a future learning-teaching tool. I hoped to gain from
my experience both as a therapist and as a teacher.
Initially, I faced some practical problems
associated with trying to include some clinical
practice during the teaching year. Lack of available
time was one problem I had to deal with. At Ryerson
Polytechnicallnstitute a unique opportunity
presented itself during a non-teaching semester, a
time for planning courses and curriculum, and for
taking a vacation. A second problem lay in finding a
clinical agency where I might gain my experience. At
Ryerson, we affiliate with Queen Street Mental
Health Centre, a large public psychiatric centre, and
it was to this agency that I turned. My request for an
opportunity to be involved in clinical practice was
accepted readily by the director of nurses there.
My greatest concern was with where to find
supervision. There were two likely alternatives: I
could meet with one of my colleagues weekly to
discuss the development of my relationship with my
client through the use of the process recordings I
kept; or I could utilize the resources of the clinical
agency. Paula Goering, the clinical specialist at
Queen Street Mental Health Centre was willing to
supervise my learning experience. After some
discussion, I decided to work with Paula,
Together, Paula and I decided on the form that
her supervision would take. I was to meet with a
client twice a week: I would record one of my
meetings using a process recording; during the other
meeting, Paula would watch me and my client
through a two-way mirror throughout the length of
our interview. Paula and I arranged to discuss these
interviews once weekly following a meeting between
my client and myself.
Paula talked to a doctor involved in after care,
and then suggested an appropriate client for me.
During our initial interview, the client and I
established the terms of our relationship, We
decided to meet twice weekly for eleven weeks.
Personally, I felt that this would be a minimum length
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The CanadIan Nurse October 1976
45
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of time necessary for therapy. I realized that the
duration of therapy actually depended on many
things - the time available, the intensity of the
relationship, and the freguency of meetings during
the week.
The client, Emily, had been hospitalized for
three months, and during this period of time, had
experienced hallucinations. A recent immigrant from
the Phil/ipines, she found herself lost and lonely in
Toronto. Before she was hospitalized. she had met
and married a Canadan. When I first met Emily, she
was living at home with her husband, and visiting
after care for Moditen injections every two weeks.
The problems that I encountered in my meetings
with Emily helped me to appreciate first-hand the
problems my students faced. They also demanded
that I become personally involved as a therapist. At
first, I had a lot of trouble being spontaneous and
natural in my meetings with Emily. I was very anxious
that every part of communication be skillful and
therapeutic. All those readings seemed to be a
barrier to effective interaction. It wasn't until much
later in our relationship that my self-conscious
concern left me and I could let myself feel and use the
warmth I felt for Emily,
Emily presented many problems of a sexual
nature and this tended to further hamper my
spontaneity. I turned to Paula for additional help and
together we reviewed current literature on sexual
therapy.
I met with further difficulty in the termination
stage of my relationship with Emily. I found it helpful
once again to turn to nursing literature to steer me in
the right direction. I knew what I had to do, but had
some self-doubts about my ability to carry this part of
the plan through. For me, termination was stressful,
and provoked a range of feelings, I worried about
meeting the goals of therapy, feeling a need to tidy
things up and leave no threads dangling. I felt sad
because Emily and I would not be sharing this time
anymore and was troubled by guilt when I realized
how much more there was to be accomplished. I was
also afraid that Emily would regress, that
hallucinatory symptoms would reappear. There was
a need in me to feel needed and indispensable and I
hoped that Emily shared some of these same
feelings. I encouraged Emily to share with me her
feelings about our relationship and its termination.
She commented on her sadness, but was not able to
express anything more,
The question remains, what did I do for Emily?
She had married during an acute psychotic episode,
Communication between Emily and her husband
had been poor, and continued to be so. It seemed
that she was unable to express her needs to her
husband. I tried to help Emily direct her energy
toward a healthier relationship with her husband by
exploring these needs and discussing problems with
her, so that she, in turn, could talk to her husband
about them. I listened and was supportive to Emily.
When a problem concerning birth control came to
light, I provided some health teaching regarding
normal menstrual cycles, fertility times and
contraceptive measures. Her need for some activity
in the community was met by introducing her to a
volunteer agency within which she could participate.
What did I gain from this experience? As a nurse
whose skills in this area were minimal, I feel there
was some growth. Paula was able to help me
understand my feelings and the way in which they
guided me throughout the interactions. Because of
Paula's skillful and warm responses, I was able to
use our relationship as a role model for my
relationship with Emily.
Educationally, the experience has proven
worthwhile. My relationship with Paula has given me
a greater appreciation of the effects of empathetic
supervision on the student I hope that our
relationship will serve as a good role model for my
interactions with students and that by confronting
Emily's problems I can better understand what my
students face,
My experience has led a colleague and me to
begin a new teaching project which IS proving to be
an excellent teaching aid in the classroom. The two
of us have made a videotape depicting a dialogue
between client and nurse - with my colleague
playing the nurse, and myself, the client. The result
was a one-hour tape in three sections: the first
depicts the initial interview between nurse and client;
the second segment demonstrates the nurse's
response to the client's need for health teachn/]
(therefore dealing with the "content" of the
interview); the third part depicts the "process" of the
interview by showing the nurse as she deals with her
client's silence. This tape will be utilized in both
undergraduate and postgraduate courses at
Ryerson. It will be a library holdmg, ready to be used
in a multidIsciplinary approach to learning.
Role playing has become an effective
evaluation tool for me. From observing my
colleague's skillful responses during the interviews
I have learned a great deal more about effective
communication and am able to understand more of
the process of the interview.
I feel very strongly that an experience that gives
the teacher an opportunity to improve clinical skills is
a vital and necessary part of a teacher's yearly
responsibilities. It can be carried out at times of the
year during which the teaching load is less
demanding. Ideally, if there is a frrm commitment
from all faculty members to this principle, teaching
loads could allow for the incorporation of a learning
experience for teachers,
The task of updating clinical skills can be applied
46
The Canadian Nurse October 1976
to any area of nursing. Within the medical-surgical
area, supervision could be available through the
nurse clinician, clinical specialist and/or head nurse.
Together with the teacher, they could help to evolve
in-depth nursing care plans, This may have
far-reaching implications as the teacher attempts to
consolidate for his/herself new scientific knowledge
of disease, therapeutics and nursing and technical
expertise. The teacher will have to tap many
resources. Planning and carrying out nursing care
has become increasingly sophisticated, a fact which
necessitates precise learning-teaching skills to be
developed. In order to be effective teachers, we must
also be willing to take the time to learn.
Paula
I was pleased when Gail asked me if I'd help her
improve her clinical skills by supervising her in a
one-to-one relationship with a client. As a clinical
specialist I believe strongly in a close connection
between clinical practice and teaching. This
seemed to be a good opportunity for a
practitioner and an instructor to work together in
a mutually beneficial way...
Because I am an active member in a treatment team,
it wasn't difficult to make the necessary
administrative arrangements to find an appropriate
client with whom Gail could work. There is certainly
no lack of after care clients who could benefit from a
more individualized and intensive approach than
what is routinely available. Clients who have been
discharged from inpatient treatment frequently
receive follow-up care for the administration and
supervision of drug therapy. Unfortunately, the
important psychosocial needs of the client may not
be met because of a scarcity of staff.
Gail's familiarity with the process of supervision
from her work with students made it easier for us to
set the ground rules. I found her enthusiasm and high
level of motivation refreshing and stimulating.
Although I am involved in teaching of various kinds in
inservice settings, I found it quite different to be
working with someone who has the time and energy
to invest a great deal in a learning situation.
It was also clear from the beginning that Gail
brought with her from the educational setting a
wealth of theoretical knowledge about counseling
and psychotherapy. I expected that this would
enhance her ability to describe and understand her
interactions with the client - which it did.
Supervision of less experienced and knowledgeable
students is often in large part a matter of helping
them learn "how to learn" about helping
relationships. The ability to observe and analyze
behavior is one that is learned by experience. As an
instructor, Gail came tothe supervisory situation with
an intellectual and emotional preparedness to look at
what was happening verbally and non-verbally
between herself and the client. This made it easier
for me to give feedback in a direct and open way.
I was surprised to find that the same knowledge
that was an advantage in the supervisory
relationship initially interfered with Gail's ability to
Interact in a spontaneous and natural way with Emily.
The first time I observed Gail with the client, I felt as if
she were a stranger on the other side of the mirror.
The bright, warm and interested woman I'd met
seemed inhibited, stiff and cool when interviewing
Emily - a problem difficult to identify if a supervisor
relies only on process recordings or self-reports.
When we discussed this it was clear that Gail's
behavior was partly due to the anxiety inherent in a
new situation. But she was also responding to a great
many ideas that she had read about how the
therapist should and should not act. It took some
encouragement and time for Gail to learn to rely
much more on her own human response to guide her
behavior. Emphasizing the similarity between
therapist/client and student/teacher relationships
helped her feel more comfortable.
When Emily began to describe serious sexual
problems in her marriage, Gail and I found it helpful
to do some reading of the current literature on sexual
therapy. This joint reading provided us with needed
information to assess Emily's problems and the
appropriate interventions. From our readings, we
found that sexual therapy is contraindicated for those
who are not stabilized after a recent psychotic break.
But Emily persistently and with great distress
initiated discussions about painful intercourse,
inability to reach orgasm and about the ejaculatory
incompetence of her husband. Gail arranged for her
to have a gynecological examination and no
significant abnormalities were found. We discussed
the advisability of using behavioral and educational
technique to treat the couple together. We decided
that Gail would offer the opportunity for the husband
to become involved and use Emily's response as an
indication of her ability to tolerate this type of
intervention. Emily wasn't interested in including her
husband in therapy. So Gail taught Emily about
sexual response and allowed her to ventilate her
feelings in a one-to-one relationship. Gail and I found
that dealing with this problem increased our
knowledge about sexual difficulties and treatment as
well as our ability to discuss the subject more
comfortably.
Termination of our supervisory relationship
indicated that the significant dynamics of the
therapist/ client relationship are often paralleled in
the therapist/supervisor relationship. When Gail
explored her hesitancy to discuss ending therapy
with Emily, she expressed some doubts as to
whether she had been effective or helpful. I looked at
my supervision of Gail with similar concerns. I found
myself questioning whether the changes I'd seen in
Gail reflected her growth as a therapist or whether I'd
merely influenced her to become more like me. Gail
and I talked about the anxieties of termination. At our
last session, Emily surprised and pleased Gail by
giving her a gift in appreciation of the help she'd
received. Gail also gave me a gift in thanks. Gail and I
shared both the pleasant and the unpleasant
feelings associated with ending what has been a
meaningful relationship,
One of the results of this type of relationship
between nursing educators and practitioners is
improved patient care. The provision of high quality
direct patient care by instructors such as Gail is an
asset to the client and to the service facility plagued
by reductions in staff and increasing needs for
treatment. The upgrading of an instructor's clinical
an -Ian 'urse ..... --
skills will also affect the quality of care given by her
students.
I felt that the time I had spent supervising Gail
was worthwhile in that it was an opportunity for my
own growth. The clinical problems Gail encountered
were a stimulus for me to explore and gain
experience with the indications and
contraindications for sex therapy, something I'd
known little about. The process of helping a nursing
instructor learn clinical skills widened and improved
my supervisory skills. Increased self-awareness
about interpersonal behavior and communication
was a benefit of both the therapeutic and learning
relationships,
Ideally, nursing education and practice should
not be split into such separate worlds.
Cross-appointments between clinical and
educational facilities would allow more instructors to
be practitioners and vice-versa. Until such positions
are available, alternative ways must be found of
bringing nursing education and practice into closer
relationship with each other. The learning
arrangement we have described IS one such
alternative. We hope that others will try it. ...
Gail Gitterman (B.A., University of Western Onrarto,
London, Ontario: R.N., Nightmgale School of
Nursing, Toronto, Ontaflo) worked as a general duty
nurse at the Jewish General Hospital in Montreal for
2 years, and taught for 4 years at the Atkinson
School of Nursing, Toronto Western HospItal.
Presently she is an instructor in the Nursing
Department of Ryerson Poly technical Institute m
Toronto.
Paula Goering (BSN, University of Kansas'
MSN, Yale University, New Haven, ConnectIcut) IS
presently a clinical specialist at Queen Street
Mental Health Centre in Toronto.
.
.
.
.
.
.
r".
I
International Council of
Nurses
16th Quadrennial Congress
May 30-June 3, 1977
Tokyo,Japan
Theme: New Horizons for
Nursing
y
For preliminary program,
registration forms or further
information, CNA members are
asked to write: Nursing
Coordinator, Canadian Nurses
Association, 50 The Driveway,
Ottawa, Ontario K2P 1 E2.
. S""blect to ch.ng.
'"
All Canadian nurses. nursing students. and-
members of their families are invited to
participate in a unique tour to the ICN
Congress and beyond.
ï---------
-------------l
I Please sehd me mformation on thelCN Nurses Orient Tour
I
I
I City Province Code_ -- -
I Clip and mail to: Professional Travel Consultants LId . I
I 330 Bay Street. Suite 11 03, Toronto, Ontario M5H 2S8 I
I ·
L __________J
-------------
Name
'TÐKYØ
tor the excitement 01 the ICN Congress
I1ØR
KÐR6
'Of mystery and exotica
I1ØRÐLULU
tor tropic sun and relaxation
THIS IS THE KIND OF
SPECIAL SERVICE YOU GET:
Roundtrip Jet transportation: deluxe accom-
modations - TOKYO 6 nights. HONG KONG
4 nights: HONOLULU 3 nights: American
breakfast dally: all transfers between airports
and hotels: shuttle bus service between ICN
Congress/ Hotel: orientation tour m each city.
welcome reception m Hong Kong: flower lei
greeting in Honolulu. Special farewell
Hawaiian banquet
JOIN US
May 27, June 10.1977
from Vancouver S995' + 15 lort,psltaxes
Special low add-ons from other Canadian
cities. single rooms available at additional cost
ThiS unique studY tour s )red by
The RegIstered Nurses' 'Ç-:;1
AssocIation 01 Ontario Y
In co.-operation 'hlth Professional
Travel Consultants lid Toronto
-'
--
Address
48
Bo()lts
The Canadian Nuraa October 1976
Nurses Guide to Cardiac
Monitoring Second Edition by
P.J.B. Hubner. 66 pages.
London, England, Bailliere
Tindall 1975.
Reviewed by A Norah O'Lsary,
RN, MScN Assistant Professor,
Lakehead UniversIty, Thunder
Bay, Ontario.
This volume has been derived
from lectures on cardiac arrythmias
presented to the nurses of the
coronary care and surgical intensive
care units at the Royal Postgraduate
Medical School, Hammersmith
Hospital. The author s objective is to
prepare the nurse to recognize
common arrythmias as displayed on a
cardiac monitor.
Chapter I simplistically describes
a bedside monitor. The statement -
"These pieces of equipment [the
cardiac monitor) are like small
television sets on which the heart beat
trace is displayed' - IS indicative of
the level at which this chapter. and
indeed the entire volume, is written
The second chapter discusses
electrodes and their placement. No
particular pattern is recommended.
indeed the position is not considered
important. No mention is made of
avoiding areas of muscle to reduce
interference
After a short review of normal
anatomy, physiology, and the normal
EC.G., a systematic method for
observing monitor patterns IS
described. There appears to be no
provision for obtaining a rhythm strip.
The nurse IS expected to evaluate the
length of the P-R interval by
observation of the oscilloscope, and
no information is given about normal
time intervals during the cardiac cycle.
The following three chapters are
concerned with common arrythmias.
Sinus bradycardia. sinus tachycardia,
extra systoles (atrial and ventricular),
coupling (bigemeny), atrial and
ventricular tachycardia, atrial flutter,
atrial fibrillation are briefly discussed
Two pages are devoted to the
identrfication of ventricular fibrillation
and cardiac asystole. There is minimal
discussion of cause, prognosis or
treÇltment of arrythmias. However,
some of the tracings are quite helpful.
The longest chapter is devoted to
cardiac pacing. temporary and
permanent, and detecting pacing
difficulties by monitor observation.
Since the only mode discussed is the
fixed rate, seldom used in this country,
the chapter is of little value.
This small volume could have
been a readily portable reference for
nurses, but the simphstic level at
which it IS written makes it unsuitable
for the Canadian nurse. The lack of
explanation of the cause of each
arrythmia, modalities of treatment and
prognostic significance severely limit
its value to nursing studenl or
registered nurse.
My personal reaction was one of
anger at the condescending tone and
both covert and overt implication that
nurses were able only to comprehend
an extremely simplified presentation.
With many superior texts on E.C.G.
interpretation and coronary care on
Ihe market. this book would serve no
useful purpose In any library.
Intensive Care by John Joakim
Skillman, M.D., 609 pages. Little,
Brown and Company, 1975.
Reviewed by Susan J. Robblee,
Teacher, Staff Education, Ottawa
Civic Hospital, Ottawa, Ontario.
Dr. Skillman states that the
purpose of his book is "to help
physicians. nurses, and respiratory
therapy personnel improve the care
given to critically ill patients." In
attempting to meet his goal, the author
has included material that ranges from
being oversimplified to highly
technical. Of fifteen contributors, one
is a nurse and the remainder are
physicians, so that the emphasis is on
medical rather than nursing
management of intensive care
patients.
The book is arranged in three
parts. Part I discusses a specific
intensive care unit set-up, the ethical
problems and the psychiatric aspects
of intensive care. The three chapters
are v ritten by physicians for their use.
The unit on psychiatric care seems to
be particularly helpful to nurses.
Part II is concerned with some of
the physiology and pathophysiology of
the important body systems
presenting problems in a surgical
intensive care unit The chapters are
very specific and draw from recent
research findings. The sections on
cardiovascular responses, respiratory
failure, the endocrine system and
neurological considerations are
comprehensive, but do not refer to
nursing care. The chapter discussing
body fluids and acid-base balance is
both technical and difficult to
understand without a broad basic
knowledge of the subject.
Sharon Bushnell makes the only
nurse's contribution to the book and
her presentation. leaves me with
ambivalent feelings. Certainly,it is a
well organized and factual
presentation but it lacks the in-<1epth
coverage required for the nursing care
of a patient in respiratory failure. Her
contribution condeilses several
chapters from her own book,
Respiratory Intensive Care Nursing,
and as a result some areas, such as
auscultation, are treated superficially
in Dr. Skillman's book.
Part III is an extension of Part II
continuing the discussion of specific
problems and their management in a
surgical intensive care unit.
The main focus of this book is on
medical rather than nursing care. For
this reason I would not recommend it
as a basic source book for nurses
interested in critical care. It would be
most useful to nurses as a reference
on specific topics of critical care.
Living with Haemophilia by
Peter Jones, EA. Davis.
McGraw-Hili, 1975. Approximate
price $11.95.
Reviewed by Penny Yule,
Assistant Head Nurse,
Pediatrics, London, Ontaflo.
Although there are many books
written about haemophilia for the use
of doctors, "Living with Haemophilia"
was written especially for the
haemophihac, his family, and the
paramedical worker. Its primary
purpose is to meet the physical,
emotional, and social needs of the
haemophiliac and his family.
Dr. Jones begins his book with a
basic introduction of the body systems
and their functions. He then focuses
on the bleeding process, explaining
clotting mechanisms and the cause of
bleeding disorders, touching on bo
the types and the degrees of severi
of the haemophilias.
"Contrary to popular belie!,
haemophiliacs do not rapidly collap!
in pools of blood," states Dr. Jone!
He then explains the cause and
effects of bleeds in areas of the bo(
most frequently affected.
Therapeutic materials, home
therapy, physiotherapy, and dental
care are included in the author's
discussion of the management of
bleeding. He also explains the
separation of blood products, the u
of local haemostatic agents ,
antifibrinolytic drugs, and analgesic
used in the treatment of bleeding. 01
Jones states, "The eartier the treat
of a bleed is started the better." HE
then discusses home management
specific bleeds, including a
description of the home therapy
program used by haemophiliacs
attending the Newcastle
Haemophiliac Centre in Britian.
Physiotherapy is an important
aspect of management for the
haemophiliac and Dr. Jones describt
specific exercises used for various
joints. He recommends aids,
appliances, and safe arrangement'
the home to protect the haemophilié
from injury.
Preschool activities, education,
surgery, employment, sex and fami
planning for the haemophiliac are
discussed in this book. The author
takes into account the attitudes,
precautions, and problems
encountered in such areas and
suggests possible solutions.
Following a brief history of
haemophilia, Dr. Jones looks to the
future, discussing developments
which could alter the present patter
of hereditary bleeding such as
intrauterine diagnosis and genetic
engineenng.
"Living with Haemophilia" is writte
in a straightforward style in
understandable language. It is a boc
designed to answer questions the
haemophiliac or the layman may hav
concerning the disorder. Most
important, it emphasizes that the
haemophiliac can expect to
ve a fl
normal life.
When you need a reference, choose only the best:
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Pediat..k
Nursing
-9JOC.^l
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. $9.25. Order #5717-6.
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Order #354&-2,
$13,90. 1976- 78
(Includes the Handbook)
current (}rug
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Every
Nurse
Should
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b-y the
Nurse
PraC\ibO\\ØI'
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. $10.85, Order #2752- 8 ,
#1220- 5 .
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Order #6356- 1 '9
Edition: $".30. Order #6355- .
, student Edition: $13.65.
Standard
#41&8-)(.
, $1.50. Order
}..\'. W. B. SAUNDERS COMPANY CANADA LTD.
833 Oxford Street, Toronto, Ontario M8Z 5T9
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FULL NAME
POSITION & AFFILIATION (IF APPLICABLE)
HOME ADDRESS
-
50
The Canadian Nurse October 1976
\\"']11:\(
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-
Emergency Baby Carrier
A new vest made to help rescue
infants in emergency situations is now
available from the J. T. Posey
Company.
The Posey Emergency Baby
Carrier will hold up to four infants from
neo-natal to pediatric size and is
designed to fit quickly and comfortably
on any adult The weight is distributed
uniformly across the shoulders,
leaving arms and hands free.
Each Posey Emergency Baby
Carrier has four deep pockets of thick
muslin which make a secure pouch for
babies. Will fit two infants in front and
two in back.
The Posey Emergency Baby
Carrier No. 5420 has been developed
to replace potentially harmful
evacuation methods. ApproxImate
price $39.00
For further information, contact:
PhIllip J. White, Marketing Manager,
J. T. Posey Company, 39 South
Altadena Drive, Pasadena, California
91107.
Techniques for
Moving Patients
. Techniques for Moving
Patients" is a 16-page employee
training manual and poster series. It
covers updated methods to reduce
employee back injuries, prevent
fatigue, and promote patient
rehabilitation.
"Body mechanics," patient
assessment, and fifteen basic
methods to hft active/passive patients
are Included. __ in step-by-step
procedures. The manual may be used
as a self-contained course, or as a
mini-text for inservice training classes
For information write: Dray
Publications Inc., Deerlield,
Massachusetts 01342.
Trylon Stethoscopes
The Trylon line of stethoscopes
by Sherwood Medical Industries
includes six models representing the
full range of general and specialized
stethoscope applications. The nurses
model is available in five attractive
colors.
Trylon acoustical instruments are
permanently magnetically powered
and contain no batteries or electnc
components. They provide more
sound output than conventional
stethoscopes, and produce a full
freq uency range of body sounds with a
single chestpiece.
For further information write:
Raymond B. Molitor, Sherwood
Medicallndustries, 1831 Olive Street,
St. Louis, Missouri 63103.
Disposable Suction
A 1200 cc Dispolex disposable
suction collection canister is now
available from Air Products and
Chemicals, Inc.
Like the larger 2000 cc Dispolex
canister, the 1200 cc units provide a
tight suction to aid in prevention of
cross contamination. This canister
also features a frosted surface on
which to write patient information.
Simple to set up and molded of
impact-resistant plastic, Dispolex
canisters are easy to use and offer
better protection against
infection-spreading breakage than do
traditional glass suction collection
bottles.
The new 1200 cc canister has a
measurement feature for accurate
measurement of the first 100 cc's of
body fluids aspirated. Its compact size
makes it particularly convenient for
use in the ICU, Recovery Room, and
pediatric surgery.
For further information, contact
Customer SerVIce Department, Air
Products and Cnemicals, Inc., Box
538 M, Allentown, Pennsylvania
18105.
Intrauterine Pressure Kit
The new ARGYLE Transcervical
Intrauterine Pressure Kit allows
monitoring of intrautenne pressure
during labor without rupture of fetal
membranes. Early rupture of
membranes can lead to prolapse of
the umbilical cord, and greatly
increases the risk of Infection if
cesarean section proves necessary
The ARGYLE balloon-tipped
catheter is Inserted transcervically
between the fetal membranes and the
uterine wall. When filled with water,
the balloon sensor conducts
intrauterine pressure to the fetal
monitoring unit with the same or better
accuracy than an open-ended
catheter, but with much less risk to the
patient
Because this catheter need not
be inserted as high in the uterus as
open-ended catheters, there is less
chance of injury and patient
discomfort. If induction of labor is
unsuccessful, the balloon may be
collapsed and the catheter withdrawn
without risk to mother or fetus - with
the fetal membranes intact
The balloon-tipped catheter is a
closed system, so there is no danger
of cross-contamination, no need to
sterilize the pressure transducer, and
no possibility of occlusion.
The ARGYLE Transcervical
Intrauterine Pressure Kit includes an
80-inch 7 Fr. plastic catheter, plastic
insertion guide, and a three-way
stopcock. The kit is packaged, sterile,
and ready for use.
For more information write to:
Sherwood Medical, Dept. TD., St.
Louis, MO 63103.
Calculi Strainer for
Graduated Pitchers
The new Sage Calcuh Straine
designed to fit into graduated pitchE
and most other containers used in
laboratories. The strainer is plastic
making it strong enough to be used
one patient for several days, yet
inexpensive enough to be thrown
away.
The Sage Calculi Strainer ha!
micromesh filter which holds particl
as small as .007".
For further information, write.
Sage Products, Inc., 1300 Morse
Avenue, Elk Grove Village, Illinois
60007.
'\
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. . . \\
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,
t
I
,
_ I .........
Geriatric Chair Safety Bar Ki
A new kit to help prevent patien
from sliding and slumping in genatr
chairs, is now available from the J.
Posey Company, Pasadena,
California.
The Posey Geriatric Chair Safe
Bar Kit fits all standard geriatric chai
and uses a soft padded bar to stop th
patient from sliding forward while a
shoulder "Y" strap counteracts
slumping.
There are three bar models to
meet the needs of cooperative,
uncooperative and difficult patients
Each kit comes complete and Instal
in minutes.
A Posey Safety Bar Kit is also
available for wheelchairs. Price:
Posey Geriatric Chair Safety Bar Kit
$31.80 to $41.1 Oapproximate. Safe
Bars alone: $9.00 to $16.00
approximate.
For further information, contac
Phillip J. White, Marketing Manage
J. T. Posey Company, 39 South
Altadena Drive, Pasadena Californ
91107.
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52
The Canadian Nurse October 1976
Anatomy & Physiology)
gth Edition! TEXTBOOK OF ANATOMY AND PHYSIOLOGY. By
Catherine Parker Anthony, R.N., B.A., M.S.; with the collaboration of
Norma Jane Kolthoff, R.N., B.S., Ph.D. The most widely adopted
anatomy and physiology text in print, this book has been
considerably updated in this edition. Students will find three new
chapters on the nervous system; 26 new and modified illustrations;
new information on brain waves, altered states of consciousness,
and the "emotional brain"; biofeedback training; expanded
discussions of liver functions, reproduction, physiology of circula-
tion; and more! 1975.608 pp., 336 illus. (145 in color), including 239
by Ernest W. Beck, and an insert on human anatomy with 15
full-color, full-page plates, with 6 in transparent Trans-Vision.@
Price, $14.65.
gth Edition! ANATOMY AND PHYSIOLOGY LABORATORY MAN-
UAL. By Catherine Parker Anthony, R.N., B.A, M.S. This supplement
to TEXTBOOK OF ANATOMY AND PHYSIOLOGY has received
equal attention in offering up-to-date and authoritative informa-
tion. It includes new experiments that explore: ABO and Rh blood
typing; bleeding time; estimation of normal and abnormal blood
pressure; change in arterial pressure, and whether or not it is
followed by a change in heart rate; and more. 1975,224 pp., 115
illus. Price, $7.30.
)Icdical/ Sur
icül
6th Edition! MEDICAL-SURGICAL NURSING. By Kathleen Newton
Shafer, R.N., M.A; Janet R. Sawyer, R.N., Ph.D., Audrey M.
McCluskey, R. N., M. A.; SC.M. Hyg.; Edna Lifgren Beck, R. N., M. A.; and
Wilma J. Phipps, R.N., AM.; with 28 contributors. The 6th edition of
this classic text continues to focus on individualized care.
Throughout. yOU will find increased emphasis on physiology,
pathophysiology, and nursing assessment. New material covers
cardiac disease and family planning counseling. New chapters
provide current information on ecology and health, neurologic
disease, musculoskeletal disorders, and injuries. 1975, 1,048 pp.,
608 illus. Price, $18.85.
A New Book! CLINICAL IMPLICATIONS OF LABORATORY TESTS.
By Sarko M. Tilkian, M.D and Mary H. Conover, R.N., B.S.N.Ed. 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 urmalysis. This is
followed by an important table of potential variations of normal
values that compares specific entities found in the screening
process. Unit II describes evaluative and diagnostic tests that
should be used to confirm the diagnoses of abnormalities found in
screening. 1975,248 pp., 42 illus. Price, $7.90.
2nd EdItion! GASTROENTEROLOGY IN CLINICAL NURSING. By
Barbara A. Given, R.N., B.S.N., M.S. and Sandra J. Simmons, R.N.,
B.S.N., M.S. This clinically-oriented text is a practical guide to the
care of patients with common gastrointestinal disorders. It
provides a systematic approach to each condition and reports on
the role of the nurse in observation, interpretation of data,
correlation of laboratory and treatment information, and planned
intervention. Expanded sections cover pancreatitis and Crohn's
disease. New sections discuss nursing assessment for the GI
patient, elemental diets, tube feeding, and more. 1975,330 pp., 70
illus. Price, $9.40.
Help
your students
achieve
(Pharmacolog)y
New 13th Edition! PHARMACOLOGY IN NURS-
ING. By Betty S. Bergersen, R.N., M.S., Ed. D.; in
consultation with Andres Goth, M.D. Nowavail-
able 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 chapteli; examine antimicrobial
agents and the effects of drugs on human
sexuality, fetal development, and lactation,
Other important changes include: major revi-
sion of the chapters on drug legislation,
respiratory system drugs, skeletal muscle
relaxants, fluids and electrolytes; and more.
February, 1976. 766 pp., 100 illus. Price,
$13.60.
New 10th EditIon! WORKBOOK OF SOLU-
TIONS AND DOSAGE OF DRUGS: Including
Arithmetic. By Ellen M. Anderson, R.N., B.S.,
M.A and Thora M. Vervoren, R.Ph., B.S. An
effective, self-teaching guide, this new work-
book relates basic mathematics to common
solutions and dosages, and provides informa-
tion essential for proper calculation, prepara-
tion, and administration of drugs. Updated
throughout, the text now places more em-
phasis on the metric system and includes
many new problems. The totally new appendix
contains drug standards and legal regula-
tions; metric doses and apothecary equiva-
lents; dosage rules for children; and more.
January, 1976. 176 pp" 11 figs, Price, $6.85.
The CanadIan Nurse October 1976
53
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the professional success they seek.
Reh" on up-to-date
new
Iosb)' texts to
supplement )'our
instmction on øll
facets of nursing. . .
from fundamentøls
to specific care
techniques
Issues & Trends)
A New Book! THE PROBLEM-ORIENTED SyS-
TEM IN NURSING: A Workbook. By Beth C.
Vaughan-Wrobel, R.N., M.S. and Betty Hender-
son, R.N., M.N. This first-of-its kind workbook
explains all concepts of P.O.M.R. and shows
how to use the system in nursing education
and health care delivery. Three separate units
clarify the application, implementation, and
evaluation of the P.O.M.R. system. The au-
thors provide a simple, effective approach that
shows students how to: name and describe
the components of P.O,M.R.; develop a com-
plete problem list including medical,
psychological. social, demographic, and cog-
nitive problems; write an initial plan; write
necessary nursing orders for the established
patient care objectives; and convert tradi-
tional patient progress notes into the S.O.A.P.
format. February, 1976.164 pp., 19 illus. Price,
$6.85.
. .
Library of Current Practice
& Perspecti"cs in :\' ursimt
New Volume I! CURRENT PRACTICE IN PEDIATRIC NURSING.
Edited by Patricia A. Brandt, R.N., M.S., Peggy L. Chinn, R.N., Ph.D.;
and Mary Ellen Smith, R.N., M.S.; with 15 contributors. Written by
nurses with a wide variety of backgrounds, this collection of
original articles examines new developments in pediatric nursing.
The first section includes intriguing discussions on such topics as
infant day care. The second section emphasizes family needs
during fetal development and early childhood; and the last section
explores nursing care of children with special problems. February,
1976.256 pp., 13 iIIus. Price, $11.05 (c); $7.90 (P).
New Volume I! CURRENT PRACTICE IN OBSTETRIC AND
GYNECOLOGIC NURSING. Edited by Leota Kester McNall, R.N.,
M.N. and Janet Trask Galeener. R.N., M.S.; with 19 contributors.
Designed specifically for nurses working with OB/GYN patients in
community and hospital settings, this new book offers original
articles on contemporary issues and patient care. Specific topics
include: psychological stress in the last three months of
pregnancy; genetic counseling in maternity nursing; aspects of
parenthood and the decision not to parent. February, 1976.270 pp.,
39 illus. Price, $11.05 (c); $7.90 (P).
New Volume I! CURRENT PERSPECTIVES IN NURSING EDUCA-
TION: The Changing Scene. Edited by Janet A. WillIamson, Ph.D.,
R.N.; with 18 contributors. Examining the many dynamic changes
and issues in modern nursing education, this new text focuses on
accountability. Nationally known nursing educators contribute 17
stimulating articles that encompass history and international
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nurses for expanded roles while still meeting traditional roles,
February, 1976, 198 pp., 12 figs, Price, $11.05 (C); $7.90 (P).
New Volume I! CURRENT PERSPECTIVES IN PSYCHIATRIC
NURSING: Issues and Trends. Edited by Carol Ren Kneisl, R.N.,
Ph. D. and Holly Skodol Wilson, R. N., Ph. D.; with 24 contributors This
sourcebook features original articles on all facets of psychiatric
nursing. providing insights into current trends, issues, and
controversial views on many topics. Among the thought-provoking
articles are those examining: the nurse-physician relationship;
conflicts that arise between nurses' professional roles and
emotions; new sociological approaches to family mental health;
and counseling the rape victim. February, 1976. 242 pp., 9 figs.
Price, $11.05 (C); $7.90 (P).
New Volume I! CURRENT PRACTICE IN ONCOLOGIC NURSING.
Edited by Barbara Holz Peterson, R.N.. M.S.N. and Carolyn Jo
Kellogg, R.N., M.S.; with 27 contributors. Outstanding contributors
representing 14 cancer centers examine new nursing roles in
cancer care - from detection clinic to care of the terminal patIent
at home. Original articles cover: professional awareness; screen-
ing and early detection; therapy; maximizing the quality of life; and
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February, 1976.246 pp., 3 illus. Price, $11.05 (C); $7.90 (P).
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54
The Canadian Nurse October 1976
Lil)JellJeu (TI)(ll11(1
Publications recently received in the
Canadian Nurses Association Library
are available on loan - with the
exception of items marked R - to
CNA members. schools of nursing,
and other institutions. items marked R
include reference and archive material
that does not go out on loan. Theses,
also R. are on Reserve and go out on
Interlibrary Loan only.
Requests for loans, maximum 3
at a time, should be made on a
standard Interlibrary Loan form or by
letter giving author, title and item
number in this list.
If you wish to purchase a book,
contact your local bookstore Or the
publisher.
Books and documents
1. Alexander, Louis. Beyond the
facts; a guide to the art of feature
writing. Houston, Texas, Gulf, c1975.
263p.
2. Auger, Jeanine Roose. Behavioral
systems and nursing, Englewood
Cliffs, N.J.. Prentice-Hall, c1976.
212p. (Prentice-Hall scientific
foundations of nursing practice series)
3. Bernstein, Norman R. Emotional
care of the facially burned and
disfigured. Boston, Little, Brown,
c1976. 243p.
4. Bouchard, Rosemary Elizabeth.
Nursing care of the cancer patient,
by. . and Norma W. Owens. 3ed. St.
Louis, Mosby, 1976. 313p.
("tllel)(ltll-
October
Septic Shock-Incidence and
Implications. A seminar presented by
the Winnipeg Association of Critical
Care Nurses on October 20, 1976. For
further information, contact: Ms.
Eleanore Warkentin, 7 [Þ 1790
Portage Ave, Winnipeg, Manitoba,
R3J OE9.
Order of Nurses of Quebec -
Annual General Meeting, to be held
at the Queen Elizabeth Hotel,
Montreal, October 27 - 29, 1976. For
information, contact: ONQ, 4200
Dorchester Blvd., Montreal, Quebec,
5. Brown, Amy Frances. Clinical
instruction. Philadelphia, Saunders,
1949. 571 p.
6. Bunker. Barbara Benedict. A
student's guide to conducting social
science research, by . . . Howard B.
Pearlson and Justin W. Schulz. New
York, Human Sciences Pr., c1975.
120p.
7. Canadian Ross Conference on
Paediatric Research, Second,
Toronto, Nov. 4-5, 1974. Nutrition of
Indian and Eskimo children. Montreal,
Ross Laboratories, 1975. 193p.
8. Conahan, Judith M. Helping your
elderly patients; a guide for nursing
assistants. New York, Tiresias Press,
c1976. 128p.
9. Conover, Mary H. Understanding
electrocardiography; physiological
and interpretive concepts, by . . . and
Edwin G. Zalis. 2ed. St. Louis, Mosby,
1976. 241 p.
10. Conseil canadien d'agrément des
höpitaux. Guide pour ragrement des
établissements de santé mentale du
Canada 1975. Toronto, 1975. 61p.
11. Dwyer, Joyce M. Human
reproduction; the female system and
the neonate. Philadelphia, Davis,
c1976. 209p.
12. The dying patient; a supportive
approach, edited by Rita E. Caughill.
Boston, Little, Brown, c1976. 228p.
13. Emond, R.T.D. Color atlas of
infectious diseases. Chicago, III.,
Year Book Medical Pub. c1974. 384p.
6th Annual Pediatric
Seminar-"Experiences for
Learning" to be held at the Gertrude
M. Hall Education Wing, Calgary
General Hospital, Calgary, Alberta on
Oct. 28-29, 1976. For further
information, contact: Faye Ferguson
or Donna Lenties, Alberta Children's
Hospital, 1820 Richmond Road,
Calgary, Alberta.
Nursing and the Law a workshop for
nurses and other health professionals
to be held on October 23, 1976.
Speaker: Lorne Rozovsky,
Department Solicitor of Nova Scotia
Health Services and Insurance
Commission. For further information
contact: Norma J, Fulton, Director of
Continuing Nursing Education,
University of Saskatchewan,
Saskatoon, Sask.
14. Fensterheim, Herbert. Don't say
yes when you want to say no,
by . . . and Jean Baer. New York, Dell,
c1975.304p.
15. Flitter, Hessel Howard. An
introduction to physics in nursing.
7ed. St. Louis, Mosby, c1976. 288p.
16. Fourez, Gérard. Au-delà des
interdits; d'une morale de la rencontre
à une morale socia/e. Paris, Duculot,
c1972. 187p.
17. Fox, David J. Fundamentals of
research in nursing. 3ed. New York,
Appleton-Century-Crofts, c1976.
313p.
18. Franas, Gloria M. Manual of
social psychologic assessment,
by . and Barbara A. Munjas. New
York, Appleton-Century-Crofts,
c1976. 209p.
19. Gladstone, W. J. Vocabulaire de
médecine et des sciences connexes;
Anglais-Français et
Français-Anglais. Paris, Masson,
1971. 298p. R
20. -. Vocabulary of medicine and
related sciences; English-French and
French-English. Paris, Masson, 1971.
298p. R
21. Gregg, Walter H. Physical fitness
through sports and nutrition. New
York, Scribner, c1975. 112p.
22. Gunter, Laurie M.
Self-assessment of current
knowledge in geriatric nursing; 1,311
multiple choice questions and
referenced answers, by . . . and
November
Reality Orientation Workshop to be
held at the Faculty of Nursing,
University of Toronto on Nov. 10 - 11,
1976. Fee: $60.00. For further
in/ormation contact: Mrs. Dorothy
Brooks, Chairman, Continuing
Education Programme, Faculty of
Nursing, University of Toronto, 50 St.
George St., Toronto, Ont., M5S 1A1.
Scientific Writing Workshop for
Nurses to be held at the Faculty of
Nursing, University ofT oronto on Nov.
25- 26,1976. Fee:$50.oo. For further
information contact: Mrs. Dorothy
Brooks. Chairman, Continuing
Education Programme, Faculty of
Nursing, University of Toronto, 50 SI.
George St., Toronto, Ont., M5S 1A1.
Jeanne E. Ryan. Flushing, N.Y., Mecl.
Exam. Pub., c1976. 216p. I
23. Hall, Virginia C. Statutory
regulation of the scope of nursing
practice - a critical survey. Chicago,
The National Joint Practice
Commission, c1975. 51p.
24. Jacob, Stanley W. Elements of
anatomy and physiology, by , . . and
Clarice Ashworth Francone.
Philadelphia, Saunders, 1976. 251p.
25. Kershner, Velma L. Nutrition and
diet therapy for practical nurses. 2ed.
Philadelphia, Davis, c1976. 266p.
26. Kron, Thora. The management of
patient care; putting leadership skills
to work.. 4ed. Philadelphia, Saunders,
1976. 247p.
27. Laurin, Jacques. Corrigeons nos
anglicismes. Montréal, Editions de
I'Homme, 1975. 170p.
28. LeBow, Michael D. Approaches to
modifying patient behavior. New
York, Appleton-Century-Crofts,
c1976. 383p.
29. Maddison, David D. Psychiatric
nursing, by . . . Patricia Day and
Bruce Leadbeater. 400. Edinburgh,
Churchill Livingstone, 1975. 532p,
30. Marram, Gwen D.A.
Cost-effectiveness of primary and
team nursing, by . . . et al. Wakefield,
Mass., Contemporary, c1976. 91p.
31. Miller, Michael B. The
interdisciplinary role of the nursing
home medical director. Wakefield
Mass., Contemporary, c1976. 296p.
Tuberculosis and Emphysema
Today. A one day seminar for nurses,
physiotherapists, respiratory
technologists and other interested
health professionals. To be held at the
Town Hall, Newcastle, N.B., on
November 17, 1976. No registration
fee. For further info.rmation, contact:
Mrs. Alma Leclerc, Program Director,
New Brunswick Tuberculosis and
Respiratory Disease Association, Box
1345, Fredericton, N.B. E3B 5E3.
Canadian Intravenous Nurses
Association - Seminar and
Product Fair to be held at
Sunnybrook Medical Centre, Toronto,
Ontario on November 17-18, 1976.
For further information, contact:
C.I,N.A, Box481, StationZ, Toronto,
Ontario, M5N 2Z6.
The Canadian Nurse October 1976
55
32. National Association of
"arliamentarians. Blue book
1973-1975. Kansas City, Mo., 1975.
144p. R
33. National League for Nursing.
-;ollaboration m health care
>ducation. New York, 1976. 65p.
NLN Pub. no. 23-1617)
34. -. Coping wIth change through
Jssessment and evaluation. New
fork, 1976. 104p. (NLN Pub, no.
3-1618)
35, -. Council of Hospital and
'=telated Institutional Nursing
Services. People power: pressures,
Jroblems, persuasion, patients,
Jerspectives. Papers presented at
l"he ninth annual meeting Oct. 30-3'i.
1975, Denver, Co!., New York,
\lational League for Nursing, 1976,
58p. (NLN Pub. no. 20-1623)
36. -. Department of Baccalaureate
3.nd Higher Degree Programs. Quality
JSSurance: models for nursing
3ducation. Papers presented at the
'ourteenth conference of the Council
Jf Baccalaureate and Higher Degree
Programs, Washington, D.C., Nov.
1975. New York, 1976. 65p. (NLN
Pub. no. 15-1611)
37. PSRO: utilization and audit in
patient care, edited by Sharon Van
Sell Davidson. St. LOUIS, Mosby.
1976. 349p.
38. Redman. Barbara King. The
process of patient teaching in
nursing. 3ed. St. Louis, Mosby, 1976.
272p.
39. Richardson, Lloyd I. The
mathematIcs of drugs and solutions
with clinical applications, by. . and
Judith Knight Richardson. New York,
McGraw-Hili, c1976. 153p.
40. Robinson, Usa, Psychological
aspects of the care of hospitalized
patients. 3ed. Philadelphia, Davis,
c1976. 108p.
41. Russo, Barbara Ann.
Gastroenterology nursing continuing
education review; 412 essay
questions and referenced answers.
Flushing, N.Y., Med. Exam. Pub.
c1976. 222p.
42. The second step; baccalaureate
education for registered nurses,
edited by Mary W. Searight.
Philadelphia. Davis, c1976. 252p.
Request Form for "Accession List"
Canadian Nurses' Association Library
Send this coupon or facsimile to:
Librarian, Canadian Nurses' Association
50 The Driveway, Ottawa K2P 1E2, Ontario.
Please lend me the following publications, listed in the
. .issue of The Canadian Nurse,
or add my name 10 the wailing list to receive them when available-
I
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Short title (for identification)
Request for loans will be filled in ordel of receipt.
Reference and restricted matenal must be used 10 the CNA library
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Date of request
43. Selye, Hans. The stress of life.
Rev. ed. New York, McGraw-Hili,
c1956, 1976. 515p.
44. Sexual assault; the victim and the
rapist. Edited by Marcia J. Walker and
Stanley L Brodsky. Lexington, Mass.,
Health, c1976. 186p.
45. Simmons, Janet A. The
nurse-client relationship in mental
health nursing; workbook guides to
understanding and management.
2ed. Philadelphia, Saunders, 1976.
248p.
46. Stedman, Thomas Lathrop.
Stedman's medical dictIonary,
illustrated. Baltimore, Md., Williams
and Wilkins, 1976. 1678p.
47. Stevens, Marion Keith. Nursing du
troisiéme åge. Traduction et
adaptation: Louise Berger. Montréal,
HRW, 1976. 390p.
48. Union list of serials in the
Ottawa-Hull hospital libraries and
Canadian Medical Association
library_ Compiled by Ottawa-Hull
Health Sciences Librarians Group.
Ottawa, 1976. 1 v. R
49. Wagner, Frank. Body works; how
to shape up and stay fit in ten minutes
a day. New York, Harmony c1974,
116p.
50. Ward, Barbara G. Les
établissements humains: crise et
survie. Ottawa, Information Canada,
1974. 62p.
51. -. The home of man. Toronto,
McClelland and StewBrt, c1976. 297p.
52. -. Human settlements: crisis and
opportunit
Rev.ed.Ottawa,
Information Canada, c1976. 60p.
53. World Health Organization. Health
aspects of human rights; with special
reference to developments in biology
and medicine. Geneva, 1976. 48p.
54. -. The work of WHO, 7975,
Annual report of the director-general
to the World Health Assembly and to
the United NatIons. Geneva, 1976.
362p.
55. -. Pan American Sanitary
Bureau. Reported cases of notifiable
diseases in the Americas, 1970-1972.
Washington, D.C., 1975. 108p. (Its
Scientific Publication no. 308)
56. Yura, Helen. Nursing leadership:
theory and process, by.. Dorothy
Ozimek and Mary B. Walsh. New
York, Appleton-Century-Crofts.
c1976. 237p.
Pamphlets
57. Brown, Joan C. Socia!
development in a period of economIc
constraint: Who pays? Who Wins?
Who loses? Who cares? Ottawa,
Canadian Council on Social
Development, 1976. 22p.
58. Canadian University Services
Overseas. CUSO answers. Ottawa,
1975. 14p.
59. Carter, James L Canadian
Eskimo in fact and fIction; a dIscursive
bibliography. Toronto, Ontario Library
Association, 1975. 21 p. (Ontario
l.Jbrary Association. Monograph no. 4)
60. Cohen, Ullian Kay.
Communication aids for the brain
damaged adult. Minneapolis, Minn.,
Sister Kenny Institute, c1976. 25p.
61. General Nursing Council for
England and Wales. Overseas
regIstration fuquirements. London,
1975. 1v. R
62. Levison, Andrew. Unemployment:
the problem we can solve. New York.
Public Affairs Committee, c1976. 28p.
(public affairs pamphlet no. 534)
63. National League for Nursing.
Division of Nursing. Some statIstics on
baccalaureate and higher degree
programs in nursmg 1974-75. New
York, 1976. 18p. (NLN pub. no.
19-1609)
64. Saskatchewan Registered
Nurses' Association. Guidelines for
developing a qualIty assurance
program. Regina, Sask., 1976. 7p.
65. La Société canadienne de la
Croix-Rouge. Division du Québec.
Joie et sante. Montréal, 1975. 37p.
66. Taubenhaus, Marjorie. The fights
of patlents_ New York Public Affairs
Committee, c1976. 28p. (Public affairs
pamphlet no. 535)
67. WHO Interregional Seminar on
Health Economics, Geneva, 2-6 July,
1973. Health economics: report of a
WHO interregional seminar Geneva,
World Health Organization, 1975.
44p. (WHO Public health papers no.
64)
68, Washington State League for
Nursing. A suggested plan for
teaching intravenous technique in
inservice and civil defense programs.
New York, National League for
Nursing, 1957. 15p. (League
Exchange no 27)
56
The Canadian Nurse October 1976
I.JI)I-.ll-!J lTI)(I.lt
Government documents
Canada
69. Commission de réforme du droit
du Canada Rapport. Le droit de la
famille. Ottawa, Information Canada,
1976. 79p.
70. Conseil du Tresor. Convention
entre Ie Coflseildu Tresoretf'Alliance
de la Fonction publlque du Canada
groupe: commis aux ecritures et aux
réglements (tous les employés).
Ottawa. Information Canada, 1976.
63p
71. -. Guide de gestion du
personnel 1975. Ottawa, Information
Canada, 1976. 47p.
72. Dept. of Indian and Northern
Affairs. The Canadian Indian; a brief
outline. Ottawa, InformallOn Canada,
c1975. 17p.
73, Dept. of National Health and
Welfare. Report on the operation of
agreements with the provinces under
the hospital insurance and diagnostic
services act for the fiscal year ended
March 31, 1975. Ottawa, 1975. 73p.
74. Law Reform Commission of
Canada. Report on family law.
Ottawa, Information Canada, 1976.
73p.
75. Laws and Statutes. Canada
pension plan. R. S. c. C-5 and
regulations made thereunder. Office
consolidation, 1976. 248p. R
76. Lois et statuts. Régime de
pension du Canada. S.R., c.C-5 et
réglements établis en vertu de cette
loi. Codification administrative, 1976.
248p. R
77. Mlnistère de la Santé nationale et
du Bien-être social. Direction de
I'Assurance-Santé. Direction
génerale des Programmes de la
Santé. Services d'urgence au
Canada, Rapport prepare pour Ie
groupe de travail sur les unités de
soins spec/aux dans les hópitaux, Ie
sous-comite federal-provincial de la
qualité des soins et de la recherche et
Ie comite consultatif de
f'assurance-sante. Ottawa, 1975. 3v.
78. Ministère des Affaires indiennes et
du Nord. Les Indiens du Canada; un
bref expose. Ottawa, Information
Canada, c1975. 17p.
79. Northwest Territories. Department
of Information, Interpreter-Translator
Corps. A language guide for patient
and nurse in English and native
languages. Yellowknife, Canarctic,
19? 1v.
80. Parlement. Comité mixte spécial
sur la politique de l'immigration.
Rapport, troisiéme. Premiére session
de la trentiéme législature,
1974-1975. Ottawa, Imprimeur de la
reine, 1975. 124p.
81. Parliament. Special Joint
Committee on Immigration Policy.
Report, third. First Session, Thirtieth
Parliament 1974-1975. Ottawa,
Queen's Printer, 1975. 111 p.
82. Santé nationale et du Bien-être
social. Rapport sur f'applicatlOn des
accords conclus avec les provinces
en vertu de la loi sur
f'assurance-hospitalisation et les
services diagnostiques pour f'annee
financiére qui se termine Ie 31 mars,
1975: Ottawa, 1975. 35p.
83. -. Bureau de la recherche.
Direction de I'usage non médical des
drogues. Protection de la santé.
Usage du tabacau Canada de 1965à
1974. Ottawa, 1976. 27p. (Son
Rapports techniques no. 1)
84. Transport Canada. Road Safety.
Road safety annual report, 1975.
Ottawa, Information Canada, 1975.
19p.
85. Transports Canada. Sécurité
routière. Rapport annuel sécurite
routiére, 1975. Ottawa, Information
Canada, 1975. 20p.
86. Treasury Board. Agreement
between the Treasury Board and the
Public Service Alliance of Canada
group: clerical and regulatory (all
employees). Ottawa, Information
Canada, 1976. 63p.
87. -. Personnel management gUIde
1975. Ottawa, Information Canada,
1976. 47p.
Quebec
88. Régie de I'assurance-maladie.
Rapport 1975-1976. Québec, 1976.
95p.
UnÍ1E<d States
89. Public Health Service. The health
consequences of smoking
1971-1975. Bethesda, Md.
1973-1975. 4v.
90. -. Division of Nursing.
Monitoring qualitY,!Jf nursing care, pt.
II: assessment and study of
correlates. Bethesda, Md., 1976.
128p. (DHEW Pub. no. (HRA) 76-7)
91. Department of Health, Education
and Welfare. Public Health Service.
Blood donor characteristics and
types of blood donations. United
States - 1973. Rockville, Md., 1976.
71p.
92. -. National Institutes of Health.
Communication in the service of
American health. . a bicentennial
report from the National Library of
Medicine. Bethesda, Md., 1976. 98p.
(DHEW Pub. no. LNIH) 76-256)
93. -. Differentials m health
characteristics by marital status
United States, 1971-1972. Rockville,
Md., 1976. 75p,
Studies deposited in CNA
Repository Collection
94. Baudry, Jeannine. Etude
comparative de la formation des
fonctions et du statut professionnel de
I'infirmiére et de f'assistant medical,
dans six regions du monde Montréal,
1975. 401p. (Thèse - Montréal) R
95. Gascon. Monique. Pro'" de
comportements d'interactions
verbales lors de la rencontre
post-clinique, chez des professeurs
et des étudiantes en techniques
infirmiéres dans des CEGEP de la
region métropolitaine. Montréal,
1975. 74p. (Thèse (M.A.) - Montréal)
R
96. Hefferman, M. Gwen. The
predictive efficiency of a
pre-entrance nursing test. Ottawa,
1975. 48p. R
97. Jones, Phyllis Edith. An
educational programme for nurse
practitioners, 1972-74;
supplementary report 1976 of a joint
project conducted by the Faculties of
Medicine and Nursing, University of
Toronto. Toronto, Faculty of Medicine
and Faculty of Nursing, 1976. 53p. R
98. Kirouac, Suzanne.
Experimentation d'un programme
d'enseignement pré-opératoire pour
des clients de chirurgie elective
(PEPCE). Montréal, 1974. 145p.
(Thèse (M.N.) - Montréal) R
99. Kyle, Mavis E. The development
and testing of an instrument for
assessment and classification of
patients by types of care. Saskatoon,
Sask., 1975. 181p.(Thesis(M.H.S.A.)
- Alberta) R
100. Lange-Sondack, Pierrette. Etude
descriptive des dimensions de
f'actualisation de so; et de la
compétence des infirmiéres
soignantes Montréal, 1975. 193p.
(Thèse (M.Nurs.) - Montréal). R
101. Lévesque, Louise. Anxlété, foyer
de contr61e et les effets d'un
enseignement sur f'etat physique et
emotionnel des opérés, par. . . et
Michelle Charlebois. Montréal,
Faculté de Nursing, Université de
Montréal, 1976. 175p. R
102. McKeever, Patricia Taylor. A
study of what it is like to be the father I
in a family in which a child is
chronically ill and is living at home.
Montreal, 1976. 38p. (Thesis
(M.Sc.(App.)) - McGill) R
103. Mountjoy, Anita. A study to
explore patients' perception of their I
mental health and their reflections 01
hope. Montreal, 1976. 34p. (Thesis
(M.Sc.(App.)) - McGill) R
104. Perkin, Catherine Ann. A study 01
continuity of nursmg care from the
hospital emergency room into the
home. Toronto, c1976. 92p. (Thesis
(M.Sc.N.) - Toronto) R
105. Registered Nurses' Association
of Ontario. Project for team nursing
development; five year report Nov
1969 - Aug. 1974. Toronto, 1974.
28p. R
106. Ritchie, Judith Anne. Adjustive
and affective responses of
school-aged children to a leg
amputation. Pittsburgh, 1975. 122p
(Thesis - Pittsburgh) R
107. Thibaudeau, Marie-France. The
health behaviour of mothers following
a consultatIon with three primary care
health services (CLSC, Emergency,
private office), by. . Mary Reidy and
Jean-Pierre Bélanger. Montréal,
Université de Montréal, Faculté de
Nursing, 1976. 258p. R
Audiovisual aids
108. Canadian University Nursing
Students Association. Conference,
Queen's University, 6-8 Feb. 1976.
Conference speeches. Kingston,
1976. 2 audio cassettes.
109. Institute of Continuing
Education. Primary nursing care.
Sawyer, Michigan, c1975. 6
cassettes.
The Canadian Nurse October 1976
57
L'eggs@ Nurse White Pantyhose
u
I
..ftftIu- hu --nail.
SPECIAL GROUP OFFER CERTIFICATE
Ir Nurse While Panlyhose,
chart, hllm the order form. enclose a
d mad to this address
ox 8116 Toronto, Ontario M5W IS8
eight below and choose the appropriate size
Sheer Enero
Size A S,zeB Queenslze
1I0-130Ibs.
105 1351bs
100-140Ibs. 145.180Ibs_
95-1451bs 1501851bs
90 1401bs. 141-150Ibs_ 155-190 Ibs.
90-135Ibs. 1361551bs 160-195Ibs_
95-130Ibs. 1311601bs. 1651951bs_
100-1251bs 126.1651bs 170-195Ibs
105120lbs 121-165Ibs. 170 190 Ibs
1I0-ll5lbs 116.165Ibs_ 170-185Ibs.
Il5 160 Ibs. 165.1801bs
120-150 Ibs. 1551751bs
125-1451bs 150.170Ibs.
130-140Ibs. 145 170Ibs_
145 160 Ibs
Gentlemen: Please send me. free and ,.,ithout obligation, your color-
ful Preview Booklet which pictures and describes the latest edition of
Encyclopaedia Britannica in full detail - and complete information
on how 1 may obtain this magnificent set. direct from the publisher,
through your eJlcJ\ing group offer
Name ,............ ...................,...... ..............' ................ ..........' ............ ......... '................ ,............ .....,...
t PLEASE PRIST)
Street Address ....,.....,.......................,.......h..........,.....,............................. .................,......,..".......
Ci\y..,..... ......................,........................... _ Zone ....................,...... Provo ,.....,..,........,..................
Signature ...............,...............................................,........... .....,.................................... ........'.........
f VALID ONLY WITH YOUR FULL SICN'\TURE HERE I
NURSES SPECIAL GROUP OFFER
_.._. __..__ __.....::/_ urn ''VI tr.CJ P',""O VI "V'C',
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
pnce lor Your Order
3 pairs 6 pairs to-
pnce of 5
$ 7.45
$ 7_95
$1995
$19_95
$19.95
12 pairs for
price oflO
$14.90
$15.90
$3990
$39.90
$39.90
If the coupon below has been used, please
prepare your order using the above charts
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, PO. Box 8116,
Toronto, Ontario M5W 1S8.
MAIL THIS COUPON TODAY!
p-----------------------------------------------
-s
-
,.
Nurse White only color available-See size chart
Available Styles and S,Zes 3 pairs 6 pairs lor 12 pairs lor TOTAL
pnceol5 pnce of 10
l'eggs-Regular $ 447 $ 745 $1490
l'eggs-Queensize $ 4.77 $ 7.95 $15.90
Sheer Energy -Size A $11 97 $1995 $39.90
Sheer Energy" -Size B $1197 $1995 $39 90
Sheer Energy' -QueenS/ze $11 97 $1995 $39 90
(Check" righl box) TOTAL PURCIVISE
Ontario residents add 7." sales tax SAl ESTAX
CDN N1076 TOTAL AMOUNT
NAM E
ADDRESS
CITY
PROVINCE-POSTAL COD F
-----------------------------------------------
56
The CanadIan Nurse October 1976
.,.iI)I-;II.!J lT1)(I;lt.
Bu.lness
Reply Mall
No P
lege Slemp
Nee....ry it m..1ed
in Cen8de
Government documents
Canada
69. Commission de réforme du droit
du Canada. Rapport. Le droit de la
famil/e. Ottawa, Information Canada,
1976. 79p.
70. Conseil du Tresor. Convention
entre Ie Coflseil du Tresor et /'Alliance
de la Fonction publique du Canada
groupe: commis aux ecritures et aux
réglements (tous les employes).
Ottawa, Information Canada, 1976.
63p.
71. -. Guide de gestion du
personnel 1975. Ottawa, Information
Canada, 1976. 47p.
72. Dept. of Indian and Northern
Affairs. The Canadian Indian; a brief
outline. Ottawa, Information Canada,
c1975. 17p.
73. Dept. of National Health and
Welfare. Report on the operation of
agreements with the provinces under
the hospital insurance and diagnostic
services act for the fiscal year ended
March 31, 1975. Ottawa, 1975. 73p.
74. Law Reform Commission of
Canada. Report on family law.
Ottawa, Information Canada, 1976.
73p.
75. Laws and Statutes. Canada
pension plan. R.S. c.C-5 and
regulations made thereunder. Office
consolidation, 1976. 248p. R
76. Lois et statuts. Régime de
pension du Canada. S.R., c. C-5 et
réglements établis en vertu de cette
loi. Codification administrative, 1976.
248p. R
77. Ministère de la Santé nationale et
du Bien-être social. Direction de
I'Assurance-Santé. Direction
générale des Programmes de la
Santé. Services d'urgence au
Canada. Rapport prepare pour Ie
groupe de travail sur les unités de
soms speciaux dans les hðpitaux, Ie
sous-comite federal-provincial de la
qualite des soins et de la recherche et
Ie comité consultatif de
/'assurance-sante. Ottawa, 1975. 3v.
78. Ministère des Affaires indiennes et
du Nord. Les Indiens du Canada; un
bref exposé. Ottawa, Information
Canada, c1975. 17p.
Po. tOil. will!>>. poicl!>>y
79. Nor
of Infor
Corps.
and nu
langua!
19? 1v
60. Pal
sur la
RaPPol
de la tr
1974-1
reine, 1
81. Pal
Commi
Report,
Parlia"
Queen
82. Sal
social.
accord
en vert.
"assuréJ.,n",C'-"võ:Jpltall\::Þcllv" C'l lCO""
services diagnostiques pour /'annee
financiére qUi se termine Ie 31 mars,
1975. Ottawa, 1975. 35p.
83. -. Bureau de la recherche.
Direction de I'usage non médical des
drogues. Protection de la santé.
Usage du tabac au Canada de 1965 à
1974. Ottawa, 1976. 27p. (Son
Rapports techniques no. 1)
64. Transport Canada. Road Safety.
Road safety annual report, 1975.
Ottawa, Information Canada, 1975.
19p.
85. Transports Canada. Sécurité
routière. Rapport annuel sécurite
routiére, 1975. Ottawa, Information
Canada, 1975. 20p.
86. Treasury Board. Agreement
between the Treasury Board and the
Public Service Alliance of Canada
group: derical and regulatory (all
employees). Ottawa, Information
Canada, 1976. 63p.
87. -. Personnel management guide
1975. Ottawa, Information Canada,
1976. 47p.
SPECIAL GROUP OFFER
Box 501
Station F
T cronto, Ontario
M4Y 9Z9
Quebec
88. Régie de I'assurance-maladle
Rapport 1975-1976. Québec, 1976.
95p.
Uni1E:d States
89. Public Health Service. The health
consequences of smoking
1971-1975. Bethesda, Md.,
1973-1975.4v.
90. -. Division of Nursing.
Monitoring quality,pf nursing care, pl.
nC,.,UDIIUI, ,""uncn,..uu..
94. Baudry, Jeannine. Etude
comparative de la formation des
fonctions et du statut professionnel de
/'infirmiére et de /'assistant medical,
dans six regions du monde. Montréal,
1975. 401 p. (Thèse - Montréal) R
95. Gascon. Monique. Profil de
comportements d'interactions
verb ales lors de la rencontre
post-clinique, chez des professeurs
et des etudiantes en techniques
infirmiéres dans des CEGEP de la
région métropolitaine. Montréal,
1975. 74p. (Thèse (M.A.) - Montréal)
R
96. Hefferman, M. Gwen. The
predictive efficiency of a
pre-entrance nursing test. Ottawa,
1975. 48p. R
97. Jones, Phyllis Edith. An
educational programme for nurse
practitioners, 1972-74:
supplementary report 1976 of a joint
project conducted by the Faculties of
Medicine and Nursing, University of
Toronto. Toronto, Faculty of Medicine
and Faculty of Nursing, 1976. 53p. R
98. Kirouac, Suzanne.
Expérimentation d'un programme
d'enseignement pre-opératoire pour
des clients de chirurgie elective
(PEPCE). Montréal, 1974. 145p.
(Thèse (M.N.) - Montréal) R
99. Kyle, Mavis E. The development
and testing of an instrument for
assessment and classification of
patients by types of care. Saskatoon,
Sask., 1975. 181 p. (Thesis (M.H.S.A.)
- Alberta) R
r'......'l.u. """1."'1.11 Loll'..... "'.....11 ''-''',",''''I.'VlloJ v,
hope Montreal, 1976. 34p. (Thesis
(M.Sc.(App.)) - McGill) R
104. Perkin, Catherine Ann. A study of
continuity of nursing care from the
hospital emergency room into the
home. Toronto, c1976. 92p. (Thesis
(M.Sc.N.) - Toronto) R
105. Registered Nurses' Association
of Ontario. Project for team nursing
development, five year report Nov.
1969 - Aug. 1974. Toronto, 1974.
28p. R
106. Ritchie, Judith Anne. Adjustive
and affective responses of
school-aged children to a leg
amputation. Pittsburgh, 1975. 122p.
(Thesis - Pittsburgh) R
107. Thibaudeau, Marie-France. The
health behaviour of mothers following
a consultation with three primary care
health services (CLSC, Emergency,
private office), by. . Mary Reidy and
Jean-Pierre Bélanger. Montréal,
Université de Montréal, Faculté de
Nursing, 1976. 256p. R
Audiovisual aids
108. Canadian University Nursing
Students Association. Conference,
Queen's University, 6-8 Feb. 1976.
Conference speeches. Kingston,
1976.2 audio cassettes.
109. Institute of Continuing
Education. Primary nursing care.
Sawyer, Michigan, c1975. 6
cassettes.
..------
The Canadian Nurse October 1976
57
L'eggs@ Nurse White Pantyhose
available only by mail.
Here's something specially tor you. Famous
L'eggs Pantyhose 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-tit
.
00;
".;
As Nurse White pantyhose 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 tor 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 to order your Nurse White Pantyhose.
Check your size on the size chart 1111 In lhe order lorm, enclose a
cheque or money order and mall to this address_
l'eggs Nurse While. POBox 8116. Toronto. Ontano M5W 158
Fo- best lit. find your height and weight below and choose the appropnate size
Re gu lar Pan ty hose Sheer Enero'
Hei
ht Avera
e Size Oueenslze Size A SlzeB Oueenslze
4'10" 110 130lbs
4'W 105-135Ibs
5'0" 100-130Ibs. 131-180Ibs. 100-1401bs 145-180 Ibs_
5'1- 95 1351bs_ 136-185Ibs_ 95-1451bs 150-185Ibs.
5'2" 90-140Ibs. 141190lbs 90-1401bs 141.150Ibs. 155 1901bs_
5'3- 90-1451bs 146-195Ibs_ 901351bs_ 136-155Ibs. 160-195Ibs_
5'4- 90-145/bs. 146- 200 Ibs_ 95-130Ibs 13l.160Ibs_ 165-1951bs
5'5- 90-1451bs 146-200Ibs_ 100 1251bs 126-165Ibs. 170195Ibs_
5'6- 901451bs_ 146 2001bs. 1051201bs_ 121-165Ibs. 170.190 Ibs_
5'7" 95 1451bs 146-1951bs 110 1I51bs_ 116-165Ibs. 170 1851bs_
5'8- 100-1451bs 146-190 Ibs. 115-160Ibs. 165.180Ibs.
5'9- 105.1401bs 141.185Ibs_ 120 150 Ibs_ 155-175lbs.
5'10" 115.135Ibs 136 180lbs 1251451bs 150-170Ibs.
5'11" 130 1401bs_ 145-170Ibs.
6'0- 145-160Ibs.
Determine the pnce tor Your Order
3 pairs 6 pairs fo-
pnce of 5
$ 7.45
$ 7.95
$19.95
$19.95
$19_95
12 pairs for
pnce oflO
$14_90
$1590
$39.90
$39_90
$39_90
Available Styles and Sizes
$ 447
$ 477
$11.97
$11.97
If the coupon below has been used, please
prepare your order using the above charts.
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
-
:JI
J
.
.
Nurse White only color available-See size chart
Available Styles and Sizes 3 pairs 6 pairs for 12 pairs lor TOTAL
pnceol5 pnceof to
L eggs-Regular $ 447 $ 745 $1490
L' eggs - Queensize $ 4.77 $ 7.95 $1590
Sheer Energy -Size A $11 97 $1995 $39 90
Sheer Energy -Size B $t1.97 $1995 $39_90
Sheer En ergy' - Queenslze $11 97 $1995 $39.90
(Check" right box) TOTAL PURCHASE
Ontano residents add 7"J. sales tax SAL ES TAX
CDN N1076 TOTAL AMOUNT
NAME
ADDRESS
CITY
PROVINCE_POSTAL COD F
-----------------------------------------------
58
The Canadian Nurse
('I
IHHi fï(>>(1
Á.\(IY(>>I-t iHelllelltH
British Columbia
ÞOSltlon available - OR Nurses needed for 96
bed acule care hospi-
tal situated In North West British Columbia Accommodations availa-
ble In residence. Salary as per RNASC contract For further mforma-
tlon contact Mrs. P. Janzen. R.N.. Director of Nursmg. r<ltlmat Gene-
ral Hospital. 699lahakas Blvd.. .-(,tlmat, Bntlsh Columbia, V6C 1 E 7
General Duty Nurses for modern 41.bed hospital located on the
Alaska Highway. Salary and personnel policies in accordance with
RNASC. Accommodallon available In residence. Apply: Director Of
NurSing, Fort Nelson General Hospital, P.O Box 60, Fort Nelson,
British Columbia, VOC IRO.
Ontario
RN or RNA, 57" or over and strong. Without dependents, to care for
160 pound handicapped executive with stroke. LIve-In. '/2 yr. In To-
rontoand '/2 yr. 10 MiamI. Preferably anon-smoker Wage $200.0010
$22000 weekly take home pay. depending on expenence plus Miami
bonus. Send resume to. M.D.C., 3532 Egllnton Avenue West, To-
ronto, Ontario, M6M IV6.
United States
California/Oregon hospitals need you' ExcIting choIce locatron, full
fnnge benefit. Visa sponsorship, assistance in obtaining State Licen-
sure etc. Phllcan Personnel Consultants. 5022 Victoria [;)nve. Van-
couver, British COlumbia, V5P 3TB. Canada Tél.: 327.9631 Tlx.:
0455333.
R.N.s' - Immediate need eXists for your services Excellent salary,
full paid benefits. We WIll assist you with your H-1 Visa forlmmigrahon.
Vanous locations available. Immediate licensure available ,f needed.
Wrlta tor an application to: Medical Staffing ServIces, SUite 2122, 333
North Michigan Avenue, Chicago, Illinois, 60601.
Nurses - RNs and SRNs -Immediate openings available In large
and small hospitals 10 ctlOlce locations 10 the USA Permanent and
temporary pOSitions In the department of your expenence Complete
licensure and visa aSSistance for RNs and SANs with no deficiencies
Call (516) 467.2616 or write Windsor Employment Agency. Inc.
POBox 1133, Great Neck. New York 11023
Registerad NurseS - Change and Challenge?? - Sunny Texas
beckon the experienced or graduate RN. We otter challenging oppo<-
tunltles In small or large commUnities In chOice surroundl9Qs with
beautIful weather 10 months out of the year. Included are great
benefits, career advancement. evening shift differentials. Fare and
accommodations assumed by our clients Salanes from $9600 to
$12.000 per year 12 month contracts minimum with options Send
resumes Immediately to: Medi-Search, 909 Burnett. Wichita FaUs,
Texas 76301
October 1976
United States
RN s - Texas Gulf Coast: Spohn Hospital, located In beautltul Coil
pus Chnstl. Texas has several openings for registered nurses. Th
hospital IS a 422 bed facl
ty specialIzing In short term patient cart
Several posl
ons available In new ICU - CCU facllty as well as OthE I
departments within the hospital. Excellent salary and benefits. Insel
vice education and working conditions are supenor. Individual growl I
and development are encouraged with advancement based on pe
formance. The city offers exceUent weather, conducIVe to outdoc l
activIties such as swimming, fishing, boallng and other pursuits. Co
pus Chrrsti, IS large enough to satisfy a person's cultural and SOCI.
needs, yet does not have the disadvantages of the larger me1ropolita I
areas. There are adequate housing and living faciilles availablp Wit
IOformation furnished upon request. If Interested In our opportunltie::
contact the. Personnel Department at Spohn Hospital. 1436 Thll
Street, Corpus ChriSti, Texas 76404 Phone No. 512'664-2041, Ex
126.
Texas wants you! If you are an RN. experienced or a reee
graduate. come to Corpus Chnstl Sparkling City by the Sea a Co
budding for a better future where your opportunities for recreation ar
studies are limitless Memonal Medical Center 5oo-bed generé
teaching hospital encourages career advancement and provldt I
Inserv,ce onentabon Salary from $602 53 to $1,069 46 per mont
commensurate with education and expenence Dliterenhal t
evenrng shifts. available. Benefits Include holidays sick leav
vacations. paid hospitahzatlon. health, hfe Insurance, PPFlSI(
program Become a vital part 01 a modern. up.to-date hospital. write
call John W Gover Jr.. DIrector of Personnel. Memonal Medic
Center P O. Box 5260 Corpus Christi Texas. 76405
Announcement - Who
Fellowships
1976 -77
Advertising Rates
For All Classified Advertising
$15.00 for 6 lines or less
$2.50 for each additional line
The World Health Organization allocates each year a small
number of fellowships to Canadian Health Workers. Awards will
cover per diem maintenance and transportation. The fellowships
are used to provide short programs of study abroad of
approximately 2 to 3 months' duration.
Canadian citizens engaged in a professional capacity in
operational or educational aspects of health care are eligible to
apply. Ineligible are workers in pure research, undergraduate and
graduate students and applicants more than 55 years of age.
Applicants will be rated and chosen by a selection committee on
the basis of their education and experience, the field of activity they
propose to study and the intended use of the knowledge gained
during their fellowship upon return to this country. Final
acceptance will remain the responsibility of WHO.
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,
Requests for further information should be directed at the
earliest opportunity to International Health Services.
International Health Services
Jeanne Mance Building
Tunney's Pasture
Ottawa, Canada
K1A 0L2
Address correspondence to:
The Canadian Nurse
50 The Driveway
Ottawa, Ontario
K2P 1 E2
.
..------
The Canedlan Nurse October 1976
59
31 paid-time-off days
your very first yea.:
Stanford LJniversity Medical Center needs
professional registered nurses as much as anybody.
But unlike anybody, we can satisfy all of your
requirements, both professional and personal.
Stanford University Medical Center is one
of the most prestigious in the world, and the role
of the professional nurse within this center is
perhaps one of the most enlightened and
progressive anywhere.
Then there is the San Francisco Peninsula.
The redwood forests and Pacific Ocean on the
west. The snowcapped Sierras to the east, and San
Francisco-just 35 miles to the north.
Finally, like the headline says, you are
eligible for up to 31 paid-time-off days your very
first year. Your second and third years you're
entitled to 36 days. For your fourth and subsequent
years, 41 days.
These are just a few of the things Stanford
University Medical Center can give you. You can
give us your valuable nursing expertise. If your
background and / or interest is in intensive care-
cardiovascular, medical, surgical or nursery, then
we may have an opportunity for you. Positions are
also available in general care areas. All openings
require at least 1 year of experience.
And a place to enjoy them.
a
I" .,
... '"'
...... .
-
"..
-
j
-
.
--...í... '"
............. ..J. _
.-....- -
..
.
Local interviews across Canada will be conducted in late I
October. For an appointment, call collect now. Contact Anne
Moroziuk, R.N., Nurse Recruiter, Stanford University Hospital, .
at (415) 497-7330. If you won't be available for a personal intervie\-v, I
please send your resumé to Anne Moroziuk, R.N., Nurse
Recruiter, Stanford University Hospital, Stanford, CA 94305, I
Nurses trained in Canada are usually eligible for reciprocal
. California license. Nurses trained outside of Canada must be I
__e;e; i
a
a
r; tï.;í ;b
o
al;n
c.e ..
.
I
I
I
I
Local Interviews-Call Collect
Stanford University Medic:al Center
An Affirmative Action Emplover
80
The Canadian Nurse October 1976
'j,:."'
PRESTON INSTITUTE
_ of TECHNOLOGY
= i Plenty Road, Bundoora, 3083,
Victoria, AUSTRALIA.
.........
=
, 111111 '..I:
. ..
Lecturers in Nursing
The Institute will pioneer from 1977, in the State of Victoria, a tertiary course for basic nursing
students, with the support of one of Melbourne's larger general hospitals.
The Institute campus, on 40.5 hectares (100 acres), is situated 20 km from the centre of Melbourne,
the capital city of Victoria. The Institute offers Degree and Diploma courses in Applied Science, Art
and Design, Business Studies, Engineering, Physical Education and Social Work.
The Nursing Department within the School of Applied Science, will offer the pioneer programme, a
Diploma in Nursing. It also offers a post-graduate Diploma in Community Health Nursing, and is
developing further courses.
Positions available:
Lecturers: (6 positions) Salary range: $A 11.425 - $A 17, 727 annually. Appointments will be made
within this range depending on qualifications and experience.
Possession of a degree in nursing is desirable but applicants with other degrees and/or diplomas who
have relevant nursing experience may be considered
Applicants must be willing to make meaningful contributions to a developing nursing department.
Each lecturer will have an area of responsibility, related to his/her particular interest and expertise, will
share in the general teaching activities and will be expected to teach and supervise nursing students
within the hospital and community setting.
Appointments are available on a long-term basis or, if desired, on a 2-3 year teaching contract basis.
The salary for an overseas appointee will be calculated from the agreed date of embarkation.
Re-Iocation assistance:
The Institute has established allowance schemes covering relocation expenses for family and
household goods, an immediate superannuation insurance cover, and assistance with
accommodation.
Closing-date for applications is: - October 25, 1976.
Appointees are expected to take up duties on January 15, 1977
Applicants should forward a curriculum vitae, including personal details qualifications and
experience to the Staffing Officer, (Ref.f. 189).
THE REGISTERED NURSES' ASSOCIATION OF ONTARIO
invites applications and nominations for the position of
EXECUTIVE DIRECTOR
RNAO enters Its second fifty years of service \'\ .th a np\\ tocu
geared to
optimizing the effectiveness of the nurse in contributing to the quality ot litp
The position of Executive Director of the AssoCIation has tremendou5
copP lor
challenge, creativity and Innovatron and affords opportunity for an pxcltlng and
enriching experience
The Executive Director, as the executive officer of the Association, ha
overall
responsibility for carrying out polICies, established by the Board of Directors,
pertaining to the management and administration of the affairs of the A
o( latlon
The applicant should have university preparation at the Master's level, a broad
nursing background and administrative experience
Written applications or nOminations, accompanied by a resump 01 qualill(ðtJom
and names of referees, will be received In confidence by
The Chairman
Search Committee
Box 31, Islington, Station B
Etobicoke r Ontario M9C 4X9
Head Nurse
for
Psychiatric Unit
required for 20-bed unit in modern
general hospital in Greater Vancouver
area of British Columbia. Successful
applicant must have at least 5 years
psychiatric experience, preferrably with
experience at Head Nurse level. Must be
eligible for registration in B.C. and have
post graduate course in administration.
Salary in accordance with R.NAB.C.
contract. This position will be available
December 1, 1976.
Please apply to:
Personnel Officer
Surrey Memorial Hospital
13750 - 96th Avenue
Surrey, British Columbia
V3V 1 Z2
Training in Art
Therapy
offered by the Toronto Art
Therapy Institute for
professionals in mental health
and education.
New trainees, if eligible, can
begin at the time their application
is approved.
Interested candidates should
forward their curriculum vitae to:
216 St. Clair Avenue West
Toronto, Ontario
M4V 1 R2.
For details regarding
admission requirements and
fees contact:
Dr. Martin Fischer - 921-0636
or Gilda Grossman - 921-4374
The lzaak Walton Killam
Hospital for Children
Halifax, Nova Scotia
Offers a 13-week
Post Basic
Pediatric Nursing Program
for
Registered Nurses
Classes Admitted
January, May, September
For further information
and detail write:
Associate Director
of Nursing Education
THE IZAAK WALTON KILLAM
HOSPITAL FOR CHILDREN
Halifax, Nova Scotia
83J 3G9
pala
bee î
2477 EST, RUE SHERBROOKE ST EAST,
MONTREAl. QUE., H2K 1E8
OFFERS NURSING OPPORTUNITIES IN
VARIOUS TOWNS AND CITIES
THROUGHOUT CANADA.
DO YOU FEEL YOU CAN TAKE ON A NEW
CHALLENGE?
If so, Para bee Ltd offers you this possibility.
Parabec, one of Canada's leading paramedical organizations.
offers you the opportunity of developing a paramedical service
in your area.
Through its team of specialists both in the medical and
marketing fields, Parabec Ltd can bring you the opportunity
you have always looked for, that is combining your nursing
and management experience,
By letting us know your interest we will be happy in discussing
our business opportunity program allowing you to set up a
business in your area and benefiting of our experience.
PARABEC L TO - Marketing Manager
2477 Sherbrooke St. East, Montreal, P,Q. H2K 1E8
\
I
#
Occupational
Health Nurse
Consultant
The Nova Scolla Department of Public Health. Occupational
Health Division, Health Engineering Services invites
applications for the above position for Nurses registered or
eligible for registration with the Registered Nurses Association
of Nova Scotia.
Qualifications:
The successful candidate will have an Occupational Health
Nursing Certificate or its equivalent by examination and not
less than ten years varied experience in occupatIonal health
nursing in industry of which five years should be at the
supervisory level. Travel throughout all areas of the Province.
Training in audiometry, advanced preparation in Occupational
Health Nursing. and some knowledge of basic industrial
hygiene would be an advantage.
Duties:
A comprehensive occupational health program is now being
developed and a O.H. Nurse Consultant will be a key member
of the consultant team, responsible to the Director of the
Occupational Health Division for a major segment of the total
program.
Salary:
Commensurate with qualifications and experience
Full Nova Scotia Civil Service Benefits.
Competition IS open to both men and women.
Please quote competition number 76-525
Application forms may be obtained from the Civil Service
Commission, J.W. Johnston Building, P.O. Box 943, Halifax,
Nova Scotia, B3J 2V9, and from the Provincial Building,
Sydney, Nova Scotia, B1P 5L1.
TM CanadIan Nurse October 1976
111
Wish
ere
) --
.
..
.
f} _r.
!!'
- <<
.
...
...in Canada's
Health Service
Medical Services Branch
of the Department of
National Health and Welfare employs some 900
nurses and the demand grows every day.
Take the North for example. Community Health
Nursing is the major role of the nurse in bringing health
services to Canada's Indian and Eskimo peoples, If you
have the qualifications and can carry more than the
nonnalload of responsibility.,. why not find out more?
Hospital Nurse
are needed too in some areas and
again the North has a co
tinuing demand. . ,.
Then there is OccupatIOnal Health Nursmg which in-
cludes counselling and some treanTIent to federal public
servants,
You could work in one or all of these areas in the
course of your career, and it is pos
ible to advance to
senior positions. In addition, there are educational
opportunities such as in-service training and some
financial support for educational leave.
For further infonnation on any. or all, of these career
opportunities, please contact the Medical Services
office nearest you or write to:
........,
Medical Services Branch I
Department of National Health and Welfare
Ottawa. Ontario K1A OL3
I
I
I
I
I
I Name
I Address
I City
I . . Health and Welfare Sante et Blen-ë\re social
Canada Canada
'-........
Provo
62
Medicine Hat & District
Hospital
Clinical Co-ordinator
Positions Open:
(1) Staff Development Co-ordinator
(2) Clinical Co-ordinator - Surgical
Nursing Program
These are senior positions.
Co-ordinators report directly to the
Assistant Executive Director - Patient
Services.
Qualifications:
(1) Bachelor of Science Degree in
Nursing - Masters preferred.
(2) Advanced clinical knowledge and
expertise.
Salary: Negotiable
Submit Resume To:
Mrs. Gwynneth Paterson
Assistant Executive Director - Patient
Services
Medicine Hat & District Hospital
666 Fifth Street, South West
Medicine Hat, Alberta T1 A 4H6
Director of Nursing
Position carries responsibilities for the
coordination of all facets of Nursing
services within a 87-bed accredited
General Hospital with an expansion
program for an additional 31 beds.
Preference given to applicants with
University preparation in Nursing
Administration or successful Supervisory and
Nursing Administration experience.
Apply in writing giving resume and
date available to:
Administrator
Mills Memorial Hospital
2711 Tetrault Street
Terrace, British Columbia
VaG 2W7
Royal Jubilee
Hospital
School of Nursing
requires
Nursing Instructors
with background in
Maternal & Child Health
Medical Surgical Nursing
Qualifications:
Baccalaureate Degree and
experience.
Eligibility for B.C. registration.
Policies in accordance with
R.N.A.B.C. contract.
Apply to:
Director of Educational Resources
Royal Jubilee Hospital
Victoria, British Columbia
V8R 1J8
The Canadian Nurse
Kinderspital Wildermeth
Biel/Switzerland
Requires for immediate or future
openings
OR Nurses
If you like to work with children,
child surgery offers an interesting
and varied field of activities
(Some) knowledge of German
and French necessary.
We are awaiting your
application at the:
Administrative Services
Kinderspital Wildermeth
Kloosweg 24
CH-2502 Biel
Switzerland
Night Supervisor
. Required for 65 bed
accredited hospital.
. Previous training and
experience in a senior nursing
position preferred.
. Residence accommodation
available.
. Must be eligible for
Newfoundland Registration.
Apply to:
Director of Nursing
Capt. Wm. Jackman Memorial
Hospital
Labrador City, Newfoundland
A2V 2K1
Two Head Nurses
Two Head Nurses with preparation
and lor demonstrated competence in
Psychiatric Nursing and
Management functions.
One to be responsible for
participation in the organization,
initiation, and the management of a
New Psychiatric In-Patient Unit.
The other to be responsible for
participation, organization and
management of an existing
Psychiatric Day Care Unit.
Forward complete resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
October 1976
Overseas - Norway
OR R.N.'s
Immediate vacancies for experienced OR
nurses at the Lillehammer Fylkesykehus
in Lillehammer. Norway. Hospital new,
modern, well-equipped. Lillehammer, one
of Norway's most attractive and
well-known tourist centers.
Active in-service program. Paid vacation,
t:ick leave, other benefits.
S,\lary from U.S. $9,900 - $13,150.
Liv;ng accommodation arranged.
Nor Negian language courses arranged
upor' request.
Serio,Js applicants may write to the:
Director of Nursing
lillehammer Fylkesykehus
2600 lillehammer, Norway
for further information. Please send
resume.
Clinical Co-ordinator
Obstetrics and Gynecology
Required for 302 bed fully
accredited hospital.
Demonstrated managerial ability
is requi red.
Baccalaureate degree and
experience in the clinical areas
are preferred.
Please apply with complete
resume to:
Personnel Department
Grace General Hospital
300 Booth Drive
Winnipeg, Manitoba
R3J 3M7
You'll
score
every
time t \
I/J 0
when you are a
RED CROSS
Blood Donor
i .ßi1 Alfred Hospital
(",,, " Road, P'ahran 3181
Wanting a refreshing
change of scene?
AUSTRALIA
STATE OF VICTORIA
MELBOURNE
AlJp c lions ..Ire Inv.ted from qualified nurSing
5J&Jff 10 fill positIOns In general wðrd areas
opt ung theatres and intenSive care areas At
presenr Alfred hospital has 523 aDJle care hPc1..
wt'llch will mcredse to 730 beds when a new
",ard block opens In the near future This
e1l.pansIOn requires an Increase In nurSing
establishment to meet the extra service needs
Three pOSt basIc courses are conducted -
1 Renal Intensive Care
2 CardlO thoracIc care
3 Acu Ie resp.r atory care
Allred Hospital IS a school of nurSlOg admitting
240 students annually It 15 also affiliated with
the Monash Unlversltv School of Medicine
bemg responsible for reaching and research
activitieS
SALARIES SISters - 151 year graduate from
SA798720 (Canada 59678) wIth Increments
annually to 5A9380 80 (Canada S 11 ,366)
Penalrv rates are paid Umforms are provided
and laundered Accommodation IS available
close to the Hospital which IS with 10 15 minutes
of the City centre. For prospective migrants
the Hospital,s wlllmg to act as .sponsor If the
applICant IS appolOted
Applications together with a recent photograph
and the names and addresses of two referees
and or requests for further mformauon to be
directed to MIss N Sewell. Director of Nursing.
ALFRED HOSPITAL. CommercIal Rd.Prahran,
Victoria. 3181 Australia 4214
The Montreal
Children's Hospital
Registered Nurses
Nursing Assistants
Our patient population consists ot the
baby ot 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 qualiffed applicants should
apply to the:
Director of Nursing
Montreal Children's Hospital
2300 Tupper Street
Montreal, Quebec, H3H 1P3.
The Canadian Nurse October 1976
63
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Quebec's Health Services are progressive!
So
.
.
IS
nursing
at
The Montreal General Hospital
a teaching hospital of McGill University
Come and nurse in exciting Montreal
--------------------------------.
tjfß\
,
g
"..,,-
The Montreal General Hospital
1650 Cedar Avenue, Mantreal, Quebec H3G 1...4
Please tell me about hospital nursing under Quebec's new concept of Social and
Preventive Medicine
Name
Address
L_______________________________J
64
Department of Health, Newfoundland
Public Health Nurses
Applications are invited from registered nurses with a diploma in
Community Health Nursing or Baccalaureate Degree in Nursing to
carry out generalized public health nursing programmes for the
following areas:
Badger's Quay, Bonavista Bay
Botwood, Exploits
Catalina, Trinity Bay
Come By Chance, Placentia Bay
Deer Lake/Pasadena
Ferryland
Fogo
Grand Falls
Green's Harbour, Trinity Bay
Harbour Breton
(Pool's Cove), Fortune Bay
Jeffrey's
Labrador City/Wabush
Lourdes, Port au Port
Musgrave Harbour
Springdale, Notre Dame Bay
St. Alban s, Bay d'Espoir
St. George's, St. George's Bay
Twillingate, New World Island
Applicants must be eligible for registration with the Association of
Registered Nurses of Newfoundland
Nurses are required to have a car except In Labrador Clty/Wabush
area.
Salary range - $11,781 - $14,401 per annum.
Isolation Allowance - Labrador - $675 per annum
Fogo - $600 per annum
Harbour Breton - $600 per annum.
Uniform provided.
Wol1<ing conditions in accordance with the Nurses Collective
Agreement.
Applications should be addressed to:
Director
Public Health Nursing Division
Department of Health
Confederation Building
St. John's
1
ComV'-- ,.-(
II: 11\\
oin the- Thü'tO' Jamltr
Opportunity to learn French
A
y
off
Director 01 Nursing Ongoing st education
Montreal Neurological Hospital
3801 University St.
Montreal, po. H3A 284
Individual orientation
The Canadian Nurse October 1976
Index to
Advertisers
October 1976
Barco of California
14
Burroughs Well come Limited Cover 4
Encyclopaedia Britannica Publications Limited 8
Equity Medical Supply Company 17
Frank W, Horner Limited 35
L'eggs Products International Limited 57
J.B. Lippincott Company of Canada Limited 32,33
The C. V. Mosby Company Limited 52, 53
Procter & Gamble 2
Professional Travel Consultants Limited 47
R
æ
mpa
5
W.B. Saunders Company Canada Limited 49
Sears (White Sister) 7
3M Canada Limited 1
Uniform Specialty
Uniforms Registered
White Sister Uniform Inc.
Cover 3
51
7, 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.
BÐ:I
1 76
E..,7J\JL
35
U :;11 LI lArtY
OTIAWA L TAKIO
.
... 7 l
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J, . r .5
Ot 1awa
(.,
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The Canadian Nurse
1217
t<.lN 6 t<i5
,..
STEP FOR
TARD
with designer's
choice
A. Style No. 47227
Si zes 3-15
Rib Royale and Gabardine Royale
10036 Polyester Knit
White .......... about $25.00
B. St yle No. 7294
Sizes 8-16
Ri b Royale and Gabardine Royale
1 OO>,-b Po Iyester Kn it
White, Blue ....... about $35.00
designer's
A h .
LIMITED C OlCe
EDITION
A PROUD CANADIAN NAME
IN THE FASHION INDUSTRY
J /
/J A T YOUR FA VOURIT
STORr!
\
The Canadian N ur.. November 1976
9
@
æOOw0[] WCiJOTI[]
HOSIERY
j . j . j
$ $ * $
ON 6 PAIR *
PAIR REGULAR STYLE ON 6 PAIR
JLAR STYLE OR 3 PAIR SHEER ENERGY
SHEER ENERGY! PANTYHOSE
PANTYHOSE
eggs@ Hosiery Fits Your Legs And Your Pocketbook, Too.
,
tþ
Special Price For A Limited Time Only. 15)J Regular Style & Sheer
This Special sale on L'eggs. Nurse White hosiery allows Energy" Come In A Size To Fit You.
you to buy She
r Energy" support pantyhose f
r as little Regular Style pantyhose come in Average and
as $3.16 per .palr or regular panty
ose fo
as little as. Queensize, Sheer Energy pantyhose come in 3 sizes: A, 8
$1.16 per pair when you buy 6. This special offer expires and Queensize. See Size Chart for your proper size.
January 30th, so order now.
tþ
DJ"J Sheer Energy R Supports,
Stimulates And Refreshes.
Quick & Convenient
Just fill in the coupon and enclose your cheque or M.O. in
an envelope. Your order will be shipped to you postage-free.
(Sorry, do not send L'eggs store-redeemable coupons,)
tþGuarantee
If, for any reason, you are not happy with the L'eggs
hosiery you receive, just return them for refund or
replacement to:
L'eggs Guarantee
1775 Sismet Road, Mississauga L4W 1P9
L'eggs Sheer Energy Nurse White is a sheer support
pantyhose made with "Springknit" yarn that supports
and stimulates your legs every time you move. Take
advantage of our special offer and save $2 to $5 on
Sheer Energy Pantyhose.
. Bawd on nOf'rnol 3 pair price
MAIL THIS COUPON TODAY!
r---------------------------------------------,
Choose Your Size/Style.
REGULAR
Height Average Size Qu..n5iz.
411- 105 14L IIx ---
5 0 100-140 lb. 145- 180 IIx
5' J 95- JA5 lb. 150- 1 85 lb.
5' 2- 90- 150 IIx 155-190 lb.
5 3 90- 150 IIx 155-195 lb.
5 . 90 150 lb. 155-200 IIx
5 5 90 150 lb. 155- 200 lb.
5 6 90- 1 50 IIx 155- 200 lb.
5 7 95-Jdlb. 150 195 lb.
5 8 100-1'511x 1 SO- '90 Ibs
5 9 105- 140 IIx 145-185 lb.
510 JJO-J..OJbs 1'5-180 lb.
511 '40-1151bs
SHrrR ENrRGY PANTYHOsr
Heigh. Si..e A Size I Qu..nsiz.
'10 110-13011x
. 11- 105 135 IIx -
5 0- 100-1'011x 1'5-180 IIx
5' I 95-'4Slbs - - 150-18511x
5 2 90 140 II>. l'I.I501b. 155 190 lb.
5 3- 90- 135 II>. 1 Jb. 155 lb. 16O-19511n
5 . 95.130 ... 131-160 lb. 165-19511n
5 5 100-1251b. 126-1651b. 170-19511>.
5 6 105 120 II>. 121-16511>. 170.190 II>.
5 r 110-115 IIx 116-16511>. 17018511>.
5 8- 115-160 Ib. IM-I80 II>.
5 9 - 120150 IIn 155- I 75 II>.
510- 125-1'511>. 150-170 II>.
511- 130-1'0 II>. 145- 170 II>.
6 0 145-160 II>.
OFFER EXPIRES JANUARY 30, 1977
QUANTITY TOTAL
6 Pair 3 Pair AVAilABLE STYLE SIZE COLOR Circl. # Pairs $
Off.r Off.r STYLES CODE CODE CODE Ord.r.d: 6 3 AMOUNT
SHEER ENERGY Save 55.00 when
518.9" 5 9.97 Size A 601 A 02 you buy 6, 6 3
SHEER ENERGY Save 55.00 when
518.9" 5 9.97 Size B 601 B 02 you buy 6, 6 3
""$ti-oQL SHEER ENERGY
ave 55.00 when
518.9" 5 9.97 aveen
1 ze 6-40 02 you buy 6, 6 3
Regular Style Save 52.00 when
5 6.9" 5 3..7 Average Size 101 02 you buy 6, 6 3
Regular Style Save 52 00 when
5 75" 5 3.77 Oveensi z.e 401 02 you buy 6 63
Nurse White only color available TOTAL OF OROER
Ontario Residents Add 7 10 "0 Soles TaJl;
PLEASE PRINT TOTAL AMOUNT ENCLOSED
M.
Mln
Nome Mn.
Flr'l
Los'
Iniliol
Addre..
City Province Postal Code
MAKE CHEQUE OR MONEY ORDER PAYABLE TO, l'egg. NURSE WHITE
Ma.1 To, L'egg. Nune White. P.O Box 8116 Taranto, Ontario M5W IS8
L____________________________________________
10
The Canadian Nurse November 1976
Se\
s
Newfoundland nurses hold twenty-second annual meeting
Nursing in Canada's youngest
province and the direction the
profession will take over the next few
years, came under close scrutiny
during the 22nd annual meeting of the
Association of Registered Nurses of
Newfoundland. Close to 400 nurses
attended the meeting in St. John's
from September 27 to 29.
During the meeting they heard
outgoing ARNN president, Roberta
Clegg, assistant administrator of
nursing service, International Grenfell
Association, St. Anthony, Nfld., make
a strong plea for better health care for
the "pioneer oftoday who feels he has
the right to adequate medical services
while he is engaged in opening up the
resources." She urged nurses in the
urban areas of the province to
remember that their actions also affect
the nurse in isolated areas and
pointed oul that unless they have
strong fam ily ties most of these nurses
are reluctant to work 10 the outports.
She encouraged ARNN members to
act collectively to obtain increased
nursing enrolment in the province,
equal education opportunities for
children in northern communities and
nursing education programs more
directly relevant to the health needs of
people in the outports.
Canadian Nurses Association
executive director, Helen K.
Mussallem, reminded nurses at the
meeting that membership in their
professional association constitutes
one of the "hallmarks of the
professional." Other criteria she
named include: a flexible education
base; a code of ethics; commitment to
continuous learning; mastery of
fundamental skills and accountability.
"If we consider ourselves an
independent profession, we must also
consider ourselves accountable for all
our acts," she said. Mussallem was
guest speaker on the opening day of
the meeting. She replaced CNA
president Joan Gilchrist who was
unable to attend.
Reviewing the goals and
accomplishments of organized
nursing in Canada, Mussallem
remarked that "it is no accident nurses
in this country have never been as well
prepared as they are now to make
long range decisions." She also
reminded her audience that the
establishment in each province of
collective bargaining organizations
did not release professional
associations from their obligation to
obtain satisfactory social and
economic working conditions for their
members.
In order to meet rising costs of
maintaining a professional association
and to provide professional liability
insurance for nurses in the province,
ARNN members approved a $20
increase in asso.s;iation fees. Active
membership next year will cost nurses
$60; the fee for inactive members will
be $7.50.
In other business dunng the
meeting, members approved an
amendment to the Association bylaws
making it compulsory for all nurses
from outside Canada and the United
States who have not written and
passed CNATS or NLN examinations
to write Canadian examinations after
January 1, 1978. After that date,
nurses from outside Canada and the
United States wishing to practice in
Newfoundland will have to write the
Canadian exams within six months of
arrival and must obtain a score of at
least 350.
Council members for 1977-78 w
be as follows;
Executive- Violet Ruelokke,
president; Margaret D. McLean,
president-elect: Elsie Hill, first
vice-president; Gertrude Caines,
second vice-president; Roberta M.
Clegg, immediate past-president.
Councillors - Beverley Andrews;
Janette Ball; Judith Chubbs; Myrtle
Cummings; Marcella Linehan;
Ada Simms.
Chapter Representatives will
include: Elitina Clarke, Corner Broo
1
Imelda Head, Grand Falls; Hilda
Jewer. Gander; Minnie Pelley,
Labrador CitylWabush; Janet Greer'
Trinity/Conception; Frances Bouza!1
Stephenville; Arthura Squires, Burir
Peninsula; Bessie Facey, Triple
Island; Dorothy Sutcliffe, St. Anthon)
Non-voting Members will be: Phylli
Barrett, executive secretary; and Alic i
Furlong, assistant executive
secretary. I
Did you know no
Canada's population passed 23
million on April 1, 1976, according t
estimates by Statistics Canada. I
f ,'1-
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The Extension Course in Nursing Un
Administration held its Ottawa
workshop September 20-24, 1976
the Chateau Laurier with 78 student
from northern and eastern Ontario
and Quebec attending the sessiom
This nine-month in-service course
consists of an initial workshop, horn
study with correspondence lessom
and a final workshop. Each year,
more than 500 nurses from across
Canada attend NUA workshops in
seven Canadian cities. The prograr
is offered both in English and Frenc
and has also been initiated in other
countries. All participants are nurse
who are employed full time in
managerial positions in hospitals an,
community agencies The NUA
course, begun in 1960, is sponsore,
jointly by the Canadian Nurses
Association and the Canadian
Hospital Association.
The Canadian Nurse November 1976
11
'University of Toronto terminates
nurse practitioner course
This year, the University of Toronto
Nill end its continuing education
::curse for nurse practitioners,
eportedly for lack of funds. The
Jniversity of Toronto program was
unded as a research project by the
esearch Program Development
)irectorate of Health and Welfare
:anada from 1972 to 1975, and the
rant was renewed for 1975-76.
The program was developed by
he faculties of medicine and nursing
It U of T. Requests for further
.mding, directed to both federal and
)rovincial governments, were
11 successful.
Last December, U ofT requested
he financial support of the Ontario
...1inistry of Colleges and Universities,
i request that was turned down
)ecause it came too late, and because
)f budget cuts. Murray Tarleton,
X'ogram analyst for the university
lffairs division of the Ministry,
I;uggested that funds were not
orthcoming "because we were
'ldvised by the Ontario Ministry of
-iealth to wait until the qu alifications of
he nurse practitioner and our
nanpower needs are resolved." He
;aid "There might be a surplus of
foctors in Ontario,"
Kathleen King, Dean of the
:aculty of Nursing at U or T and R
Irian Holmes, Dean of the Faculty of
edicine, state that the termination of
le course does not mean that U of T
o longer prepares nurses for
xpanded roles in health care. "The
egree programs in nursing have for
orne years placed emphasis on
linical nursing skills rather than
'aching or administration ...
The dem ise ofthe U ofT program
leans that McMaster University in
amitton will be the only center for
ducating nurses practitioners in
ntario. A course at the University of
estern Ontario in London trains
rthern nurses, but does not
der them nurse practitioners.
,\iurse practitioners have been
ed for an eXpanded role - for
on< in isolated communities, as
ained assistants in physicians'
ffices and in other settings. Their
sitive role in monitoring treatment,
assessing problems. assisting 10
home care and health education has
been well-documented. A recent
Globe and Mail editorial criticized the
government's role in the whole
question of health care delivery,
suggesting that if prevention and
cutting health care costs are
government priorities, the lack of
government financial support of the
nurse practitioner course is a "foolish
and uneconomic way to proceed.'
The program at McMaster
University is still going strong,
flOanced by a three-year grant
received from the Ontario Ministry of
Colleges and Universities effective
last May. The program is directed
towards nurses and physicians
practicing in a number of primary care
settings including family medical
practices, community health centers
and occupational health settings. Dr.
Dorothy Kergin and Dr. Fraser
Mustard of the Faculty of Health
Sciences at McMaster, state:
"McMaster research studies
concerned with the utilization of these
primary care teams have
demonstrated a high level of
acceptance by patients, personal
satisfaction on the part of the
practitioners, and most importantly, a
pattern of increased care on an
ambulatory basis and a lesser
tendency for care in the hospital.
except for serious problems which
clearly require these more highly
specialized resources. In our view it IS
in the area of reduced hospital costs
where the true dollar savings lie."
In their letter to the Globe and
Mail Kergin and Mustard point out that
three reports emphasizing the
importance of the nurse practitioner in
primary care. have been submitted to
the Ontario Ministry of Health. These
include the Report of the Health
Planning Task Force (1974), a report
following a conference of the OntarIO
Council of Health (January. 1975),
and an Ontario Council of Health
Report on the Evaluation of Primary
Care ServiCes (1976). The reports
have been submitted - the OntarIO
government still has no stated policy
regarding the future of nurse
practitioners in Ontario.
Health happenings
Canada's Minister of National Health
and Welfare, the Hon. Marc Lalonde
says his department has now
embarked on "Operation Ufestyle"
- an over-all education program
designed to encourage Canadians to
assume greater responsibifity
for health. He told delegates to the
Seventh International Congress of
Medical Records in Toronto in
September that positive gains in
health for Canada depend upon
encouraging individuals to modify
adverse lifestyles.
A Lifestyle Profile which will
enable individuals to determine the
quality of their lifestyle and see where
improvement is needed, is part of the
new program, as are the Lifestyle
Awards which will soon be instituted to
honor Canadians making a significant
contribution to health through their
own lifestyles.
Other features include the
Department s Fit-Kit and Dialogue on
Drinking. a health education program
aimed at reducing exæssive alcohol
consumption, as well as plans for
emphasis on industrial safety, a
cleaner environment and safety
measures to reduce injuries and
deaths associated with traffic
accidents.
Elghty-year-old comedian George
Burns, who says he knows some
people who were 75 when they were
25 years old and figures this makes
him about 32, was guest of honor
recently at Baycrest Geriatric Centre
in Toronto.
Burns was chosen by the Centre
to be the first recipient of its new "Life
Begins at 65 Award." His comment on
the subject of geriatrics. '" know lots
about old age but little about death. I
never died before, except in
Schenectady. ..
A kidney transplant program
involving four hospitals 10 Metro
Toronto is expanding to acquire body
organs from all over Ontario and
neighboring states in the U.S.
Dr. Michael Robinette, chairman
of the Metro Organ Retrieval and
Exchange Program, says the program
Will use a station wagon donated by an
auto manutacturer to carry medical
teams, which will be on 24-hour call
whenever a body becomes available.
Directory of
member associations
Registered Nurses' Association of
British Columbia 2130 West 12th
Avenue, Vancouver, B.C. V6K 2N3.
Executive Director - FA Kennedy
Alberta Association of Registered
Nurses, 10256 - 112th Street,
Edmonton, Alta. T5K 1 M6 Executive
Secretary - Helen M. Sabin.
Saskatchewan Registered Nurses'
Association 2066 Retallack St..
Regina, Sask. S4T 2K2. Executive
Director - Valerie Cloarec
Manitoba Association of
Registered Nurses, 647 Broadway
Avenue, Winnipeg, Man. R3C OX2.
Executive Director - M. Louise Tad
Registered Nurses' Association of
Ontario 33 Price Street, Toronto.
Ontario, M4W 1Z2. Asst. Executive
Director - Doris Gibney
Ordre des infirmières et infirmiers
du Québec (Order of Nurses of
Quebec), 4200 Dorchester ouest, bd,
Montreal, Quebec H3Z 1V4.
Executive Director and Secretary of
the Order - Nicole Du Mouchel
New Brunswick Association of
Registered Nurses, 231 Saunders
St.. Fredericton, N.8. E3B 1 N6
Executive Secretary - Karon Croll
Registered Nurses' Association of
Nova Scotia, 6035 Coburg Road,
Halifax, N.S. B3H 1Y8. Executive
Secretary and Registrar -
Frances M. Moss
Association of Nurses of Prince
Edward Island 188 Prince Street,
Charlottetown. PEl. C1A 4R9.
Executive Secretary-Registrar -
Laurie Fraser
Association of Registered Nurses
of Newfoundland 67 LeMarchant
Road. St. John's, Nfld A1C 6A1.
Executive Secretary - Phyllis Barrett
Northwest Territories Registered
Nurses Association, Box 2757,
Yellowknife, N W.T. XOE 1HO.
Secretary- Treasurer -
Jeanette Plaami.
12
The Canadian Nurse November 1976
MOSBY BOOKS
OFFER YOUR STUDENTS
A New Book! NURSING AND MEDICAL TERMINOL-
OGY: A Workbook. By RuthK. Radcliff, R,N., M.S. andShei/a
J. Ogden, R. N., B.S. The first workbook ro combine nursing and
medical terminology in a single source, this text helps students
develop and expand their nursing and medical vocabulary.
Opening chapters introduce terminology components -
prefixes, medical combining forms and suffixes. Subsequent
chapters then organize material according ro body systems.
Self-evaluation quizzes accompanied by answer sheets and flash
cards make this workbook a valuable self-help guide for your
students. January, 1977. Approx. 208 pp" 27 ill us, About
$11.00.
A New Book! THE PROBLEM-ORIENTED PSYCHIAT-
RIC INDEX AND TREATMENT PLANS. By Monte j.
Me/dman, M.D.; Gertrude McFarland, R.N., M.S.; and Edtlh
johnson, B.A. This dynamic new text exemplifies a new way to
standardize psychiatric treatment and improve the delivery of
health care services. This index - a systematic listing of
problems, goals, and treatment methods - enables all
members of the mental health team ro coordinate, integrate, and
record the multiple aspects of prevention, diagnosis, treatment,
and rehabilitation into a comprehensive prescription for care of
the individual and his family, Initial sections provide a general
description of the indexing system and subsequent chapters
review the chronological order of service delivery. July, 1976.
212 pp., 88 illus. Price, $7.90.
New 3rd Edition! NURSING CARE OF THE CANCER
PATIENT. By Rosemary Bouchard, A.B., A.M., Ed. D., R.N.
and Norma F, Owens, A.B., A.M., Ed.D., R.N. Keep your
students informed of the latest aspects of nursing care for the
cancer patient with this new edition. The text investigates the
multidimensional factors of prevention, detection, diagnosis,
therapy, rehabilitation, and terminal care in a context of rotal
patient management. Related pathology is presented in each
chapter - enabling students ro adapt suitable nursing measures
to meet the needs of each individual. Additional emphasis has
been placed on behavioral conditions, family counseling,
antineoplastic agents, self examination for breast cancer, and
more. June, 1976. 325 pp" 189 illus. Price, $9.40.
New 6th Edition! SIMPLIFIED DRUGS AND SOLU-
TIONS FOR NURSES, INCLUDING ARITHMETIC. By
Norma Dison, R.N., B.A., M.A. With this new edition, students
will gain the fundamental and practical knowledge needed ro
solve problems of dosage, solution, and interpretation of drug
orders. Alternative methods of solving dosage problems are
presented in each chapter - along with the suggestion that
students consistently use the method they understand best,
This revision reintroduces Young's rule for computing
children's dosages, and recognizes the trend roward the use of
u.IOO insulin. January, 1976, 120 pp" 18 illus. Price, $5.00.
HUMAN SEXUALITY IN HEALTH AND ILLNESS. By
Nancy Fugalt Woods, R.N., M.N.; with 1 contributor. This
informative new book illustrates ways in which health
professionals can deal successfully with a patient's sexual needs,
fears, and self-image. Lucid, well-written discussions examine
human sexual response patterns in a life cycle framework;
adaptation ro events that threaten sexual integrity; and
adjustment ro disease and disabilities that interfere with
sexuality and sexual function. Important concepts on sex
education and counseling are also provided. 1975,242 pp" 7
illus, Price, $7.65.
A New Book! HANDBOOK OF PRACTICAL PHAR-
MACOLOGY. By Sheila A. Ryan, R.N., M.S.N. and Bruce D.
Clayton, B.S" Pharm.D. Students will find this convenient
handbook a practical source of valuable information on the
precautions and proper utilization of roday's most commonly
used drugs. Drugs have been categorized according ro their
primary pharmacologic activity and, within chapters, mono-
graphs on drugs have been arranged alphabetically by generic
name. All drugs are indexed at the end of the book. Discussions
include: primary action and use, physiologic parameters,
dosage administration, cautions and special remarks. January,
1977. Approx. 320 pp., 1 illus. About $8.40.
The Ca...cllan N_ No.......... 11711
13
MOSBY
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A TOTAL PERSPECTIVE
OF EFFECTIVE PATIENT CARE
. up-to-date information on
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. clear, concise discussions
. relevant topics
New 11th Edition! MICROBIOLOGY AND PATHOL-
OGY. By A/ice Lorraine Smith, A.B., Af.D.. F.C.A.P.. F.A.C.P.
This newest edition has been eX(ensively revised and updated
ro answer your studenrs' questions on the u'hat's, when's, and
how's of microbiology with the most recenr informarion
available. The section on microbiology begins with basic
concepts, caregorizes and classifies microorganisms, describes
whar happens when microbes arrack living cells, includes lab
methods, and more, The second half presenrs an outstanding
overview of the fundamenrals of general pathology. April,
1976, 698 pp., 564 illus. Price, 515.70.
2nd Edition! A COMMONSENSE APPROACH TO
CORONARY CARE: A Program. By Mane//e Ortiz Vinsant,
R.N., B.S.; Martha I. Spence, R.N., B.S., M,N.; and Dianne
Chape// Hagen. R.N., B.S. An ideal teX( for studenrs with litde
or no previous knowledge of cardiac care, this 2nd edition uses
a successful programmed format to explore major problems
associated with acute myocardial infarction. Completely
revised and expanded, discussions now conrain material on
hemodynamic moniroring, mechanisms of arrhythmias, drug
therapy of shock-heart failure, and more. 1975. 244 pp., 439
illus. Price. 57.90.
NURSING SERVICE ADMINISTRATION: Managing
the Enterprise. By He/m M. Donrnan, R.N., M.A. Firmly
rooted in classical administrarive theory, this teX( offers
students a solid foundation of knowledge from which to
idenrify strengrhs and weaknesses in administration and to deal
with them effectively, It encourages efficiency, completeness
and economy, and at the same time gives cohesiveness and
order to the task of providing nursing services, Planning,
organizing, staffing, directing, conrrolling, reponing, budget-
ing, coordinating, public relations, research and more - are all
examined, 1975,284 pp" illustrated, Price, $7.10.
BEHAVIOR AND HEALTH CARE: A Humanistic
Helping Process. ByJane E. Chapman. R.N.. Ph.D. and Harry
H. Chapman, Ph.D. Here's a new approach that deals
effectively with the problematic issues repearedly encounrered
by health professionals, The authors have devised an "advocacy
model for humanistic helping" which provides a practical
framework for evaluating the presenr health care services. and
clearly idenrifies helping roles and behaviors as they apply to
helper and parienr. Actual case studies provide stimulating
examples and clarify theoretical concepts. 1975,206 pp. Price,
55,80.
3rd Edition! COMPREHENSIVE CARDIAC CARE: A
Text for Nurses, Physicians, and Other Health Practition-
ers. By Kathleen G. Andreo/i, R.N.. B.S.N., M.S.N.; Virginia
Hunn Fowkes, R.N.. B.S.N.; Douglas P. Zipes, M.D.; and Andrew
G. 'IX' a/lace, M.D. A leading text in the field, this 3rd edition
offers studenrs a total physical assessmenr of patienrs with
coronary artery diseases - emphasizing prevention of cardiac
arrhythmias and early rehabilitation, Additional illustrations,
new electrocardiogram tracings, and an updared appendix
augment this highly informative teX(. 1975,368 pp.. 959 illus,
Price, 58.35.
PRACTICAL NURSING
Neu' 4th Edition ! TOTAL PATIENT CARE: Foundations
and Practice. By Dorothy F. Johnston, R.N.. B.s.. M.Ed, and
Gai/H. Hood, R.N., B.S., M.S. Fully updared and expanded. the
new 4th edition of this frequendy adopted text encompasses all
areas of medical-surgical nursing, Studenrs will find detailed
information on principles of effective nursing care, techniques
for their applicarion, and specific guidelines for the treatmenr
of such disorders as: respiratory, cardiovascular, gasrroinresti-
nal, nervous, musculoskeletal, ete. Significanr new material
discusses microbiology, pathology, inrravenous solutions,
shock, cardiac monitoring, drug dependency, allergic condi-
tions, menral retardarion, and much more. February, 1976.630
pp" 311 illus. Price, $11.50.
Neu' 4th Edition.' MEDICAL-SURGICAL NURSING:
Workbook for Practical Nurses. By Dorothy F, Johnston,
R.N., B.S" M.Ed. and Gai/ H. Hood, R.N.. B.S., M.S. The new
edition of this practical workbook is an ideal companion (0 the
above teX(. Carefully following the text, it presenrs
hypothetical clinical situarions for studenrs (0 solve, After an
inrroduc(Ory discussion of the concept of patienr care, the
workbook approaches nursing care of patienrs with various
disorders: respirarory. cardiovascular, gasrroinresrinal, repro-
ductive, ete. Convenienr learning (Ools - vocabulary
definitions, discussion questions. and chapter inrroductions -
help students absorb and retain informarion, February, 1976,
208 pp" 18 ill us. Price, $6.05.
MOSBY
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The Canadian Nurse November 1976
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The Canadian Nurse November 1976
15
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impressive, and seems to make sense. attack. These people need to know how
,
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We have always centered our energies
on getting people through one crisis or
another, and now we are looking at
everything - from prevention through
diagnosis, acute care, and rehabilitation
People need to know what steps
they can take to keep them out of the
hospital in the first place... Improved
diagnostic measures and acute care
treatment means that more people are
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to live productively once they step
outside the protectIve walls of the
hospital, and how to prevent further
problems. A bandage and a pat on the
head just isn't good enough.
Changes mean broadening our
horizons. We can help to make
comprehensive health care more than
just a clIche.
,
..
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16
The CanadIan Nur88 November 1976
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Within a brief eight to twelve-
hour period, a nurse often has a
great deal to do. There are
patients, relatives, doctors,
nurses and technicians to talk to;
there are blood tests and X rays
and ORs to arrange. There are
patients who need a listener and
those who require her teaching.
There are charts to read, blood
results to know, medications
and treatments to give, vital
signs to take, and procedures to
assist in. (And) That phone is
ringing again...
"How is Mr. Jones today?"
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In September, The Canadian Nurse
published an article on the 'Head to Toe'
method of assessment and charting.
What follows is a specific example of its
use in an intensive care unit. The
emphasis in this follow-up article is not on
treatment, which often varies dramatically
from setti ng to setti ng - but on a method
of nursing assessment and its
implementation through charting.
The method involves looking at the
patient systematically, observing and
charting all that there is to be seen. Used
in conjunction with the monitoring of vital
signs, fluid balance, and test results, it
forms the basis for informed and total
patient care from a nursing and medical
standpoint.
The case history presented here is
sketchy - it does not attempt to give the
rationale for treatment nor to describe
nursing care. The focus of this article is on
-
(,
.
,
J
Lynda Fore
the first half-hour or so of the nurse's day
with Mr. Jones. At 0730 hours on the first
postoperative day, she receives report I
from the night nurse.
The following is her 'Head to Toe'
assessment of Mr. Jones.
Post-op Day 1
Mitral and aortic valve
replacement
0730 hours:
Received patient sedated on
MA 1 * ventilator
. MA 1 is a registered trademark of
Puritan-Bennett CorporatIon.
The Canadian Nurse November 1976
17
Head:
1 - Sleeping, rouses
asil
to .li9ht tOU
h.
- Pupils equal, medium In Size, reacting
briskly to light
- Moves four limbs to command.
- Hand grips - moderately strong and equal.
- Leg movements - strong and equal.
Sensation good.
- Color - pink to ears, lips, and nail beds.
Chest:
- On MA1 . ventilator. 40% en, tidal volume
(T.V.) 700 ee, respiratory rate (A.A.) 15/min,
self trigger (S.T.), airway pressure 20 cm
H2O.
- No. gendotrachealtube (E.T.T.) in situ, cuff
Inflated.
- Chesl expansion equal bilaterally. Air entry
audible to both apices and bases; moist
breath sounds throughout. Suctioned for
small amounts white sputum per E.T.T.
- Apex strong, clear, regular.
Chest inCIsion dressing dry and intact.
Mediastinal and pericardial chest tubes in
situ, draining scant amounts
sero-sanguinous fluid.
Pleur-evac. set at 20 em suction.
Pacer Wires In situ: temporary demand
pacemaker set at rate 90/min., milliamperes 5
and turned off.
Abdomen:
Soft, rounded, no bowel sounds audible.
xtremities:
All peripheral pulses palpable, moderately
trong.
Feet pink, cool to touch. Slight pitting edema
,f ankles bilaterally.
.. kin:
Warm and moist. Heels, elbows and coccyx
slightly reddened; no skin breakdown
noted. No sacral edema noted.
Pleur-evac is a registered
trademark of Deknatellnc
Equipment:
-IV's
1. 1000 ee 5% DW infusing at 75 ee/hour via
CVP line in the right anticubital fossa. CVP
fluctuating well for readings
2. 250 ee 5% DW running via left hand site to
keep vein open (TKVO)
3. xylocaine drip: xylocaine 1 gm/500 ee 5DW
to control premature ventricular
contractions (peripheral line) on standby,
and turned off.
- Arterial line: right groin, patent, (flushed Q1 h
with heparinized saline). Dressing dry.
- ECG: showing regular sinus rhythm, rate
80/min.
- Foley catheter: no. 16, 5ee ballon - in situ,
draining clear amber urine at 20-30 cc/hour.
- Nasogastric tube: No. 14 - in situ, patent,
and draining moderate amount bile-colored
fluid to intermittent suction.
Vital Signs:
- charted on the parameter record. BP 130/90,
apical rate 80/min., CVP16 em H20, A.A.
15/min., temperature 37.6 rectally.
0800 hours:
The 'Head to Toe' check gives the nurse a
good idea of how Mr Jones is doing, It also
provides the nurse with an opportunity to
reassure him and initiate care as she goes
about her assessment. His current status
can be compared with previous charting; it
can also be used as a baseline for further
assessment of his improvement or
deterioration, and for nursing pnorities.
Today Mr, Jones is relatively
comfortable, showing no major signs of
developing problems or unusual distress.
The equipment he depends upon is
functioning well, His morning chest X ray
indicates that his chest is clear, and his
blood gas results are within the normal
range on 40% 02.
Biochemistry results are normal,
urinary output adequate. His .
cardiovascular signs are stable; he IS
ventilating well and responds well to verbal
I would like to thank the nursmg staff of
the Cardiothoracic Unit at the Vancouver
General Hospital for sharmg the 'Head to
Toe' check with us. I would also like to
thank Kathi Olsen, AssIstant Head Nurse of
ICU at St. Michael's Hospital, Toronto, for
sendmg us 'Mr. Jones' for assessment.
and non-verbal stimuli, Mr Jones will be
very closely monitored until his condition
stabilizes. Within a few days, barring
complications, ventilation will be
discontinued, his chest tubes removed, IV
fluids discontinued (with increased oral
intake) and he will be up and around. The
'Head to Toe' check will be altered as his
condition improves, with an emphasis on
his rehabilitative progress,
The Patient
Bill Jones, a 58-year-old plumber,
was fairly healthy until three years
ago, when he began to experience
an unusual sense of fatigue and
shortness of breath on any physical
exertion. His doctor diagnosed
pericarditis, the symptoms of which
resolved with treatment and time,
Over a period of three years, Bill
was able to lose fifty pounds by
watching his diet. However, he
continued to smoke rather heavily
He took Digoxin 0.25 mgm once a
day, and Lasix 40 mgm twice daily
as ordered by hIs doctor,
This spring, Bill began to notice
increasing shortness of breath,
forcing him to cut back on his
smoking. Soon he required three
pillows to support him if he wanted
to get any comfortable sleep at all.
He had no chest pain.
Investigation through coronary
angiography showed that Bill Jones
had both mitral and aortic valve
insufficiency, but no coronary artery
disease. Consequently, he had a
double valve replacement, with no
problems arising during the surgical
procedure itself.
When transferred from surgery
to ICU, Mr. Jones was still not
awake, but his cardiovascular signs
were stable, and his cardiomonitor
showed no arrhythmias.
Immediately following surgery,
the plan included monitoring of his
vital signs, ventilation, blood
transfusions for hypovolemia, and
sedation to keep him comfortable
18
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The Canadian Nurse November 1976
.
I
I
a
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I
-5tepping 5tones:
A ROAD to Coronary
Rehabiliat ion Programs
Penny Jessop
The concerns of the nursing
profession have traditionally focused
on the patient who is acutely ill. Only
recently has positive rehabilitative
health education been accepted as a
vital component in comprehensive
care. Now it is up to us to help ih
providing an opportunity for the
exchange of questions and answers,
in initiating and coordinating
in-hospitallpost-hospital programs,
and in structuring the environment in
such a way as to make rehabilitation
more than just a possibility.
Within the past year, the Ontario Heart
Foundation through its Public Education
Director, has acted as a resource and
consultant in the establishment of 14
post-hospital teaching/support programs in
Ontario. These programs are basically
designed to meet the health education needs
of cardiac patients and their families following
hospitalization. Though basic core content is
similar, each area has an individualized plan to
allow health educators to meet the priority
concerns of their area, to incorporate local
medical preferences, and to utilize their own
community resources most effectively. What
follows is an outline of the program; it includes
the basic concepts underlying our lear-
ning/teaching philosophy, considerations in
program development, the experience of im-
plementation, and methods of program eva-
luation.
Basic concepts
In setting up our program
we realize that
effective teaching, particularly I clgarding
rehabilitation, must recognize the unique
quality of each person we hope to teach.
Realizing the importance of relating to
people as individuals, there remains a
common approach to the rehabilitation plan for
each patient. Our philosophy then, recognizes
that:
. The patient's readiness to learn is always
there.
. Only facts presented in an effective
environmental structure will become
knowledge,
. A positive approach is best, emphasizin! I
health promotion needs as opposed to I
disease orientation.
. Observation of phases through which th,l
post-coronary patient and his family pass
will help to organize !he teaching plan. I
. Assessments must be made not only 0
what was taught, but also what the patient I
demonstrates he has learned.
. Success cannot be expected 100 percen
of the time. In teaching we can convey the
information, let the patient and family know
what they are to do with that information, an,
provide the environment for reinforcement.
The aims and objectives must be realistic -I
for the learner and for the teacher,
Program Development
In planning a post-hospital teaching
program, it makes sense to find out what ha
been discussed with the patient and family
during his stay in hospital. This will form the
baseline from which the post-hospital teachin
staff can select topics for their program. For
this reason, a simple checklist used during the
patient's stay (see Figure I) coupled with thE
admission history and discharge summary,
offer those concerned with the patient's
follow-up a starting point for their teaching.
The initial development of a double set 0
objectives is helpful in facilitating evaluation of I
the program. Both patient-centered (includin
the family) and program-oriented aims shoulc
be developed. In several instances, these
aims may overlap. For example, it is hoped
that the implementation of a teaching plan wil
decrease readmission rate. This
program-oriented aim can be measured by a
readmission data flow sheet recording the
patient's readmission diagnosis, duration of
time since discharge, his age, and problem
;
existing on discharge which could have
contributed to his readmission.
The corresponding assessment needed
in a patient-centered review would relate
to the actual learning accomplished through
the post-coronary teaching. Hopefully such
The Canadian Nur.. November 11176
19
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II
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teaching will change the individual's behavior
and avoid the development of complications
leading to readmission. These could include
non-compliance with his medication,
nutritional or exercise regime; development of
congestive heart failure; post-coronary
anxiety; or family non-acceptance.
Once determined, the objectives will
indicate the need to include several
associated disciplines. A suggested initial
planning committee will include a
physician-consultant, a critical care nurse,
psychologist or social worker, nutritionist,
pharmacist, physiotherapist, chaplain, public
health nurse, home care nurse, and industrial
health nurse. A meeting of members of the
involved disciplines should be held to plan the
various topics of a post-hospital discussion
series, drawing from specific areas of
expertise. The first meeting can lay the
philosophical groundwork for the program,
and it acts as an introductory meeting for those
to be involved in the program.
Hesitancy is sometimes expressed by
those who want to become involved in the
program planning. One of the concerns
expressed is over stereotyping of information
given to the patient and his family; another
centers on the advisability of patients getting
together to 'compare notes' abouttheir cardiac
event. It must be emphasized that the intent of
a post-hospital support program is just that-
support. Initially, planning is done in general
terms - experience has taught us that there
are certain major learning concerns that need
reinforcement.
Group discussions are designed to be led
by a specialist for each topic. Such
discussions are carefully observed and
evaluated. We have found it helpful to have
one member of the planning team act as a
chairman or coordinator of all group
discussions to bring cohesiveness and
con
istent leadership to the program.
Our present programs cover a variety óf
topics, but there are many topics common to
all programs. The areas discussed are those
most often needing post-hospital
reinforcement including basic anatomy and
physiology, nutrition, multi-factor risks,
medications, activity, sexuality, stress, work
evaluation, and life-style review. These are the
real issues of daily life, not those of a protective
clinical environment.
The program is presented to Medical
Advisory Boards, the local Academy of
Physicians, and various community
assistance branches for recognition.
Additional revision of the program may be
necessary following the response of these
groups. It takes approximately six months
following initial planning for the program to be
ready for implementation.
Implementation
Once the groundwork is laid, details
concerning place, time, number of sessions,
group leaders. and public relations can be
worked out.
It is not advisable to try to "catch up" on
the many cardiac patients and their families
who have never had the opportunity to attend a
discussion series. Usually, patients eligible for
the program (within the subscribing hospitals)
are notified two to four weeks prior to their
discharge from the hospital. They may be
informed of the program during in-hospital
patient teaching programs, by the hospital's
discharge planning officer, or by a special
notice given to patients and staff.
We have found it most convenient for
those attending the sessions as well as for
volunteer discussion leaders to arrange early
evening sessions, approximately one and a
half hours in length. Once the time for groups
has been established, a roster of discussion
leaders is developed, with one member of the
planning committee attending all discussions
to add cohesiveness through reference to past
sessions. Time is arranged for a structured
review of the evening's topic, followed by a
question period, open discussion, and friendly
conversation. Sometimes, the group may be
divided to encourage patients and family
members to express their thoughts in separate
groups. A total group size of no more than 24
has proven most satisfactory.
A centrally located setting outside of the
hospital seems to be most effective as a
meeting place. Discussions have been
20
The Canadian Nurse November 1976
r
/
,
I
Ii
I
Figure 1
Date Teaching Started:
Assessment of Previous Knowledge:
CORONARY HEALTH TEACHING RECORD
Level of Knowledge about
Condition on Discharge:_
PATIENT ASSESSEMENT
TOPIC Date Adequate Appre- Needs Little or Relative Comments
Taught Compre- hensive Review No Com pre- Present
hension hension
Basic Anatomy
Review
BasIc Physio-
logy Review
Diagnosic
Tests
Identification
of Risk Factors
Heart Attack/
Angina
Concept of
Rehabilitation
(multifactor)
Atherosclerosis
Nutrition
Obesity
Exercise &
Activity
Lifestyle &
Occupation
Physical
Stress
Psychological
Stress
Sexual
Relations
Hypertension
Age &
Heredity
Medications
Smoking
Signs & Symptoms
of Complications
The Canadian Nurse November 1976
21
:onducted in local libraries, church rooms,
:;chool rooms, and municipal government
Jffices. These places often have their own film
3.nd slide projectors, blackboards, tables and
:hairs. Easy access must always be kept in
Tlind for patient convenience.
The choice of an extra-hospital location
::;eems to allow greater freedom of discussion.
l " hospital setting suggests the possible return
:0 the 'patient role.' This atmosphere is
31iminated through the use of an extra-hospital
I :;etting, where the focus on return to a healthful
ifestyle is more easily established.
Evaluation
In order to make any progress with
:ehabilitative programs, those involved in
Jlanning must continually assess their
3ffectiveness. It is estimated that
'eadmissions for cardiac patients have
jecreased by 30 percent, and that patient
::ompliance (activity and medications) has
;sen to 88 percent through long-term
'ehabilitation regimes.'
In assessing the programs set up by the
:Jntario Heart Foundation, we consider the
I
ollowing questions:
, 1. is there a measurable change in the number
Jf patient readmissions since the
9stablishment of the program?
2. are we attaining the program-oriented goals
ostablished at the onset of the program?
3. is the patient indicating that he has learned
from his involvement in the program?
The effectiveness of the program is
assessed by comparing readmission rates
Jefore and after the program was begun, i.e.:
. the number of readmissions within the
first eight weeks post-discharge (how many
were repeatedly admitted, and how many
limes each?)
. readmission diagnosis as compared to
'nitial diagnosis
. age, sex, occupation, marital status of
re-admitted patients
e how many of the readmitted patients had
een seen by their family doctor, a specialist,
. In conjunction with programs at St. Joseph's
Hospital, Chatham, Ont., and York Central Hospital,
Richmond Hill, Onto
The author acknowledges appreciation for
the work and interest of those involved in the
teaching/support programs of Chatham,
Cornwall, Kitchener-Waterloo, Richmond Hill,
Hamilton, Windsor, Scarborough, Etobicoke,
and Sudbury,
Penny Jessop(R.N., St. Mary's School of
Nursing, Kitchener, Ontario; B.Sc.N.,
University of Ottawa) has extensive
experience in nursing education. She has
been Nurse Clinician in the intensive care unit
of the Kitchener- Waterloo Hospital and in the
or a community health nurse prior to
readmission?
These statistics, plus a record of the
telephone enquiries received from cardiac
patients or their families by hospital staff over a
six month period provide a good baseline for
comparison to show us what we have, in fact,
accomplished.
Evaluation of the program-oriented goals
is facilitated by writing out these goals at the
beginning of the program. The initial six
months of the program can be assessed
through the use of a flow-sheet.
Patient assessment can be accomplished
by asking patients to evaluate themselves -
have they, in fact, attained desired changes in
attitudes or behavior? Self-evaluation serves
the useful purpose of reinforcing what has
been taught. Measurable criteria might
include:
. weight reduction/cholesterol reduction
. medication compliance
. smoking cessation
. corrective modifications in nutritional
pattern
. change in response to stresses
. recording of activity program
. preventive measures taken by other
family members.
In weighing the merits of the program, we
can also measure its cost by examining
nursing and patient care hours involved, the
patient's average length of stay in hospital,
and the investment involved in continuing
education for staff to help them to become
more effective teachers.
Nursing responsibilities are by no means
over when the patient leaves the hospital.
Limitations in time mean that we can only
accomplish part of the rehabilitation process
while the patient is hospitalized. It is hoped that
the post-hospital cardiac teaching sessions
will give reinforcement, review and support to
the patientsaftertheirdischarge. and will offer
a long-term and meaningful approach to
rehabilitation, ..,
Department of Ambulatory Care, Hamilton,
Ontario. At present she is the Director of
Public Education for the Ontario Heart
FoundatIon.
Bibliography
1 National conference on posthospital care of
coronary patients, Feb. 23-26, 1970. Richmond, Va.
Report, American Heart Association, 1970
2 American Heart Association. Rehabilitation of
the coronary patient, New York, Amencan Heart
Association, 1974.
3 Storlie, Frances. Patient teaching in critical
care, New York, Appleton-Century-Crotts, 1975.
4 Zifferblatt, S.M. Increasing patient compliance
through the applied analysIS of behaviour. Prevo
Med. 4:2:173-182, Jun. 1975.
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22
The CanadIan Nur.... November 1976
Heart disease, with its related
Illnesses, afflicts and kills more people
than any other single health problem.
The statistics are staggering, but even
more staggering is the fact that health
professionals allow their patients and
families to leave the hospital setting
without knowing what has happened
to disrupt their lives, and what to do
about it. People with cardiovascular
disorders and their families have the
right to know where they stand...
f
..
\
"'-
.
Health educators are just beginning to realize
the problems involved in changing an adult's
lifestyle. Preventive programs are
well-intentioned and, in fact, statistics indicate
that the mortality for heart diseases has
declined by two percent - from 51 percent to
49 percent - in recent years. 1 But the fact
remains that most people don't really listen
until the lesson-hits home - after the fact-
and this is our usual point of contact.
The typical, coronary prone adult is
usually confronted with the 'fait accompli' - he
is an individual in crisis. He has developed
symptoms that force him to present at an
emergency room and later a coronary care unit
- if he's lucky, Too many people die before
hospitalization.
He has his first taste of hospitalization in
an atmosphere of fear. His survival
threatened, he finds himself in a strange world
of wires, tubes, unfamiliar sounds,
white-uniformed hustle and medical authority.
Hospital nurses play an important part in his
life at this point, ensuring that he survives
In-Hospital Cardiac Education Programs:
THE
RIGHT
TO KN OW
é
1
'.
(
\
.
\
)
life-threatening arrhythmias, that his pain and
apprehension are relieved, and that his very
basic, immediate "total needs" are recognized
and met.
As the members of the health team in
closest contact with the patient and the
'significant others' in his life during the acute
phase of his illness, professional nurses have
another obvious responsibility. From the
moment our 'victim' enters the hospital door-
he has the right to know what is happening to
him. The question is, how, when and what do
we tell him?
This article is a combined effort - it
comes from two different settings and
illustrates two approaches. Our intent is to
demonstrate that the professional nurse, as
part of a well-organized health team, can make
the difference in cardiac rehabilitation and
prevention of heart disease - whether she
works in a small community hospital, a large
university teaching hospital, in education,
research, or community health. By sharing our
experiences. we hope to be of some help to
Carolyn Stockwe I
Jeanette Tada
,.
9
.
Simulated group session at Sf. Joseph's Hospital ir.
Hamilton, including patients, family members,
nurses and a doctor. Author Jeanette Tada is
seated on the far left.
those who are in the process of setting up
cardiac patient education programs. We make
up only a part of the whole picture, and we
acknowledge the value of many established
programs throughout the country. With these
programs, we share common goals: to
educate cardiac patients and their families
about the nature of the disease, to help them
live productive lives, and to establish a positive
emphasis on health.
As a consumer of health care, every
individual has learning needs. As a deliverer
of health care, every health worker has
educating responsibilities
The Canadian Nur.. November 11176
23
Sf. Joseph's Hospital, Hamilton:
I At the time of writing, the Cardiac
Education Program of the
Cardiac Unit at St. Joseph's
Hospital, Hamilton, was not yet In
operation. Target date -
September 1976,
The problem
WHY did this patient require another
3.dmission? What is he doing back in hospital?
- he was just sent home! We knew our
:>roblem. Some patients just don't understand
Nhat it means to have a 'heart attack' - let
I alone a 'myocardial infarction'. Why didn't he
lake his medications? His doctor told him to
-est! Why didn't he listen? What about his
f
mily? - surely they knew better.
The solution
A progressive hospital cardiac education
program - that's what we wanted! As the
patient and family progressed through his
IIness, we needed a program to ease the
patient's transition from hospital to home, to
prepare him for a new way of life, a lifestyle
"focusing on prevention," and including the
entire family.
Our program would be designed to:
.facilitate learning in individual and group
sessions
.involve nurses, pharmacists, doctors,
. ietitians, physiotherapists and community
health workers in the teaching process
.discuss and provide information on the
nature, treatment and risk factors of heart
disease
. evaluate the patient's understanding
through follow-up to prevent another
e-admission due to lack of compliance and
nderstanding.
Perhaps the patient and his famify appear
o understand the instruction they have
eceived in the hospital. But the patient is in a
elatively dependent situation as long as he is
ospitalized. His activity is restricted as a
. irect result of the hospital environment. How
- n we help him to be more responsible for
coking after himself before he goes home?
Medication compliance is an important
- spect of therapy for cardiac patients. Self
-: dministration of medications could be a
ignificant aspect of increased independence
or the patient. Once discharged, he is
esponsible for taking his medications; he
ust use his judgment as to when to call the
.octor because of certain uncomfortable
signs. We can help him to prepare for this
responsibility.
Self-administration of medications is
certainly not a new idea, and has proven a
successful one. Some hospitalized patients
can be educated in appropriate
self-administration of prescribed medications
prior to discharge. The patient is given
responsibility for learning about his
medications and for taking them in order to
facilitate better compliance after discharge.
This also allows nurses to evaluate the
patient's understanding of his medications
before he leaves the hospital.
Because a cardiac patient and his family
struggle with an 'invisible disability,' we must
take every step we can to help them visualize
and understand....
Grace Hospital, Windsor:
Health teaching of cardiac
patients and families has been
operative at the Grace Hospital
for approximately five years, with
the support of physicians,
nursing staff and allied health
team members.
With the ability to monitor individuals in
practically any setting, it is important not to get
caught up in gadgetry. People are attached to
those gadgets and they need so much more
than acute care. Perhaps we can prevent their
readmission to hospital by teaching them
about factors over which they can have
control. Under the proper guidance and
experience, we have the potential to teach as
well as to provide care. At the Grace Hospital,
our CCU staff presently teaches in both
in-patient and out-patient settings.
There are important concepts to
remember in teaching:
. the initial commitment of one human being
helping another
.a solid knowledge of what you're trying to
impart
. a united front - ie. different members of the
health team teaching the same individual and
his 'significant others' basically the same
information - each knowing what the other
has done via a written record
. honesty, tempered with a wisdom that comes
from experience
.a sense of timing
. a sense of humor.
Teaching begins by active involvement of
the patient in his own rehabilitative process,
24
The Carwcllan N...... November 11176
"
<--.
I
He receives basic explanations of his I
surroundings and situation in understandable
terms, He is assured of family participation as I
an integral part of his care. Our Patient
Information Booklet outlines progression of
care, the flexibility of restriction and regulation
to ensure his comfort and safety, and the I
assurance of a competent and caring team.
With confirmation of the initial diagnosis,
the physician imparts basic information, I
reinforced by the nurse. Incidentalleaming is
an integral part of nursing care, but our usual I
initial teaching approach is the one-to-one
session.
Much has been written about 'nursing
process.' Meaningful nursing process is
simply credible, honest, and humane action. It
is only common sense to get to know as much
as possible about the individual patient, to
respect him as a member of society, to assess
what is really important to him, and to assist
him to return to the mainstream as a I
productive individual.
This is what nursing conferences and
nursing care plans are all about - the
utilization of all the data and observations of
the health team to realistically assess his
progress. If you really know your patient, you
will recognize his behavioral or verbal cues
and his readiness to leam. Build on his basic
knowledge of his situation, use specific heart
foundation booklets to strengthen the effect of
your teaching, clear up misconceptions,
reinforce relevant information on his level. By
being honest with yourself and with him, by
using a positive helping approach, you
encourage his independence and
self-esteem.
Thus the patient's nursing care plan
reflects your nursing management - it
illustrates your approach and the patient's
response to your teaching. When the patient is
transferred from the progressive coronary unit I
to the medical unit, his transfer sheet gives a
nurse-to-nurse written communication of his
care and teaching in preparation for his
discharge.
Recognition of the need for a more
comprehensive cardiac follow-up led to the
establishment of a pilot project in cooperation I
with the Public Education Committee of our I
local branch of the Ontario Heart Foundation,
with post-hospital follow-up of MI and
pacemaker patients by V.O.N. and/or public
health nurses.
We are in the planning stages of defining I
nursing content for a common plan of care and
I
Sometimes, bab ets
more air than formula.
---
---
That's why we make soothing,
peppermint-flavoured Ovol
Drops.
Ovol is simethicone, an
effective but gentle antiflatu-
lent that relieves trapped air
bubbles in baby's stomach and
bowel without irritating gastric
mucosa.
Ovol works fast. And that's a
rei ief for baby. And for mother.
\
Also available in adult-strength
chewable tablets.
OVal DROPS
FOR INFANT COLIC
O"õl
'.M
.
''".II
"-
..."
A HORnER
, M . 1.......anaaa
The Canadian Nur.. November 1976
25
About the authors:
Carolyn J. Stockwell (R.N. Grace Hospital
School of Nursing, Windsor; B.Sc.N"
University of Windsor) is the Head Nurse of the
Coronary Care Unit, Grace Hospital, Windsor,
, Ontario. She is Chairman of the Canadian
i Council of Cardiovascular Nurses and a
member of the Board of Directors of the
I Canadian Heart Foundation,
teaching, with input from physicians and allied
' health professionals, Very valuable liaison has
been achieved through regular visits ofV.D.N.
and public health liaison nurses in CCU.
Exposure of the family group to a post-hospital
support system and medical direction
regarding the specifics of post-discharge care
reflects the trend toward decreased
hospitalization time, and more effective
utilization of all health resources in our
community.
Tuned to health
If we really care about health - we use all
our professional skills and human talents to
communicate to other human beings what's
happened to them and how they can help
themselves What they do with that
information is up to them - as adults they
have the right to choose, A truly tuned-in
health team uses all of its resources
cooperatively and more efficiently to prevent
costly hospital readmissions, improve quality
of lifestyle and hence promote health rather
than disease. This concept allows the
individual to know where and when to tune in to
a system that is ready and willing to accept him
at any point in the spectrum of service which
he contacts.
A truly enlightened health care team
works together for the good of the patient
without threat of overlapping roles. But the
unsettling reality IS that the job of health
teaching often doesn't get done or gets
deferred because of a human obstacle -
obstinacy to change.
The layman is much too sophisticated to
accept lack of answers for long. He is
perpetually bombarded by all forms of media.
And if he can't get answers from the people
who should be giving them - the ones who
really know his situation, then he will turn to
other modes of obtaining the information he
requires - and the advice 'for his own good'
from nonprofessional sources may not be the
best for his health, That's why the need to
know and know from the right people is so
important.
Nursescan help to prevent heart disease;
we can minimize the risks of our own lifestyles
and implement programs to educate and
produce change.......
Jeanette M. Tada (R.N., Regina General
Hospital School of Nursing, Regina, Sask.;
B.Sc.N. University of Alberta, Edmonton,
Alberta) is a Nurse Clinician with the Cardiac
Care Unit, St, Joseph's Hospital, Hamilton,
Ontario.
References
1 Canadian Heart Foundation. Heart facts and
figures. Ottawa, Canadian Heart Foundation, 1975,
p.6.
Bibliography
1 Allendorf, Elaine Erickson. Teaching patients
about nitroglycerine, by... and M. Honor Keegan.
Amer. J. Nurs. 75:7:1168-1170, Jul. 1975.
2 Baum, Sonya Solosko. A programme for
teaching cardiac surgery patients. AORN J.
23:4:591-599, Mar. 1976.
3 Bragg, T.L Psychological response to
myocardial infarction. Nurs. Forum 14:4:383-395,
1975.
4 Corday, Eliot. Prevention of heart disease by
control of risk factors: the time has come to face
facts, by.... and Stephen Richard Corday. Nurs.
Digest 4:2: 21-23, Mar./Apr. 1976.
5 Cox, Mary Ann. A myocardial infarction
prevention program in industry. Nursing '76
6:3:25-26,28-29, Mar. 1976.
6 Crawshaw, Joanna. Community rehabilitation
after acute myocardial infarction. Heart Lung
3:2:258-262, Mar./ Apr. 1974.
7 Delaney-Naumoff, Mary. The heart of the
family, by... and Ingvarda Hanson. Paper presented
at a workshop on health teaching of the
cardiovascular patient and family, May 5, 1976,
Windsor. Ont. (Co-sponsored by St. Clair College
and the Canadian Council of Cardiovascular
Nurses.)
B Granger, Judith W. Full recovery from
myocardial Infarction: psychosocial factors. Heart
Lung 3:4: 600-610, Jul./Aug. 1974.
9 Johnston, Barbara L Eight steps to inpatients
cardiac rehabilitation: the team effort -
methodology and preliminary results, by... et al.
Heart Lung 5:1 :97-111, Jan.lFeb. 1976.
10 Jourard, Sidney M. The transparent self:
self-disclosure and well-being. 2ed. Toronto, Van
Nostrand Reinhold, 1971.
11 McGann, Mar1ene. Group sessions for
families of post-coronary patients. Superv. Nurse
7:2:17-19, Feb. 1976.
12 Murray, Ruth. Guidelines for more effective
health teaching, by ... and Judith Zentner. Nursing
'76 6:2:49-53, Feb. 1976.
13 Redman, Barbara Klug. The process of
patient teaching in nursing. Rev. 2ed. St. Louis,
Mosby, 1972.
14 Rule, Dorothy. The road back begins in CCU
Nursing '76 6:3:48-51, Mar. 1976.
15 Storlie, Frances. The family: thirteen years of
observation. Superv. Nurse 7:2:712-714, Feb.
1976.
16 Van Bree, Nancee S. Sexuality, nursing
practice and the person with cardiac disease. Nurs.
Forum 14:4:397-41', 1975.
17 Winslow, Elizabeth Hahn. Symposium on
teaching and rehabilitating the cardiac patient. Nurs.
Clin. NorthAm. 11:2:211-212, Jun. 1976.
26
The Canadian Nurse November 1976
,
Cécile Boisvert is presently Clinical Nurse
.
\ Ii- (;
- ,......:.;- ..t. Specialist at the Montreal Heart Institute. She
"1< ) ,
r.. ._""
.
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Convalescence
following coronary A
surgerY:GROUP
EHPERIEnCE
Cécile Boisvert
The patient who has heart surgery and
returns home will experience many
problems in adjusting to a modified
lifestyle. Successful rehabilitation
depends on many factors - the
knowledge the patient has about his
condition, his own motivation and the
support he receives from family and
friends. If he has received good teaching
in the hospital, his task will be much
easier. But is in-hospital teaching
enough?
Current nursing research suggests
that patients are more receptive to health
teaching after they have returned home
and benefit from sharing experiences with
a group. The author describes the results
of an investigation into the concerns of
convalescent coronary patients and their
wives and tells how group sessions
helped ease their transition from hospital
to a productive lifestyle.
Several authors 1 2 3 4 have used
group-therapy sessions to study the problems
encountered by myocardial infarction patients
and to help them adjust during the first year
after the event. Until we began this study at the
Institute of Cardiology in Montreal, however,
no such study had been undertaken using
aorto-coronary bypass patients as subjects.
David 5 found that 38% of the coronary patients
did not return to work even if the operation had
achieved three major goals: relieved the
angina, improved the myocardial flow and
performance and returned them to a useful
social life. Considering the lack of data with
surgical patients, it was decided to do a pilot
project to identify major problems during the
convalescent period and to facilitate the
reintegration of the patient to normal family
and social life.
Method
Selection of subjects
The sample included only male patients who
had had aorto-coronary bypass surgery during
two consecutive weeks in January and who
were residents of a metropolitan area, Six
patients and their wives agreed to be
participants in the study and to meet for 1 and
1/2 hours every other week, during the
convalescent period, for a total of eight
meetings. The group sessions were attended
by a clinical nurse specialist and a social
worker and were tape-recorded. Each taped
session was analysed after the meeting by the
investigators. Based upon Adsett's3
experience, it was decided to start with a joint
session, to have separate husband and wife
groups afterwards and to conclude with both
groups together.
Characteristics of participants
The ages of the six patients ranged from 37 to
56 years. Five of them were blue-collar
workers. Considering the heterogeneity of the
group in terms of age, socio-economic
conditions and family problems, it would have
been very difficult to have a control group.
The subjects presented these general
characteristics: they were action-centered,
had very little insight, presented type A
behavior. including job involvement, speed
and impatience, and were hard driving.
Role of the investigators
A modified non-directive technique was used
by the clinical nurse specialist and the social
worker. The fact that both investigators were
women could have influenced the reactions of
the group members, one way or another.
The following approaches were used:
- support and clarification;
-information and correction of erroneous
notions or perceptions;
- frequent recalls of the contract i.e. the
investigators had to remind the patients
several times that they would not carry over
. Note: for information on type A behavior, see: Type
A behavior and your heart by Meyer Friedman and
Ray H. Rosenman, Knopf, 1974.
information from one group to another;
- problem-solving for current difficulties
experienced by the patient and his family;
- reinforcement of weak signals and
assistance to express feelings associated witt
heart disease and the rehabilitation process
Separate meetings were scheduled for
participants who had personal problems not
common to the group.
I
Patients' concerns I
The themes changed gradually. At first, the I
subjects were mostly preoccupied with their
health status but later became more restles
and anxious to return to work. Most of therr
experienced psychological instability going I
from depression to euphoria and finally to al
realistic outlook on their future. Analysis of th
tapes permitted the investigators to identify
eleven main concerns expressed during the
group meetings.
Results
Fatigue: Most patients experienced
unexpected fatigue and a feeling of weaknes
after they left the hospital. They could not
concentrate on minor tasks such as readin
the newspapers or novels and their reactior
was one of depression and/or irritability,
Pain: They became more sensitive to pain an
more body-conscious. They were often afrai
that their heart would beat too fast or too slov
etc. ... Even if they were told before dischargl
that muscular pain would continue for a fe....
weeks, they were surprised to be
uncomfortable at home and hesitated to takE
their analgesics.
Sexual activities: Several patients expresse
concern about resuming se>Çual intercourse
especially because they were afraid to
increase their heart rate or thought it might
reopen or hurt the sternal incision.
Daily activities: Not being too sure of their
own capacities, many patients wanted to knO\
if they could resume certain activities. As fc
sexual activities, the more hesitant were
helped by the experience of the audacious
ones, One patient reported having walked fou
blocks, taken the subway and climbed four
flights of stairs to go to the Insurance Bureau
At the next session, everybody reported mon
physical activities during the week,
28
The Canadian Nurse November 1976
Margaret Wehrley
The threat of sudden death due to a
myocardial infarct inevitably
places a sev
re strain on the
patient, who may realize the
severity of his condition, on the
family who are justifiably
concerned about the life
threatening situation the patient is
in, and on the coronary care nurse
who is involved in his care. Each
one reacts to this stress in his
own way. If the nurse can begin to
understand her own reactions and
the reactions of the family and
patient, she will be better equipped
to help them cope with this crisis
situation. '
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II
,
The Family
Sudden illness or death from a myocardial
infarct causes intense shock to the
relatives who have no opportunity to
prepare themselves for such a change.
Very often, the lasttime the family saw the
patient, he was well, perhaps leaving the
house for work. They are summoned to
the Coronary Care Unit to find him
critically ill, attached to various machines
and other unfamiliar devices, Most
relatives are not able to listen to detailed
explanations at this early stage - they
want reassurance that the patient will
survive this crisis.
In the CCU, during the first critical
hours, the nurse's energies are directed
towards the care of the patient, but the
family, also, needs a great deal of
support. Relatives require simple,
concise and personal explanations about
the patient's condition and his care.
[Often, fear of the equipment in the CCU
keeps relatives from coming close to the
patient. A simple explanation of unit
equipment by the nurse may alleviate
some fears and she can let them know
that it is alright to touch the patient.].
If sudden death occurs due to cardiac
arrest. resuscitative measures prohibit
the family from being atthe bedside at the
time of death. A family's reactions to such
a sudden loss are usually intense: they
include grief, anger, despair and disbelief.
The nurse who has studied the patient
and that particular family's reaction to
illness, can offer valuable support during
this crisis.
The Nurse in CCU
The Coronary Care Nurse acts as a
mediator between patient and family,
answering questions, facilitating their
expressions of fear and supporting them
in their sorrow. She is also closely
involved with her patient. This
involvement is sometimes difficult but it is
always essential. From the time he arrives
on the Unit, the patient depends heavily
on her support. Like his family, the nurse
feels anxiety and fear when the patient
has a sudden cardiac arrest, but this
anx iety can be transferred into the energy
necessary to deal with the situation. She
is geared towards the prevention of
sudden death in the Unit and therefore
tends to think of death as a failure on her
part. Rather than thinking "Could the
health team have done anything
differently?" - she may think "What did I
do wrong?" - What did I miss?' The most
difficult hurdle the nurse in CCU must
cross is acceptance of a patient's
irreversible diagnosis or unsuccessful
resuscitation.
The Canadian Nurse November 1976
29
..
o
The Patient Who Survives
A Cardiac Arrest
If the patient realizes what has happened
to him, it becomes vitally important that he
be encouraged to communicate his
thoughts and anxieties regarding this
event. The nurse in CCU is in a unique
position, because of her constant
presence, to invite the patient to express
his concerns freely. Having suffered one
cardiac arrest, he must Jive with the
possibility of another. Anxiety is the
normal reaction and research has shown
that it can place as much strain on the
cardiovascular system as does exercise
Unalleviated anxiety, can lead to
depression, and together these two
emotions can cause a mental and
physical deterioration. This condition has
been named ''The Lazarus Syndrome."
Acceptance of cardiac arrest varies
from one individual to another. The
following examples of patients in our CCU
who have survived a cardiac arrest and
their reactions to it, illustrate these
differences.
. An elderly lady was in the Coronary
Care Unit for a second time. She suffered
a cardiac arrest and was successfully
resuscitated, On recovering and realizing
what had happened. she was able to give
this description of her "death," '" was
walking down a long avenue; it was very
dark, but I kept walking because I could
see, at the end, a beautiful purple haze. I
knew instinctively that there was peace
and happiness there, so I kept on walking.
I was almost there when a voice said to
me, 'Mary, you must turn around and go
back now.' I thought it was the voice of
God and I obeyed - walking back along
the dark avenue until I woke up here in my
bed." This lady stated that she was happy
to be able to spend more time with her
family, and now she feels no fear of death,
but can accept it whenever it should
occur.
. A 42-year-old school teacher
suffered a cardiac arrest while he slept.
He was quickly defibrillated and
continued to sleep until morning. On
being told of the occurrence by the patient
in the next bed, he flew into a rage
shouting "What right do you have to
interfere in my life?" Perhaps anger was
his way of expressing his fears.
. A middle-aged man who had been the
executive director of a large company was
involved in city council and service club
work. Following his cardiac arrest and
resuscitation, he became depressed and
fearful, refusing to become involved in
any kind of rehabilitation program, He
stayed at home worrying about his future,
his disease, his next chest pam. He had
repeated admissions to hospital, each
causing more anxiety but no further heart
damage. Fi"ally, he died -an example of
"The Lazarus Syndrome."
The majority of patient's
psychological reactions fall between
examples one and three. Many people
have a feeling of impending death in the
early hours following myocardial
infarction, but for the majority, their
condition stabilizes and death does not
occur, However, the patient often
remembers this feeling and emotions of
loneliness. depression, anger or denial
may follow as he improves physically. The
nurse may notice her patient is quiet and
withdrawn. Although he is surrounded by
hospital personnel, he feels lonely -
perhaps because of the unfamiliar
surroundings which prohibit or restnct
activities of daily living and contact with
family members. Statements such as "I
am just another piece of machinery," or
"You treat me like achild," or "I am no use
any more" should alert the nurse that her
patient is developing feelings of
loneliness and depersonalization.
Depression can often be seen in patients
returning to the Coronary Care Unit after
their second and third myocardial infarct
within a relatively short penod of time. The
nurse should try to counteract these
feelings with words of reasonable hope.
Some patients react to this condition
with anger, particularly if the patient is a
younger person. He IS angry because he
feels this illness will interfere with his life
plan, perhaps jeopardize his future. He
may direct his anger towards the nurse or
the doctor, but usually it is towards the
one he cares for most - his wife or a
close friend.
Other patients may appear jovial,
joking with the staff and doing more than
their activity program allows. One may
feel that a patient who behaves in this way
has accepted his condition, but the
"happy-go-lucky" air is sometimes a front
to hide the anxieties inside. This behavior
may be a form of denial because he is not
able to face up to the situation at this time.
Conclusion
Excellence in nursing in the Coronary Unit
is not measured by the number of medical
responsibilities a nurse is allowed to
assume but. rather, by her willingness
and ability to invest in supporting
emotional as well as physical adaptation
to stress. '"
Margaret Wehrley, the author of "Sudden
Death" has been Head Nurse in the
Coronary Care Unit of Plummer Memorial
Public Hospital in Sault Ste. Marie,
Ontario, for just over eight years. Her
motivation in writing the article came from a
desire "to share some of this experience
with other members of the profession",
A graduate of Leicester Infirmary in
England, Wehrley has also worked at St.
Catharines General and
Kitchener- Waterloo Hospitals,
Bibliography
Lawrence, Edward Meltzer. Intensive coronary
care; a manual for nurses by .., et al.
Philadelphia, Charles Press, 1970. p. 11.
Roberts, Sharon. Behavioral concepts and the
critically ill patient. Englewood Cliffs, N.J.,
Prentice-Hall, 1976. p. 355.
30
The Canadian Nur.. November 1976
Last Spring my mother died. In a sense it was
a victory for her, and because the situation
surrounding her death was unusual, I
promised the hospital's patient representative
to describe our experience in the hope that it
will provide some insight into the relationship
between dying patients and their families and
the medical staff. What made my mother's
case unusual was not the fact that she was
resuscitated against her will, but that my sister
and I seemed to be the first family at that
hospital to actively object to maintenance
procedures and to take action on her behalf...
You would have to have known my mother to
appreciate the circumstances of the case. She
was a gutsy, independent lady, a registered
nurse, class of '26. Her working experience
was comprehensive. She had a congenital
back deformity that was a source of
intermittent (though it often seemed constant)
pain. She did not complain often. She was
privately religious. She had a mercurial
temperament, a wide range of interesting
friends, the desire to look after others and take
care of herself. She was widowed for eight
years and while she didn't express bitterness
at the loss of my father, she must have missed
him a great deal. He had been the victim of a
tragic accident in 1959 and after numerous
stays in hospital and five major operations,
recovered to the point where he could drive a
car and playa little golf. He bore his suffering
stoically: he said he felt it was worth the fight to
live when he first regained consciousness and
realized his brain was undamaged. The only
time we heard him complain was when he was
served a piece of "shoe leather" roast beef for
his first solid meal after three weeks of IV's!
In 1968, my father had two or three
massive strokes in one day and then died. My
mother was grateful that he was spared the
ordeal of a lingering death. After he died, at
various times that werenot stressful, members
of the family talked about our feelings and
desires. What emerged was a pattern of
opinion on the quality versus the quantity of
life. Mother in particular expressed the hope
that when the time came, she would die
quickly. She asked us to protect her from the
use of heroic measures to prolong her life. She
feared dependence on others and pain. She
wanted only to be an active individual. In
retrospect, I think Mother knew how sick she
was. This is why she resisted going to hospital
and gave such inaccurate verbal histories. I
think she was terrified of the treatment she
would have to submit to; at one point she said
she would never have open-heart surgery.
Mother entered hospital early one
morning. During the next five days, she was
moved to seven different rooms. Then, on the
fifth night, she had a cardiac arrest. She was
placed on a respirator and never became
conscious again. At about noon the next day
(my memory of exact times becomes hazy) we
began to communicate mother's desire not to
be kept alive by extraordinary measures. What
follows is an account of what happened after
that, without naming individual doctors or
attempting to reproduce specific
conversations with each medical staff member
we approached for help. With one notable
exception, we found the nursing staff to be
totally compassionate and sympathetic to us
as well as utterly competent in carrying out
their professional duties.
The evening of her cardiac arrest,
Mother's doctor telephoned me at home to say
that her condition was so bad that she would
be better to die. Probably at his insistence, the
cardiac unit chief confirmed the hopelessness
of Mother's condition early the next afternoon.
All the residents gave us the "element of hope"
routine, saying the chances were she wouldn't
die and could go home, basing their judgment
on her initially favorable response to
resuscitation. One said, "Wouldn't you like to
have her back if you could?" This particular
resident seemed to appreciate our feelings at
the outset. He said he wished he'd known
Mother's wishes before he resuscitated her
but after this was effected, he could not
withdraw mechanical and chemical aids.
Another commented: "She isn't suffering, and
if she regains consciousness, she won't
remember." One even used a frog with its
head cut off as an example of reflex action to
demonstrate response in the absence of pain.
I felt this was in poor taste and was an
unsupportable scientific analogy to draw in
Mother's case. This man also hid behind a
.0001% statistic of chance of recovery. In
another context, he said that the cardiac unit
was not "machine oriented" and that there was
much more elaborate equipment that could be
mobilized in an intensive care unit. If that is so,
what justification was there for a halfway
approach?
One doctor said he had not heara my
mother express a death wish in her conscious I
state, Of course he hadn't. We are not talking I
about suicide. I feel that the initial refusal to I
withdraw aggressive life support measures in
this case, given the knowledge that so many of I
her body systems were past hope of recovery,
was a "Godlike" decision, and served only to I
martyr a human being. My language is no
stronger than the doctors who told me they
refused to "play God." How can doctors
identify themselves with murderers or
executioners because they remove life
. I
support measures when the process of dYing
was initiated before they interrupted and I I
arrested it?
Argument on a philosophical plane seems I
to lead to a stalemate. In our case, the patient
and the family lost (temporarily). Would a more
businesslike approach have been better? Can
health care be considered a service that may
be cancelled at any time by the patient or his
family? What legal rights does a person give
up when he enters hospital? The patient and
family have no power in a hospital setting
unless they are fully aware of whatever rights
exist and they can only be advised of these by
legal or hospital personnel who are
sympathetic to them and willing to assist them.
In our case, a nurse directed us to the patient
representative whose intelligent handling of
our situation was invaluable to us. The balance,
of power resides with the doctors who I
supposedly view each case objectively. They
have the power to divulge or not to divulge
knowledge of a patient's condition, the power
of that knowledge and its attendant aura of
expertise, the power to act and then inform or
not inform the family and patient. The
tendency of some doctors to close ranks with
their colleagues reinforces all these other
powers,
I understand that patients who are
physically able may leave hospital by signing a
form stating that their departure is without their
doctor's approval. How many patients are
aware of this situation? Is there such a thing as
a patient's bill of rights? Who makes this
information available? Who counsels patients
when they sign hospital consent forms? Do
they always know the full import?
The rights and wishes of the patient must I
be the sole concern of the family and of those
who provide health care. These rights can only
be protected if each case is considered on its
own merits. In our case, the patient was a
seventy-year-old grandmother who had
The Canadian Nurse November 1978
31
Catherine Winter is a pseudonym used by the
author to prevent identification of the hospital
where the incident she describes took place.
As she explains in the letter that accompanied
her submission: This is written only two
months after an experience that was intensely
painful. I am convinced that what we did was
right but I am so emotionally involved that it is
difficult to present a cogent case. This
account, therefore, is primarily a record of our
feelings addressed "To whom it may
concern".
concern
clearly expressed the desire to lead nothing
less than an independent life and to die with
dignity when her time came. Our statements to
this effect were ignored or disbelieved. Where
I was the element of humanity?
We found our relationship with the
members of the medicai profession caring for
our mother generally difficult. For the most
part. the older and more experienced the
doctors were, the more realistic and
sympathetic they were. There was a
noticeable difference in the attitude of
members of the nursing profession with whom
we came into contact. Are nurses less
threatened by impending death and therefore
I better able to respond to patient and family?
, Does the education that members of the
medical profession receive make them
anxious to deny death? Do they perceive
death as a failure rather than an inevitable
happening that the patient and his family are
I sometimes prepared to accept and even
welcome? Someday doctors will have to
accept that their patients are not case histories
from a textbook and that a family's knowledge
and experience can be a valuable asset. When
doctors stop hiding behind their oath to
preserve life at all costs we will have taken a
giant step towards an acceptable approach to
our ultimate destiny. '"
o
1
N' U RS (NG Cl': E ---
b f C f[ CL.ORE!
9TH EDITION
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In Tune With TO-DA
o
NURSING CARE OF THE GROWING FAMILY:
A MATERNAL NEWBORN TEXT
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 nursing 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
$15.00
445 pages
1976
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
s
Ninth Edition
NURSING CARE OF CHILDREN
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 834 pages
S1Z95 1976
s
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., Leonide 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 genetic counseling.
LIPPINCOTT
S14.75
706 pages
1976
t
Maternal-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 IVISUAL MEDIA
HUMAN BIRTH FILMS
In dramatic, live action. . , close-up, full-color (sound or silent)
films of birth complications which students rarely have an
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34
The Canadian Nurse November 1976
EMERGENCY
CARE OF THE
ACUTE
Lise Viau Gauthier
Miché/e Simoneau
In Canada, 50,559 people died of heart attacks in 1973. The swift administration of emergency
medical treatment is the key factor in increasing the MI patient's chance of survival. The patient with
chest pain must be considered the number one priority if mortality rates for acute myocardial
infarction are to decline.
Subjective symptoms of the patient
The most common subjective symptom of an acute
MI is pain. The patient may describe the pain as;
. tightness in the chest
. pressing, crushing, viselike
. radiating down arms (most often the left) and into
fingers causmg numbness
. radiating up the neck and into the jaw
. havmg a sudden onset
. constant and not relieved by nitroglycerine or by
change in position
. may compare it to indigestion or gallbladder
attack.
Objective observation by the nurse
Look at the patient.
Does he exhibit the following signs and symptoms;
. diaphoresis?
. pallor?
. cold, clammy skin?
. labored and rapid breathing?
. cyanosis especially around lips, nail beds and ear
lobes?
. nausea and vomiting?
. anxiousness and restlessness?
. altered vital signs
lowered BP?
tachycardia or bradycardia?
apical pulse irregular in rate and rhythm
indicative of arrhythmias?
Emergency Management
1, Give 02 to the patient at 4-51/min by mask and
place in semi-Fowler's position if not already sitting
up.
2. Start an intravenous (usually 5% OW) to keep
the vein open.
3. Apply chest leads, attach patient to a cardiac
monitor and take a twelve-lead ECG. Observe ECG
tracing and check the S- T segment. If the S- T
segment is elevated, this signifies injury to the
myocardium. If the S-T segment is depressed, this
signifies ischemia. Ischemia will also be indicated if
the T wave is inverted. A deepened 0 wave on the
tracing indicates that the myocardium has suffered
necrosis several days prior (see Figure 1}.
Figure 1
-- -t:; I J' --.
=--( â sJiOO'r...... .. - }
:r
Normal PORS tracing S-T elevation indicating recent injury to the myocardium
Figure 2
Enzymes
SGOT
LDH
CPK
Enzyme Blood Levels Following MI2
Normals Blood level peak
7-40mU/ml 1-2 days
Up to 288mU/ml 2-3 days
0-94 mU/ml 6-24 hours
4. Relieve severe pain and anxiety. (Usually
Demero175-100 mgm or morphine 10-15 mgm I.M.
will be ordered by the doctor). Give intelligent
explanations and reassurance to the patient.
5. Take blood samples for CBC, electrolytes and
cardiac enzymes (see Figure 2). Blood gases should
be taken if the patient is having very labored
respirations (see Figure 3).
6. Be alert for developing complications;
. cardiac arrhythmias
Have a bolus of Xylocaine 1 00 mgm and a Xylocaine
drip 1 mg/500 ml" readily available for the treatment
of PVC's (premature ventricular contractions) and
ventricular tachycardia.
Pacemakers should be readily available in the event
of bradycardia and complete heart block.
. CHF (congestive heart failure)
. cardiogenic shock
The mortality rate associated with this complication
is reported to be as high as 80%.1
Signs and Symptoms; hypotension, oliguria,
cyanosis, restlessness, apathy, metabolic acidosis.
Central venous pressure (CVP) equipment should
be on hand for insertion if necessary.
. leN ventricular rupture
. cardiac arrest
" Dosage used at Ottawa General Hospital, Ottawa,
Ont.
Return to normal
4-6 days
7-10 days
2-3 days
Figure 3"
Blood Gas Analysis
pH 7.35-7.45
H mEq/1 45-35
PC02 mmHg 35-45
HC03 mEq/1 22-26
PÜ2 mmHg 80::,::15
02 Sat.% > 95
" Normal values at Ottawa
General Hospital
---
The Canadian Nu... November 1976
CHEST
PAIN
....a summary
!schemia
o WAVE
Infarction!
T
ï"
I c:1
t
I T wave inversion indicating ischemia
Deepened Q wave indicating necrosis
Diagnosis of an acute MI is usually based
on:
. patient history
. ECG changes
. cardiac enzyme elevation
Remember, the nurse must be cautious in
her evaluation of the patient with chest
pain. Some MI patients have very few
symptoms and no ECG changes. They
may be admitted to hospital solely on the
basis of a patient history for observation
References
1 Zschoche, Donna A. ed, Comprehensive
Review of Critical Care, St. Louis, The C.V, Mosby
Company, 1976, p. 488.
2 Cosgriff, James H., Anderson, Deann Luden.
Practice of Emergency Nursing, Philadelphia,
Lippincott, 1975, p, 193.
About the authors:
Information contained in Emergency Care of the
Acute MI is made available to readers with the
cooperation and assistance of two nurses presently
working at the Ottawa General Hospital.
Lise Viau Gauthier (RN, CEGEP de Hull,
Quebec) works in the Emergency Department at
that hospItal and recently completed a course in
Coronary Care at Algonquin College in Ottawa.
Michele Simoneau (RN, Lorrain School of
Nursing, Pembroke, Ontario) is Nursing Coordinator
of Ambulatory Care at the Ottawa General Hospital. ..,
35
Lynda Parks
When a person enters the Emergency
Department and states that he is
experiencing chest pain, what is your
reaction? How do you evaluate his
complaint? What knowledge do you utilize
in making a nursing assessment?
The purpose of this short text is to aid
you in your evaluatIon of chest pain as a
symptom of many varied conditions.
Hopefully this summary will provide a basis
for making intelligent decisions regarding
the severity of the condition and about the
kind of emergency care you will provide.
Pain is a subjective symptom. What the
patient can tell you about his chest pain, how
he describes it, can be the key to diagnosis.
Often, we miss pertinent information due to
poor interviewing and questioning skills. In
communicating with patients, try to speak
within their frame of reference and understand
that their interpretation of the pain is Influenced
by past experiences, conditioning to pain,
culture, age, sex, and emotional stability.
Systemic evaluation of the chest pain
according to character, location, onset,
duration and associated symptoms gives us a
more complete picture and allows for a more
thorough nursing assessment of the possible
causes of the pain. This can then be related to
other members of the health team as a concise
informative history of the current episode so
that prompt treatment is instituted.
Let us now review chest pain as a
symptom and discuss the various diseases or
problems in which chest pain is a complaint.
True cardiac pain will be dealt with first
Pain from Mediastinal Structures
. Angina pectoris is paroxysmal pain due
to myocardial ischemia. The patient may
describe it as a tightness, heaviness or a
weight on the chest. Or, it may be burning,
gripping, stabbing, crushing or squeezing. A
familiar picture is the individual with a clenched
fist on his chest. The location is generally
substernal, precordial or widely diffused
throughout the upper chest. This pain
frequently radiates to the left pectoral area and
down the medial aspect of the arm continUing
to the ulnar aspect of the hand. Radiation may
also occur to the neck, jaw,
temporomandibular joint, scapular area, and
occasionally to the epigastrium and may mimic
indigestion. Onset is sudden, usually on
exertion, emotional excitement, eating a
heavy meal, sexual intercourse or mental
stress. It is mild to severe in intensity lasting
3 to 5 minutes and is relieved by rest and/or
nitroglycerine. If anginal pain lasts more than
one half hour, suspect an impending
myocardial infarction.
. Myocardial infarction pain has the same
location, radiation and quality as angina
pectoris. The differences are;
- infarct pain can be unrelated to exertion or
stress and may wake the person from sleep.
- it is a constant severe pain unrelieved by
rest, nitroglycerine and other remedies
36
The CanadIan Nurse November 191b
-
With this extreme pain, diaphoresis,
hypotension, cyanosis, labored respirations,
nausea and vomiting often occur. Pain due to
myocardial infarction is relieved only by
narcotics.
. The pain of pericarditis arises from the
irritation it causes to adjacent structures. The
friction rub may be heard with a stethoscope
as a scratchy, grating or creaking sound. The
pain can be deep, constant and substernal or
superficial on the chest wall. Some patients
describe it as knifelike Or shooting Deep
breathing, laughing or coughing intensifies the
pain and relief may occur by leaning forward. If
the diaphragm is irritated, the patient
experiences shoulder or neck pain.
. A dissecting aortic aneurysm produces
a sudden, excruciating, sharp, crushing or
tearing substernal pain. The pain is
experienced as blood collects between the
layers of the blood vessel wall or because the
enlarged aorta exerts pressure on adjacent
organs. The pain diffuses over the upper
anterior chest and into the shoulders, base of
the neck and back. The patient is usually
restless and unable to attain a comfortable
position. A difference between the carotid and
brachial pulses exists when dissection
prevents blood flow to carotid arteries but
allows flow to brachial arteries.
Chestwall Pain
. Intercostal nerve pain from irritation of
the nerve may produce sudden pain of
variable quality. Local tenderness in the
intercostal space may be present. The pain
experienced in Herpes Zoster is one example
of intercostal neuritis.
. Pain from slipping rib cartilages is dull
and located over the costochondral junctions.
Tenderness is felt on light pressure. This pain
may exist tor long periods of time and the
location and chronicity of it help in establishing
the diagnosis.
. Pectoralis minor myositis. a muscle
inflammatory process, can produce severe
anterior chest pain that may resemble cardiac
pain if present on the left side.
. Bone pain (ostalgia) from any cause may
produce either generalized or localized chest
pain. Spinal disease causing inflammatory
processes or mechanical irritation may
produce sharp, stabbing or dull back pain
referred to the anterior and lateral chest wall
and arms, This referred pain may resemble
angina pectoris but is usually associated with
back pain and related to movement of the
thorax.
Pain Arising from
Respiratory Structures
Anterior cervical or retrosternal pain can
be produced from acute inflammation of the
tracheobronchial tree. Generally, it is
accentuated by coughing.
. With pleurisy or pleuritis the patient
experiences localized knifelike, shooting pain
adjacent to the area of inflammation. Pleurisy
may cause spasm of the intercostal muscles
producing superficial chest pain. The pain may
be accentuated by breathing, laughing or
coughing. Relief is obtained by holding one's
breath during deep expiration and by splinting
the chest. The patient often assumes an
awkward position in order to obtain relief. If the
onset of pleuritic chest pain is sudden and
accompanied by a marked shortness of breath
and decreased air entry, a pneumothorax
must be suspected and promptly investigated.
. Pulmonary embolus mayor may not be
associated with pain. If present, it is a deep,
crushing or knifelike, shooting pain reaching
maximum intensity substernally. The pain
increases on inspiration, differentiating it from
cardiac pain. The patient may be
apprehensive and express a feeling of
impending doom. To assess this pain look for
predisposing factors such as calf tenderness,
immobility, dehydration or
hemoconcentration.
Pain from Abdominal Problems
. Steady, dull, gnawing or burning pain of
slight to moderate intensity may indicate a
peptic ulcer. The patient can often predict its
occurrence in relation to meals (generally 3 to
5 hours after eating), It is relieved in 5 to 15
minutes after taking antacids. The pain may be
a generalized abdominal pain or epigastric
pain and may radiate to the shoulders.
Esophageal pain may increase with
swallowing and is frequently associated with
gaseous eructations and regurgitation, The
pain can be referred to either the sternum or
posterior chest. If a patient complains of
"heartburn", it is important to decide whether
this is due to gastrointestinal or cardiac
involvement.
. Gallbladder pain IS diffuse epigastric or
right upper quadrant pain and may radiate to
the right shoulder or back below the right
scapula. Accompanying this pain is
restlessness, pallor, sweating, fever, vomiting
and abdominal wall tenderness. When caused
by gallstones, the onset of pain is sudden,
severe and reaches its maximum intensity in 5
to 15 minutes.
On the basIs of the preceding information,
you can question the patient who arrives in
Emergency about his chest pain and either
confirm or rule out a cardiac component. The
details you gather from the patient about his
pain can be utilized to assist you in
determining the appropriate course of action. If
you are in doubt as to whether or not the pain is
cardiac, always place him on a monitor until
the physician can make a detailed
assessment. ..,
Bibliography
1 Ayres, Stephen M. Care of the criticafly ill, ed
by... et al. 2ed. New York, App/eton-Century-Crofts,
1974. I
2 Sanderson, Richard G. The cardiac patient; a
comprehensive approach. Toronto, Saunders, I
1972.
3 Clark, Marie Castellan. Chest Pain. Heart and
Lung. 4:6,956-962, Nov/Dec., 1975.
4 Lawson, Betty N.:Clinical assessment of
cardiac patients in acute care facilities. Nurs. Clin.
North Amer., 7:3,431-444, Sept. 1972.
III
Lynda Parks (R.N., Kingston General
Hospital, Kingston, Ont.) has had extensIVe I
experience in ICU, CCU and emergency rOOffo l
nursing having held positions from general
staff nurse to head nurse. She has taken a
postgraduate course in cardiovascular ICU I
nursing at University Hospital, Edmonton and
is presently enrolled in the B. Sc. N. program at
the University of Western Ontario.
-
The CanadIan NurMI November 1976
37
Five-year-old Stephanie had arrived in
Emergency with what her mother thought was
an attack of appendicitis, After careful
examination by her pediatrician, however,
she was diagnosed as having "Periodic
Syndrome." a psychologically triggered
condition. 1 The following is an account of her
mother's efforts to improve communication
with her daughter and to help relieve the
stresses that had caused her psychosomatic
conditIOn.
When Stephanie was diagnosed as having a
psychosomatic illness, I had to realize that it
had been building up for a long time. She did
not change from a healthy, normal
five-year-old to a child suffering from such
severe emotional stress ovemight. In fact,
when I analyzed it, I realized that Stephie's
problems dated back to her second year.
Three years before she was taken to the
hospital, Stephie had her first encounter with
the emotional pain of death when her
"grampa" died. That in itself was not enough to
trigger her condition, but the events that
followed were.
One month later, and only a few days
before Christmas, her father and I separated.
A Christmas without "daddy" little Stephie did
not understand, and efforts to make her happy
with impressive presents failed. No one could
mend her broken heart. No longer would she
stand patiently at the living room window of her
father's home waiting for his return from wol1<
to run into his open arms and share a mutual
love and admiration.
Mommy and daddy didn't like each other
anymore, and what about Stephanie? Did she
blame herself? Losing her father was beyond
her comprehension; yet, J was too drained of
energy and all emotions except self-pity, to
!
,
Sharon Ba/a
see how devastating this event was for my
daughter.
Five months passed and it took five
moves, complete with bag and baggage,
before Stephie's broken family (consisting of
herself, her pregnant mother and her
chronically ill one-year-old brother) finally
settled in a suitable and comfortable home.
Physically she lived there but her heart
remained in a place she once called home with
a man she once called daddy.
She found it difficult to accept that he
could not stay with her atter their day in a week
together. Those special days became scarce,
then non-existent, and Stephie's nightmares
began to occur more frequently. Still, the
message they conveyed continued to go
unheeded; I was too busy caring for Ali, whose
hydrocephalic condition and accompanying
epilepsy demanded constant care. His
seizures frightened Stephie, and when her
brother cried she cried even harder. Perhaps
she felt afraid for Aii and anxious herself
because she couldn't understand hIs
condition, I heard Stephie's cry, but not the
feeling it expressed; I was still too deeply
engrossed in my own hurt to be objective and
receptive to Stephie's.
Through the months that followed,
Stephie's life remained in a turmoil; her father
didn't visit her anymore, Ali was in and out of
the hospital, and then one day he didn't come
home at all. He was in an institution. What is an
instituDon? Doesn't mommy love him
anymore? What about me? These questions
perhaps plagued her mind but she felt too
38
afraid to ask them for fear of separating herself
from the only person she had left, her mom.
A few months later, Stephie's healthy
baby sister was born - a welcomed friend or a
threat? Stephfe didn't have much of her
mom's time as it was, now she would have
even less. One month after the birth of her
sister, Stephie attended the funeral of her
brother. She began to withdraw into herself,
lost in the midst of her confusion, all her efforts
to express herself unattended.
Physically she had been adequately
provided for but her emotional needs were
intangible, and went unheeded until the day I
found her writhing in pain on the floor. No, it
was not appendicitis as I had feared, but rather
a lack of communication manifesting itself
psychosomatically, her body's way of saying
what her heart and mind couldn't - I hurt.
Thus, "operation communication" began
as an attempt to recover Stephanie from her
alienation. It wasn't easy. Most was learned by
trial and error. But it has helped Stephanie
cope with and express her emotions, and has
improved our relationship immeasurably.
As a first step in "operation
communication" I attempted to learn more
about myself, to become more objective and
more accepting of my "faults," and to give
myself a break by "accentuating the positive."
I felt I had to rekindle my own self-confidence
before I could do the same for Stephanie.
In my relations with Stephanie, I began to
adopt a few changes in an attempt to become
more receptive to her emotional needs. I
learned to rearrange my priorities and
postpone my own needs, when appropriate, to
listen to Stephie. Gradually, she became less
apprehensive about approaching me as she
grew to know she wouldn't always hear, "Not
now, I'm busy,"
I had to learn how to really listen, not only
to the content or superficial meaning of what
Stephie was saying but also to the intent or
underlying message. To do this I had to learn
to look at things from Stephie's point of view
and begin talking with her instead of to her.
We also practiced expressing our feelings
in ways more acceptable to society.2 Good
feelings we called "warm fuzzies;" bad
feelings were "cold prick lies. " We learned to
release hostile feelings by "punching a pillow."
The focus was on getting the feeling out, not
keeping it bottled up inside as Stephie had
done in the past, or projecting it as I had done
by yelling at Stephie. Soon, it wasn't
uncommon for either one of us to stop what we
were doing to say "I love you" to the other,
regardless of the time or place.
After we had vented our pent up feelings,
we would try together to tackle the problem or
cause. We would explore possible solutions
and see which helped. We tried not to tell each
other what to do because that never worked
and only got "dander up" again.
When Stephie wanted to talk we would t:y
to find a quiet place where we could be
The Canadian NurMI November 1976
A CHILD
If a child lives with criticsm,
he learns to condemn
If a child lives with hostility,
he learns to fight.
If a child lives with fear,
he learns to be apprehensive.
If a child lives with pity,
he learns to feel sorry for himself
If a child lives with jealousy,
he learns to envy.
If a child lives with encouragement
he learns to be confident.
If a child lives with tolerance,
he learns to be patient.
If a child lives with praise,
he learns to be appreciative.
If a child lives with acceptance,
he learns to love.
If a child lives with approval,
he learns to like himself.
If a child lives with recognition,
he learns it is good to have a goal.
If a child lives with fairness,
he learns what justice is.
If a child lives with honesty,
he learns what truth is.
If a child lives with security,
he learns to have faith in himself
and those about him.
If a child lives with friendliness,
he learns the world is a nice place
in which to live.
If you are the parent,
with what is your child living?
..
Author unknown
A child's education is principally derived from its
observatIons of the words and actions of those with
whom it lives - the situations with which it comes in
customary or repeated contact.
.
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.
The Canadian Nurse November 1976
39
physically close to do so. Often just before bed
we would take time for a "little lovin" and a
"little communication," and afterwards I would
hug Stephie, conveying through gentle touch
how much I cared.
Stephie conversed at her own speed
during these special times, and I tried to stay
on the same wave length by being objective
and looking at things from Stephie's point of
view. Empathy and authority somehow did not
mix. One had to go, so during these sessions I
became a non-judgementa'''sounding board."
"Because I said so" was no longer given as
a reason without an explanation. I had heard it
often enough when I was young and
remembered how utterly frustrated it made me
feel because it told me absolutely nothing. I
tried to give Step hie an explanation of why
something should or should not be done. If she
disagreed, she was encouraged to say sO in
order that we could work it out together.
The most difficult task for me during this
time was "keeping my cool," avoiding
confrontations when emotions were high as in
the past, and not using Stephie as a
"scapegoat" for my emotions. Arguments had
always left the problem unresolved while each
of us remained isolated and angry. Now,
patience became the attribute I worked on the
most. I consciously tried to stop, listen and
communicate.
Step hie had been low on self-esteem and
I worked hard at getting her to believe she was
, "okay." Accentuating the positive became the
key to our everyday lives. I reminded Stephie
, of her good qualities and worked at developing
her potential. I praised her when she did well j
school, when she showed good play manners,
and especially when, on her own initiative, she
did nice things for others.
Once in awhile we would spend time
together in activities, such as hiking, that did
I not include her sister. I hoped that these
outings would strengthen Stephie's
I individuality and show her that she was
accepted as a person, liked as a friend and
loved as a daughter.
I
' Teaching Stephie to dance was another
way of encouraging self-expression. She
enjoyed dancing, and singing as well. The fact
that we had no radio in the car made no
difference; we would sing the songs we knew
I or make up new ones as we went along. It was
fun for both of us, and hopefully made
I Stephanie feel less inhibited in encounters
with others. I also tried not to embarrass or
tease Stephie by using such statements as
"you're too big to behave like that," since these
might belittle her and promote withdrawal.
During the months after we began
"operation communication," Ileamed more
about myself and shed the old persona to
become a better model for Stephie, Ileamed to
"hear" the feeling in Stephanie's words, to
know when she wanted "warm fuzzies" even if
she was giving "cold pricklies." We became
more closely united by the understanding that
nourished a struggling relationship into a
positive bond of love and acceptance. Time we
spent together was measured by quality, not
quantity.
"Operation communication" is by no means
complete; it is an ongoing transaction and one
that will continually be evaluated and improved
upon. But we are happy with the results so far
and optimistic about the future. Being human
we're bound to make mistakes, but as long as
we realize them, accept and learn from them
and continue to try ..' we can't lose. ..,
Sharon Ba/a is working as a Licensed
Practical Nurse at St. Paul's Hospital in
Vancouver. She wrote Operation
Communication while attending the nursing
program at Niagara College of Applied Arts
and Technology; she is four months away
from completing her R. N. She has two
children, Catherine Shae, 3. and Stephanie,
who is now 6 and doing very well, Sharon
describes herself as a "kid fanatic" and hopes
eventually to take in a couple of foster
children, The poem included with her article is
one that she reads often to remind herself of
the importance of continuing to develop her
motherhood potentials.
References
1 Hutchison, James Holmes. Practical pediatric
problems, 3ed. Chicago, Year Book Medical, 1972.
p.589.
2 Freed, Alvyn. TA for tots (and other prinzes).
California, Jalmar Press, 1973. (Transactional
analysis for everybody series),
40
The Canadian Nurse November 1976
Progress in diagnostic radiology depends
partially upon the development of new X ray
equipment that offers increased efficiency,
enhanced image detail and greater versatility.
One of the most significant of recent
technological advances in this area was the
development in 1969 of a new type of
equipment known as the EM I Scanner capable
of providing up to 100 percent more
information for neuroradiological diagnosis
than conventional X ray techniques. The EMI
Scanner (see Figure 1), which is now in wide
use throughout the United States, and at least
six cities in Canada, (including Ottawa,
Toronto, Montreal, Calgary, Edmonton and
Hamilton) was developed in England by
Godfrey N, Hounsfield of EMI Ltd. (Electric and
Musical Industries), a British-based group of
international companies. It is based on a
development of a technique for scanning the
brain in successive layers by a very narrow
beam of X rays. The technique that is used is
referred to as Computerized Axial
Tomography (CAT). Other terms synonymous
with CAT are; EMI Scan, CT Scan,
Computerized Tomography, Computer
Assisted Tomography and finally
Reconstructed Tomography. Conventional
skull X rays and other examinations such as
electroencephalography, radioisotope brain
scanning, although considered low risk
procedures, do not yield as much information
when used alone as the EMI Scanner used
alone,
Principles of the technique
The main objective of the EM I Scanning
System is to produce a series of images using
the principle of tomography (in which layers of
the anatomy are radiographed) where each
one of the images is derived from a specific
layer. The basic components of the system
include a scanning unit which houses the X ray
tube and two scintillation detectors, an X ray
control unit, a computer and magnetic disc
unit, a viewing unit, a line printer and a
teletype.
The patient's head is scanned by a very
narrow beam of X rays. The X ray tube and
detectors are coupled so that they are
arranged diametrically opposite each other on
a common frame in order to receive the X rays
that have passed through the patient's head.
Two detectors are used so that two contiguous
slices of the head can be examined at the
same time. Another detector is used to
measure the intensity of the X ray source. The
readings thus obtained are used to calculate
absorption values of the material within each
slice where, e
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The X ray tube and detectors scan the
patient's head in a linear fashion and 240
readings of X ray transmissions through the
head are picked up by each detector as can be
seen in scan 1 (See Figure 2). At the end of
scan 1, the scanning u nit is rotated 1 0 and is
continued for 180 0 . During this process, which
lasts for about 4 1/2 minutes, 43,200 readings
will have been taken by each detector and two
contiguous slices will have been examined.
The readings are stored on a disc file to be fed
to the computer which calculates the
absorption values in each slice. Figure 3
shows the absorption values commonly
encountered in clinical radiology. The values
are established on an arbitrary scale on the
equipment where water is 0, air -500 and
dense bone +500. "These absorption values
are used to build up a picture of each slice in
the form of a matrix (160x160) of 25,600
picture points. Each picture point indicates the
absorption value for a volume of tissue 1.5 mm
x 1.5 mm x the slice thickness selected at the
corresponding points in the section under
examination." (EMI Ltd. 1975)
These values can then be displayed on a
Figure 1. The EMI Scanner showing position
of patient on the adjustable couch.
cathode ray tube and can be recorded by a
Polaroid camera (see Figure 4) or they may be
printed out as a numerical 'picture' by the line
printer.
Radiation dosage
The amount of radiation administered
during any diagnostic procedure is of major
concem because X irradiation is damaging to
human life. One basic objective of all new
equipment design in radiology is to reduce the
radiation dose to both the patient and
personnel.
In conventional radiography of the skull,
the maximum exposure dose to the skin is
between 1 and 2.5 R(Roentgens) for a single
film. In an EMI examination, the maximum
dose is in the order of 2 R and is received by
the right side of the head. The dose to the male
gonads is considerably less than 0.1 mR(milii
Roentgens) and the dose is even less to the
female gonads. In summary, the X ray
exposure is about equal to that received from a
The Canadian NurMI November 1976
41
Figure 2. The scanning sequence which is
based on the rotate and translate princIple.
, DEGREE
I DEGREE
/ SCAN 2
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Within the last decade a new kind of technique -
computerized axial tomography - has become available for
rad iological investigation of the brain. Many experts claim that
the information provided by the technique is so remarkable
that the term 'diagnostic breakthrough' should be applied to
its discovery.
Figure 3. Absorption of anatomical mate"als
commonly encountered in clinical radiology.
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Figure 4. Polaroid pictures of cathode ray
tube screen during the scannmg process.
(Conray is contrast material or 'dye
conventional skull examination,
Although the X ray beam is collimated to a
very narrow width, there is still a small amount
of scattered rays present in the X ray room.
Therefore, if anyone is present in the scanning
area during the scanning process. then a lead
apron should be worn. Usually, X ray
personnel and other staff are in a shielded
area. Nurses are not usually present during an
EMI scan.
1835-28 - Infarction.
1757-2A - Hematoma.
2369-28 - Intraventricular meningioma.
1934-58 - Left orbital metastasis from breast
carcinoma.
2398. - Right parietal metastasIs.
(4A before Conray. 5A after Conray )
42
What to teach the patient
Patients are anxious to know about their
diagnostic examinations especially if they are
totally unfamiliar with the test. A clear
explanation about what the patient can expect
can help in decreasing a patient's anxiety.
Some points to emphasize to the patient about
the EMI scan are:
. It is a non-invasive procedure which
requires no special preparation prior to the
examination.
. It is a painless and safe method of X ray
examination.
. The average EMI scan takes 30 to 40
minutes.
. The patient must try to remain very still
during the procedure. (This point should be
stressed) .
On arrival in the X ray department the
patient's head may be marked to indicate the
plane of slices which will be scanned. After
this, the patient is placed in the supine position
on a hydraulically adjustable couch with both
knees flexed and supported to maintain
comfort as can be seen in Figure 1. The head
is then carefully positioned in a rubber
head-bag which forms the front of a
water-filled box. The box is then filled with
water when it is made to 'collapse' slowly onto
the patient's head, (see Figure 5) in order to
eliminate the air gap between the head-bag
and the scalp, This process does not cause
any discomfort to the patient. Using water and
eliminating the air gap ensure accurate results
and help to simplify the calculation.
The Canadian Nurse November 1976
Patient movement during the scanning
will produce blurred images and hence a poor
examination. Therefore it is of utmost
importance that the patient be immobilized,
Although seldom used, in some cases, heavy
sedation or even general anesthesia may be
given to restless patients.
Sometimes, the patient receives an
intravenous injection of contrast media, the
purpose of which is to enhance the contrast in
the image in situations which are ambiguous
For example, the injection of contrast media
can help to differentiate between neoplastic
and non-neoplastic lesions. This may then
alter the 'hazard-free' EMI examination to one
where the patient may have a reaction to the
contrast material used.
A patient in a hospital may be transported
to a facility with an EMI scanner in an
ambulance. Often, a nurse from the ward will
accompany the patient. It may help to send a
nurse whom the patient knows and trusts,
particularly if he is apprehensive about the
procedure.
Summary
The EMI Scanner is an important
technological achievement. It opens up a
remarkable new method of neuroradiological
diagnosIs and has resulted in the detection of
numerous cerebrovascular diseases and
tumors of the brain. It is more sensitive to the
presence of primary and secondary
neoplasms than is radionuclide scanning.
The EMI Scanning technique is
non-invasive: does not cause any discomfort
to the patient or carry any definite risks of
paralysis nor does it require hospitalization, as
is the case of cerebral angiography and/or
pneumoencephalography. The EMI scan
examination also results in a reduction of other
problems relating to patient management such
as post-operative care etc.
Although an EMI Scanner is an expensive
piece of equipment, costing close to half a
million dollars, it offers many advantages both
clinical and technological. Since the Scanner
does not put the patient 'at risk,' it can be
extremely useful in the early detection and
diagnosis of suspected brain injuries and
disorders. In addition, because the patient is
not hospitalized, diagnostic costs to the
community are lower since patients can be
examined as outpatients with no
hospitalization costs or 'loss of employment
income to the patient.'
All the data collected during EMI scanning
are stored either on magnetic discs or on tape
and this results in retrospective reanalysis of
the information. There is no need to
re-examine the patient if the Polaroid pictures
are lost or misplaced.
Presently, the principles of the first EMI
Scanner have been extended to generate
other equipment capable of providing X ray
examinations of any part of the body. These
<Ire referred to as whole body scanners . ..,
The author wishes to express his sincere
thanks to EMITronics Inc., for their help durin
the preparatIOn of this manuscript and thel
permission to reproduce all the figures used
this paper.
Euclid Seeram (R. T., School of Radiograph
Ottawa General Hospital; B.Sc., Carleton ,
University, Ottawa) is presently a lecturer é
the School of Radiography, Ottawa Gener.
Hospital. He also lectures on Radiation
Physics and Protection at the School of
Radiology Ottawa Civic Hospital on a
part-time basis.
Bibliography
1 Ambrose, J. Computerized transverse axia
scanning (tomography). 2. Clinical application. Br. .
Radio/. 46:1023-1047, Dec. 1973.
2 Ambrose, J. Computerized x-ray scanning c
the brain. J. Neurosurg. 40:679-695, Jun. 1974.
3 Baxter, Clive EMl's brain scanners may WOI
on entire body. Financial Post 69:17:5, Apr. 26,
1975. I
4 Davis, D.O. Computerized tomography of tt l
brain, by... and B.D. Pressman. Radio/. Clin. Nortl
Am. 12:2:297-313, Aug. 1974.
5 EMI Ltd., Personal communication, 1975.
6 Hounsfield, G.N. Computenzed transverse
axial scanning (tomography). I. Description of
system. Br. J. Radial. 46:1016-1022, Dec. 1973.
7 Kuhl, D.E. Perforated tape recorder for digité
scan data store with grey shade numeric readout, b
.. and R.Q. Edwards.J. Nucl. Med. 7:269-280, Apr
1966.
8 New, Paul F. Computerized axial tomograph
with the EMI scanner, by . . et al. Radiology
110:1 :109-123, Jan. 1974.
9 New, Paul F. Computerized tomography. A
major diagnostic advance. Hosp. Practice
10:2:55-69, Feb. 1975.
10 OldendOrf, W.H. Isolated flying spot
detection of radiodensity discontinuities displayin!
the internal structural pattern of a complex object
IRE Trans. Biomed. Bectron. 8:68-72, Jan. 1961
11 Paxton, R. The EMI scanner. A brief reviewc
the first 650 patients, by... and J. Ambrose. Br. .
Radial. 47:561 :530-565, Sep. 1974.
12 Perry, B.J. Computerized transverse axial
scanning (tomography). 3. Radiation dose
considerations, by... and C. Bridges. Br. J. Radio,
46:1048-1051, Dec. 1973.
13 Scott, W. R. Computerized axial tomograph'
of intercerebral and intraventricular hemorrhage. b
et al. Radiology 112:73-80, Jul. 1974.
I
The Canadian Nur.. Novembar 1976
43
Home care
after surgery . .
for SCOlIOSIS
Consistent, knowledgeable care given in the home by the parents is a crucial
factor in the rapid and healthy recovery of a scoliosis patient after surgery.
The necessary expertise for good care can only be developed within a
comprehensive patient - family oriented teaching program. Each institution
must devise its own home care program based on its philosophy and adapted to
meet each family's needs. As a follow-up to her previous article on "Screening
for Adolescent Idiopathic Scoliosis" in the November, 1975 issue of The
Canadian Nurse, the author outlines the basic principles of care that should be
included in such a teaching program.
'lna V. Reid
Parents are normally highly motivated to learn how
to give care to their children. Adolescents
convalescing after Harrington Instrumentation and
spinal fusion need to actively participate in
decisions concerning their Care. As much effort as
possible should be made to allow them to follow a
normal routine, within the limIts of the surgeon's
instructions, Both parents and patients need
teaching, support and reinforcement from the nurse.
They need to know how they are coping, The
parents need to be supported and reinforced in the"
performance of home care and in their acceptance
of the patient within the family life-style. Adolescents
need to be supported in their independence and
adjustmef/t to their new and temporary immobility
Assessment of the home and an informative
teaching program on home care needs to be
initiated as soon as possible after surgery.
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Bilateral Harrington rods are attached to the spine in the
surgical treatment of scoliosis.
Courtesy 01 Shirley Mohyudden
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The Canadian Nurse
Novambar 1976
Courtesy 01 Shlrtey MOh) udaen.
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A Milwaukee brace used for
flexible curvatures of the spine is a
conservative method of treatment.
It combines the forces of
longitudinal traction and lateral
pressure to help straighten the
spine.
Scoliosis is a lateral curvature of the spine.
Although there are some 31 etiological factors, the
most common causes are idiopathic, paralytic and
congenital. 1 There are two main classifications of
scoliosis:
. Functional or non-structural
. Structural
Functional scoliosis is a flexible lateral
curvature of the spine without rotation and is totally
correctable. Sit or lie down and the curvature will
disappear. It can result from one leg being shorter
than the other, from poor posture, or from pain and
muscle spasms.
Structural scoliosis is afixed lateral curvature of
the spine with rotation of the vertebral bodies in the
area ofthe major curve. Rotation is the turning ofthe
vertebral body on the long axis of its body. Because
ribs and muscles are attached to this body, rotation
pulls them up, resulting in a hump. Structural
scoliosis is produced by abnormal changes in the
bone, muscle, or soft tissue of the spine and is not
::orrectable by lying or sitting. When a curve fails to
straighten out on side bending, it is called a structural
curve. There are several types of structural scoliosis
ego neuropathic, osteopathic, myopathic, etc.
Idiopathic scoliosis accounts for 80-90 percent
of strut::tural curves. It may occur in anyone of the
following curve patterns:
. Lumbar
. Thoracolumbar
. Thoracic
. Double major (either double thoracic or double
thoracolumbar) .
The incidence of scoliosis in a given population
is usually between five and ten percent and occurs
more frequently in adolescent girls than boys. For
years, scoliosis with no known cause was referred to
as "idiopathic." However, recent evidence suggests
that it is a familial condition and that the mode of
inheritance is sex linked dominant (The Canadian
Nurse, November, 1975).
The aims of treatment of scoliosis are to prevent
progression of a mild curve and to correct and
stabilize a more severe deformity.2 There are two
types of treatment - operative and non operative-
depending on the severity of the curve, age, and
whether the curve is increasing or expected to
increase. Curves grow more rapidly during periods of
rapid growth ego 11 to 13 years in girls, and 14 to 16
years in boys, Once bone growth ceases usually at
age 16 to 18, minor curves also stop developing.
However, a lumbar curve of more than 40 degrees or
a thoracic curve of more than 50 degrees in a
teenager of 18 years may continue to grow by one to
two degrees every two years. 3
Forms of nonoperative treatment include: the
body cast, Cot rei traction and Milwaukee brace. The
Milwaukee brace functions as a stabilizer and
sometimes partially reduces the curve (see
illustration). It is used to prevent progression of the
curve, and is highly effective in improving and
correcting moderate curves providing the child is still
growing and the curve is not too severe. Generally
speaking, children under 11 years of age with a curve
of more than 40 degrees may be braced depending
on t
e individual case. Children over 14 years with a
curve over 40 degrees are treated more agressively
and are not treated with a Milwaukee brace.
Operative treatment is required for obvious
deformity and is usually done in the early teen years
after most spinal growth is completed. More
moderate curves may be passively corrected by
plaster casts or traction before surgery, followed
spinal fusion and immobilization in a body cast.
severe curvature, mechanical correction is
accomplished by a combination of spinal fusion al
application of distraction rods such as those devisE
by Harrington. The use of Harrington rods (see
Figure 1) is a method of instrumentation which
consists of distraction and compression rods tha
assist in correcting the curves of scoliosis by
providing a distracting force on the concave side
the curve and a compression force on the convE I
side. A spinal fusion of the involved segment of spill
must be done at the time of application of the rods
Postoperatively, the patient is usually
immobilized on a Foster or Stryker frame for
approximately 14 days. Nursing responsibilities
immediately after surgery include the monitoring
neurological signs (level of consciousness,
movement and sensation of lower extremities) a
monitoring of vital signs to detect cardio-pulmoné !
difficulties. Sutures are removed on the 14th day al
a body cast is applied (see Figure3). Once the caSl1
completely dry, the patient is sent home. There s
will be immobilized in bed for about 4 months. At tI
end of this time, X rays should show complete I
solidification of the bone. If bone healing is
satisfactory, a walking body cast (lighter in weigl
than the previous cast) is applied. This is worn f I
about two months and allows the patient to begi
mobilization and to return to school. I
The care given at home to the patient can mea
the success or failure of the treatment started in I I
hospital. Because of the extensive period of
immobilization, the patient and her parents need
well-structured and practically-oriented program
prepare them for home care.
A good teaching program provides the parer
with the knowledge to give physical and emotior
care to the patient to promote good recovery an.
prevent complications; allows the patient to
participate actively and constructively in her own
care; and fosters independence for both. The
overriding aim of such a teaching program is to allo
the family to function in their home setting with
knowledge and confidence, thereby reducing son
of the stress and anxiety inherent in such a situatior
Home life should be disrupted as little as possib
In most settings, a teaching program will be tt
responsibility of the nurse along with the
physiotherapist. The teaching program should Sté
about the fourth postop day and include such tools
demonstration, discussion and written materials
which the patient and parents can refer when at
home. Written instructions should be supplied ar
include exercise sheet, diet sheet, cast care and sk
care instructions. Each of these should be discussE
in detail by the nurse and physiotherapists.
Demonstration of bedmaking, bed bath , eating, u
of the bedpan, moving from the bed to the stretche
logrolling and physical exercises should be done
early in the teaching program. The nurse must
constantly check with the patient and parents to t
sure that they understand the information and
techniques shown to them.
Preparation of the home
Early in the teaching program, the patient,
parents and nurse should discuss the necessary
preparation of the home for the care of the patien
Tha Canadian Nur.. November 1976
45
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Some examples of different types
of body casts used after scoliosis
surgery.
Suggestions are given on how to prepare the
patient's room. Because she may spend four
months in bed, a cheerful, bright and well-ventilated
room can aid the child in maintaining a positive
attitude. A system of mirrors may also be erected in
the patient's room to give her a view beyond the
room. 5 Certain specific equipment may be required.
These can be obtained from the local branch of the
Red Cross Society or the ambulance service. For
example, a light stretcher is required to transport the
patient from her room to other areas of the house.
Also, a hospital-type bed, if available, is ideal for
home care because it provides a firm mattress and
greater height. As an alternative, the parents may
decide to make adjustments to a single bed at home.
A box-like frame sufficiently large to hold a firm single
bed mattress can be made from board and
decorated with colorful wall paper. Other necessary
items include a flat bedpan, a kidney-shaped basin
for mouth care, and a wash basin.
Transportation
Transportation to and from hospital can be a
problem and a source of anxiety to the parents. If the
patient lives In the same city as the hospital, a station
wagon or an ambulance will be adequate
transportation in most cases. Patients from outlying
areas may need to go by air. In this case, the parents
need to book three airplane seats for the patient
alone because she needs to lie flat on a firm surface.
An ambulance will be needed for transportation to
the airport. Many ambulance services allow the
patient to remain on the stretcher during the flight
until final destination. The airline involved then
At the Vancouver General Hospital, 125 surgical
procedures for the correction of scoliosis were
performed in 1973 and 1974. Approximately 80
percent of these operations were for severe
'diopathic scoliosis.
In 1975,870 children in grades 5, 6, and 7
were screened for scoliosis in the Vancouver
area and 30 children (10 boys and 20 girls) were
found to have scoliosis, Only 2 children with
curves of 20 degrees required active orthopedic
treatment. The rest are being followed closely by
their family physician.
The aim of the screening program is to
prevent deformity and mimmize the need for
surgical rorrection by early detection. .
. B. C, Medical Journal - VoT, 18, No. 4 April,
1976, P.. 117.
returns the stretcher to the ambulance service.
Because the metal detectors at the airport are
sensitive to the stainless steel rod(s) inserted during
surgery, a card signed by the physician stating that
rods are in place will prevent confusion and long
explanations,
Care of the cast
Instructions Qiven on cast care include:
-covering the exposed edges of the cast with
waterproof tape cut into petal shapes,
- notifying the physician or orthopedic surgeon if
the patient is complaining of pain, blueness or
numbness in the limbs, breakage of the cast or the
digging of the cast into the skin.
- waterproofing of the casrespecially before using
the bedpan or shampooing the hair is essential.
Waterproofing the cast can be done by lining the cast
with Saran wrap or plastic bags. If the cast should
become wet. some talcum powder may be rubbed in
to decrease the odor and may be dried with the
nozzle of a vacuum cleaner or hairdryer.
- sharp objects should not be used to poke under
the edge of the cast because of possible damage to
the skin. Small objects like bobby pins must not get
under the cast as they can cause skin Irritation and
cast breakdown.
- itching under the cast, a frequent complaint, can
be relieved by keeping the patient's room cool, and
by using the nozzle of the vacuum cleaner or
hairdryer to blow cool air under the cast
Hygiene
Prolonged bed rest emphasizes the need for
good personal hygiene for both comfort and
cleanliness. It is important that the patient does as
much as possible for herself while in bed and not be
encouraged to assume the "sick" role, For example,
she can do as much of her hygiene as possible by
lying on her side with the basin of water on a small
table or chair which is in easy reach. She can apply
make-up, change positions in bed, and so forth.
Some form of signal system, such as a hand bell, is
required to communicate the need for assistance.
Hair may be shampooe'd as often as desired. The
cast is protected with plastic tucked under it and
folded back, with towels on top of the plastic. The
patient may be transported on the stretcher to the
kitchen sink (see Figure 4), or the alternative is to
place a basin of water on a chair at the patient's
bedside. The patient needs to be on her side with her
head hanging over the basin. Minor disasters ego
spillage of water, will be less of a problem if the chair
and floor are covered with towels or plastic as well.
Red open skin means trouble
Maintenance of skin integrity cannot be
stressed enough. The parents are taught to reach
under the cast and rub the skin and bony
prominences with rubbing alcohol. They should be
instructed to check under the edges of the cast at
least once daily by pulling the skin down and using a
flashlight to look for reddened areas. If these are
present, the pressure can be relieved by placing a
foam pad in stockinette on either side of the
reddened area. The pad must not be placed directly
on the reddened area. If an open sore occurs, the
physician should be notified promptly. Ointments
and lotions must not be used under the cast since
they are likely to get into the cast and cause chemical
reactions, and irritations of the skin.
Positioning
The hazards of immobility including skin
breakdown, pneumonia, muscle atrophy and
contractu res, constipation, anorexia and renal
calculi can be prevented or alleviated by correct and
frequent positioning. The patient who develops
complications becomes even less inclined to help
herselfthus contributing to a self-perpetuating cycle,
It is crucial that the cycle of complications does not
start.
Position in bed needs to be changed at least
every four hours. The nurse emphasIZes to the
patient and the parents the need for proper
positioning and good body alignment;6
demonstrates logrolling technique which the patient
should be able to perform alone with practice.
The Canadian Nurse November 1976
46
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Avoid weight gain
Weight gain causes discomfort and may
interfere with respirations if the cast becomes too
tight. An instruction sheet on diet given to the parents
and patient and reviewed by the nurse, lists the types
of food to be eaten and the ones to be avoided. A
well-balanced diet including generous amounts of
flUid, will aid in healing and in the patient's general
well-being. Chocolates, cakes, candies, chips etc.
cause weight gain and may also produce acne under
the cast (not a pleasant situation for the patient). Bulk
foods, such as wholewheat breads, unrefined -
cereals, and fruits should be included in the diet to
prevent or relieve constipation. A mild natural
laxative such as Metamucil should also be
suggested to aid in elimination in case diet alone is
not sufficient.
Meal times are family times and a special
attempt should be made to make the patient feel a
part of the family by having different family members
eating with her, In some cases it may be possible for
the patientto be close enough to the kitchen or dining
room to take a more active role in mealtime (see
Figure 5).
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The bedpan problem
The use of a bedpan is often uncomfortable. A
body cast makes it difficult for the patient to relax
sphincter muscles and to increase intra-abdominal
pressure to aid elimination. 7 While in hospital, the
patient can be taught how to roll on and off the
bedpan with assistance. Hopefully, the practice vi
have been mastered by the time the patient goe
home. However, protection of the bedsheets witt-
homemade incontinence pad (a piece of flannele
with a plastic underside will do) may be a time sav
in the long run. Needless to say, the patient shou
not be left on the bedpan for a prolonged period <
time.
Exercise
Regular exercise is essential to the
maintenance of good muscle tone and adequate
circulation. The exercises started in hospital, taugl
by the physiotherapist, continue at home. Deep
breathing and blowing up balloons are good for lur
expansion and active and passive limb and joint
exercises should be done frequently. The parent
are encouraged to call the ward, the local public
health nurse orVON if assistance is required in doir
these exercises or in establishing a program of
exercise. A letter of referral goes to these health
personnel as well as to the family physician once th
patient is discharged.
Boredom
It is easy for the patient to become bored while
bed for such an extended period of time. Anger,
apathy, aggression and regression are normal
patient reactions to prolonged inactivity. The majori I
of these patients, as adolescents, are at a
particularly difficult time in their lives. Even withol
the additional crises that their surgery and recove,
pose, this is usually a time of turmoil and confusion
Therefore, they need strong emotional support an
understanding from their family. They also need hel
in keeping interested in the outside world and in
keeping contacts with friends. s Group recreation
sessions can be organized to give much needed
peer support. The patient may be removed from hi
room on the stretcher to other rooms of the house, 0
the porch ifthe weather is suitable. Frequent visits b
friends and relatives help the patient feel a part 0
things.
The nurse can suggest a variety of activities
keeping in mind the age and interest of the child.
These can Include reading, drawing, crafts, watch in!
T.V., listening to the radio, etc. (see Figure 6). The
parents should also be cautioned against devotin!
all the time and attention to the patient to the
detriment of the family unit. Emotional crippling cal
be the result of too much attention.
Usually some arrangement for schooling can bt
made either with the teacher or the local school
board to have a teacher visit or, if convenient, friend
may bring home the school work. A chair at the
bedside is ideal for storing books, as a work area or
for holding a mi rror for combing the hair etc. Readinç;
and homework may be made easier with the use of a
slanting table which may be rented or possibly ma'
be made at home.
Body image
With the application of a body cast, many
adolescent girls have concerns about breast
development and the effect of treatment on other
body functions. They may be concerned that the cas
will prevent growth or change the shape of their
breasts. Their concerns are legitimate and the nurse
should approach this topic with sensitivity,
reassuring the patient that no disfigurement will
The CanadIan Nurse Novembar 1976
47
Figure 6
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occur. The patient may also have some problems In
adjusting to the mother taking care of her more
personal body needs. The parents should be warned
that shyness or defensiveness may appeaL
Advice is needed on the choice of clothes.
These should be loosely fitted, usually one size
larger than normal to fit over the cast. Shorts, shirts.
loose dresses, and slacks are easily donned while in
bed.
Walking body cast
At the end of approximately 4 months, the
patient returns to the hospital for the application of a
walking body cast. With the assumption of the
upright position, the patient may feel dizzy and lose
her balance. She should be assisted with walking
during this period. Shoes which have low heels, and
good arch support will help make walking easieL
They will help the patient to regain her balance and
also adjust to the increase in height.
The change in height that follows Harrington
instrumentation and spinal fusion may impose
perceptual difficulties,9 and the cast will have a
tendency to "drop" when the patient walks
downstairs. She may therefore require assistance
with walking.
Cast care continues as before. Exercises
should be continued until walking has been well
established. The patient may also now sit in a chair,
on the toilet and on the edge of the bath. To get up
from the sitting position the patient should be taught
to press down with the palms of both hands on the
chair and push herself up. Once ambülation is fully
achieved the patient should return to school.
Some adjustment in clothing is necessary in the
walking body cast because of the cast's thickness
and contour. Heavy, loose clothing makes the cast
less conspicuous and is more durable since clothes
tend to wear out rapidly when rubbing against the
cast. T-shirts are ideal for both boys and girls. Girls
may prefer high collars or scarves and straight lines
that conceal the cast and do not draw attention to the
waistline.
Final removal of the cast
The patient should be warned that when the final
cast is removed she may feel weak and dizzy.
However, once normal activities are resumed, her
strength will be regained. The skin which was under
the cast will be tender and scaly and needs gentle
care. Wash with mild soap, warm water and pat dry.
Do not rub. Baby oil should be gently applied until the
scaliness has disappeared, usually in a few days.
Clothes will irritate the skin, so they also should be
soft and smooth.
Both parents and patient are instructed on the
type and frequency of activities the surgeon would
like her to resume.' 0 For approximately 6 to 12
-<.
months, the patient can walk and may swim. From 12
to 18 months, cycling and dancing may be done. No
tennis, basketball, horseback riding or twisting
sports are allowed, From 18 months on, the patient
may gradually resume all activities except
trampoline and platform diving.
After removal of the cast, It IS important that the
patient continue to maintain good body mechanics,
flexibility and correct posture. The patient is told that
back stiffness over the fused area may persist since
the stainless steel rods are permanent correcting
devices. If the growth period was not over at the time
of the surgery, the growth will continue above and
below the fused area. The unfused back and hips
can provide most normal flexibility of motion.
To sum up, almost any young girl or boy can
adapt to the greater physical problems of recovery
from scoliosis surgery, but the greater emphasis on
the psychological care in hospital and preparation of
the home and family would make home care much
simpler and more effective." ..
This article by Una V. Reid, R.N., B.Sc.N., M.S,N..
was written as a follow-up to a previously published
artIcle entitled "Screening for Adolescent Idiopathic
ScoliosIs," The Canadian Nurse, November 1975,
She is presently assigned to Trinidad as Nurse
Educator tor tha,t region by PAHO/WHO.
The author has made a slide tape program on
scoliosis for Dr. S.J. Tredwell, M.D., FRCP(C),
Dvision of Orthopaedic Surgery, U.B.C. (See
Audiovisual page). The project was funded by the
Mr. and Mrs. Woodward Foundation. Thanks are
acknowledged to the parents and children who took
part In the interview that was conducted for the
program; Ms. Margaret Nish, Head Nurse. Health
Centre for Children, Vancouver, B.C. and Bruce
Stewart, Medical Illustrator and the Biomedical
Communications Dept., UBC for photographs used
in the article.
References
1 Harrington, Paul R. Scoliosis in the growing spine.
Pediatr. Clin. North Am. 10:1 :225-245, Feb. 1963.
2 Saller, Robert B. Textbook of disorders and mjuries
of the musculoskeletal system. Baltimore, Williams &
Wilkins, 1970. p. 293-298.
3 Personal communication with Dr. S.J, Tredwell.
4 Marlow, Dorothy R. Textbook of paediatric nursing.
4ee1. Toronto, Saunders, 1973. p. 719.
5 Raynolds, Nancy. Teaching parents home care after
surgery for scoliosis. Amer. J. Nurs. 74:6:1090-1092, Jun.
1974.
6 Steele, Shirley eel. Nursmg care of the child with
long-term illness. New York, Appleton-Century-Grofts,
1971. Chap 8.
7 Raynolds, op Clt.
8 Steele op cít.
9 Ibid.
10 Reid, Una V. Interview of parents (and children)
whose children recently had Harrington instrumentation
and spinal fusion. Vancouver, 1974. Unpublished.
11 Ibid.
Bibliography
1 James, P.I.P.Scoliosis. Edinburgh, Livingston, 1967.
2 Neff, Joann. Feminine identity concerns of girls
undergoing correction for scoliosis. Matern. Child Nurs. J.
1:1:9-17, Spring 1972.
48
The Canadian Nurse No......... 1178
years ago, on August 24, 1926, the
rolling green lawns of the Parliament
Buildings in Ottawa were the scene of an
important event in the history of the nursing
profession in Canada. The occasion was the formal
unveiling of a monument honoring the 2,000
Canadian Nursing Sisters who had seen active
service overseas during the war that ended eight
years earlier. Contemporary newspaper accounts
describe the ceremony as "one of the most brilliant
functions ever seen in Ottawa."
About 300 invited guests and 700 nurses, many
of them in uniform, gathered under a bright summer
sky to watch Jean Brown, (later Mrs. W.A.
Thompson of Regina) president of the Canadian
Nurses Association for that biennium, make the
official presentation of the memorial "to the people of
Canada from the nurses of Canada."
Other dignitaries in attendance included acting
Prime Minister Sir Henry Drayton, who accepted the
memorial on behalf of the Canadian people, Dame
Maud McCarthy, war-time Matron-in-Chief, British
troops in France and Flanders, and Margaret C.
Macdonald, Matron-in-Chief, Canadian Army
Medical Corps Nursing Service from 1914 to 1923,
who read the honor roll.
The memorial itself is an impressive tribute in
white Italian marble. It stands in a recessed bay of
the corridor connecting the Library of Parliament with
the front entrance of the Parliament buildings. The
sculptured panel at its center measures eight by nine
feet and is surrounded by a carved marble arch that
reaches nearly to the ceiling ofthe Hall of Fame. The
artist who carved the panel, sculptor G.W. Hill, RCA
of Montreal, described the finished work this way:
"The group on the left represents the courage and
self-sacrifice of the nurses who offered their services
and lives for the great cause offreedom. Two sisters
dressed in the service uniform are nursing a
wounded soldier. In the background is 'History'
holding the book of records. The group on the right
represents noble sisters who left their native country,
France, to help the sick and needy. A sister within the
palisade is nursing a sick Indian child. Beside her are
two Iroquois. In the center, dividing the two groups
and presiding over them, stands the draped figure of
'Humanity' with outstretched arms."
The story of how the nurses of Canada built this
memorial is a true-to-life tale of the dedication and
perseverance of the organized nursing profession ..,
In 1921 members of the national association at a
meeting in Quebec City agreed to try to erect some
form of permanent monument in the nation's capital.
During the next five years, CNA members under the
direction of the convenor of the memorial committee
- Jean Gunn - pursued this goal enthusiastically.
They raised close to $40,000,(an amount slightly in
excess of costs) from nurses across the country.
They sponsored a national design competition that
attracted entries from top Canadian sculptors,
awarded the contract, supervised construction of the
monument and then organized the official unveiling
The exact site of the Memorial was open to
question for some time after CNA members agreed
that it should be built and that it should I)e located in
the nation's capital. A representative of the
Department of Public Works suggested it should be
set in Major's Hill Park, a grassy promontory
overlooking the Parliament Buildings ånd the Ottawa
River. In March 1923, Prime Minister Mackenzie
King notified CNA that government approval had
been obtained for the Memorial to be placed inside
the Parliament Buildings, in accordance with the
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original wishes ofthe committee. That Fall, a national
design competition was announced. The
advertisement drew six entries, including that of the
winner, G.W. Hill, Original plans had called for
Memorial Committees in each province to help
decide on the successful artist. When one province
relinquished its right in this respect the others
followed and a national selection committee was
named. Members included: (in addition to the
convenor Jean Gunn) CNA President, E.
MacPherson Dickson, M.A. MacDonald, Katharine
The Canadian Nurse November 1976
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Davidson and Kathleen Russell. Individual provincial
nurses' associations were responsible for setting up
committees charged with raising the required funds
according to the size of their membership and
Canadian nurses in all nine provinces responded
with overwhelming generosity.
Prime Minister King himself played an active
role in some stages of the construction of the
memorial. It was, in fact, the Prime Minister, who
suggested the wording of the inscription on the
memorial, a suggestion which the CNA Executive
Committee accepted. This inscription reads:
"Erected by the Nurses of Canada in
remembrance of their sisters who gave their lives in
the Great War. 1914-18 and to perpetuate a noble
tradition in the relations of the old world and the new.
Led by the spirit of humanity across the seas. woman
by her tender ministrations to those in need has
given to the world the example of heroic services
embracing three centuries Of Cal"adian history.....
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The Canadian Nurse November 1976
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. Cardiology
A Basic Approach to the
Electrocardiogram
A book and slide presentation on
electrocardiography, an audiovisual
teaching tool for the interpretation of
basic patterns and arrhythmias. The
137 page color book provides a
refresher and reference guide.
123 slides form a page by page
duplication of the book - both cover
the fundan,antals and advanced
theories of electrocardiography. For
addillonal Information, contact:
M.E.D.S. Corporation, 97-99
Stuyvesant Avenue, Newark, New
Jersey 07106.
Introduction to Congenital
Heart Disease
A series in five parts of
audiovisual self-Instructional units,
including slides, audiotape, and script.
Covers perinatal circulation, general
background for congenital heart
disease, common cyanotic and
acyanotic heart malformations, and
the large ventricular. septal defect in
infancy. Available from: National
Audiovisual Center (GSA). Order
Section, Washington, D.C. 20409.
Circulatory Control
A film showing the origin of the
heartbeat In the S.A. node and its
relationship to the AV. node and the
bundle of His. Shows the interaction
among blood pressure receptors,
cardioinhibitor and cardioaccelerator
centers and the nerves that regulate
the heart rate. Contact: Mcintyre
Educational Media Ltd., 86 St. Regis
Crescent North, Downsview, Ontario,
or 14431 Saturna Drive, White Rock,
B.C.
Our Heart and Circulation
A film tracing the circulallon of the
blood through the chambers and
valves of the heart, and through
arteries, veins and capillaries. Vessels
of systemic and respiratory systems
illustrated. Shows the
interrelationships of vanous
components of the cIrculatory system.
Experimental techniques illustrated.
Contact: Mcintyre Educational Media
Ltd., 86 St. Regis Crescent North,
Downsview, Ontario, or 14431
Saturna Drive, White Rock, B.C.
New Audiovisual Periodical -
"Cardiopulmonary
Commentary"
The American College of Chest
Physicians has announced a new
dimension in medical
education, "Cardiopulmonary
Commentary." This new quarterly
cassette tape journal will be devoted
to the evaluation and clinical
interpretation of selected articles from
current issues of CHEST, the official
journal of the ACCP. Tapes will
provide highlights of current articles,
comments on clinical implications of
groups of articles Including gUidelines
in diagnosis and therapy in coronary
heart disease, emphysema, asthma,
cardiothoracic surgery and other
related disciplines
The first volume Includes
discussions of cardiopulmonary tools
and techniques, occupational and
allergic disorders and tubular
disorders.
Subscription rates for yearly
series (4 tapes) are $32 for ACCP
members/CHEST subscribers, or $40
for non-members/non-subscribers.
Price for single tapes are $10 for
members or $12 for non-members.
For further information contact:
Warren Godfrey, Dept. of Multimedia
Communications, American College
of Chest Physicians. 911 Busse
Highway, Park Ridge, III. 60068
An Affair of the Heart
This 16 mm, 18-min. color film is
about cardiac disease in children.
Produced by CFTO-TV, it is available
from the Librarian, Canadian Hospital
Association, 25 Imperial St., Toronto,
Ontario M5P 1C1.
Your Heart is your Health
A 12-min. color film presents an
optimistic view of the conquest of
heart disease with increased
international effort, government
support and participation of health
workers and the public. The story is
told by a number of leading scientists
from several countries and is
illustrated by diagrams and cartoons.
Available from the Canadian Film
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Ontario K1Z 6X3
Pulse of Life-
This is a training film on
cardiopulmonary resuscitation (CPR)
This 29 min., 16mm or super 8mm
color film emphasizes the importance
of distinguiShing between
unconsciousness and a cardiac
arrest. Procedures are presented for
treating a resuscitation emergency
until the victim recovers or medical
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The film may be obtained from
Pyramid Films, Box 1048, Santa
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or Rent $25.
Common Heart Disorders
and their Causes
This is a 15 min. black and white
film explaining how the heart and
circulatory system work. Three
common heart disorders are
discussed: rheumatic heart disease.
high blood pressure, and
arteriosclerosis. The film emphasizes
the positive aspects of living with a
heart condition. To request this film
contact the Canadian Film Institute,
303 Richmond Rd. Ottawa, Ontario.
. Pediatrics
One Tuesday
This 14-min. color film shows a
day atthe Hospital for Sick Children in
Toronto. Available in 16 mm from the
Librarian, Canadian Hospital
Association, 25 Imperial SI., Toronto,
Ontario M5P 1C1.
Idiopathic Scoliosis - A
teaching guide for parents,
children and health care
personnel
This IS a 90-mlnute slide tape
presentation in three parts, dealing
with the definition, treatment and
home care of scoliosIs. There is a
musical break between parts. Slides
are 35 mm and a playback machine is
required for the tape. The program
may be obtained from: Mr Victor
Dorey, Biomedical Communications
Depl., University of British Columbia
Vancouver, B.C.
The Straight Child
A 13-min. color film describing the
treatment at the Hospital for Sick
Children for scoliosis, a progressive
curvature of the spine. Available in 16
mm from the Librarian, Canadian
Hospital Association, 25 Imperial St.,
Toronto, Ontario M5P 1C1
Robin, Peter and Darryl:
Three to the Hospital
This is a 53 min. black and white
film about three children's reactions to
hospitalization for minor surgical
procedures. The concepts of early
childhood development; response to
maternal separation; children's
perceptions of illness; and methods of
nursing intervention are discussed. To
request this film contact the Canadian
Film Institute, 303 Richmond Rd.,
Ottawa, Ontario.
. Health Promotion
Feelin' Great!
A 21-min. color film produced by
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physical activity in the form of simple
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great conditioner, according to this
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reduces stress and is nature's great
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Available from the Canadian Film
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Ontario KIZ 6X3.
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The 'Littmann' Series Portfolio of
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Reproduction of
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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
D
;
RI;
13m
52
The CanadIan Nurse Novømb8r 1976
Information is supplied by the
manufacturer: publication of this
information does not constitute
endorsement.
"T] 1 111 !s Ne\y
n
"
L_ -
I
I
t I
Posey locking Pants
Posey Locking Pants are
designed to prevent patients from
disrobing or exposing themselves.
They are available in plaid prints of
washable polyester cotton and may fit
over the patient's clothes or be worn
as normal clothing. Posey Locking
Pants cannot be removed by the
patient. They have an inconspIcuous
keylock on the suspenders to stay in
place and may be removed simply and
quickly by attendants.
The pants are comfortable, cool,
and have a pocket for the patient's
convenience. They are available in
long or short styles for both men and
women, in sizes small, medium, and
large. Approximate price: $24.75
(short), $28.50 (long).
For further information, contact
Phillip J. White, Marketing Manager,
J. T. Posey Company, 39 South
Altadena Drive, Pasadena, California,
91107.
Mobile Audio Testing Clinic
The Calumet Coach Company
has produced a new self-propelled
Mobile Audio Test Clinic. This facility
is now being used in Wisconsin to
provide hearing examinations and
treatments to children.
The 35-foot van is a
self-contained unit for independent
field operation. The Clinic is equipped
with a certified sound room and the
test equipment necessary for accurate
evaluation of hearing problems.
Connection is made to an external
outlet for power. Heating,
air-conditioning, and water supply
systems are installed.
A special treatment room allows
the attending physician to make
thorough examinations and provide
minor treatment. The unit also
contains a central reception-waiting
area for effioent patient flow.
For information write: Calumet
Coach Company, 11575 S. Wabash
Avenue, Chicago, illinOis 60628,
U.S.A.
Mediset container
A drug container demonstrated to
improve compliance with physician's
instructions and to eliminate
medication errors is now available
from Drug Intelligence. MEDISET, a
container for all oral drugs, has been
used successfully in Europe for
several years to help patients with
self-administration of medication on a
daily and weekly basis.
Recent studies with hypertensive
patients by doctors at the University of
Cincinnati Medical Center proved that
MEDISET has had a positive influence
on patients' compliance with their drug
therapy schedule.
MEDISET is designed to hold all
the oral drugs a patient is taking during
one week. Each day of the week is
divided into four compartments
according to the time at which the
medicines are to be taken. The day
and hour are clearly marked for each
compartment so the patient knows
exactly when to take his medication. A
window for each pill clearly shows the
patient when a dose is due and when a
dose has been taken. Braille markings
assist the visually handicapped.
MEDISET is made of durable
plastic, is easily cleaned and can be
used for many years. A profile form
located on the bottom of the MEDISET
provides a permanent record of all the
patient's drugs.
Visiting nurses will find it most
helpful for homebound patients taking
drugs. MEDISET is also useful in
hospitals and nursing homes for drug
control and for patient education.
Approximate price: $9.75 each,
10 for $65.00 and 100 for $585.00.
For further information write:
Order Department, Drug Intelligence,
1241 Broadway, Hamilton, IL 62341.
......
Call Switch for Disabled
Patients
A new highly sensitive nurse call
switch for use by patients with limited
or no use of their hands is now
available from The Ealing
Corporation.
The switch consists of a large soft
sponge encasing a sensitive switch.
The slightest pressure on the sponge
activates the switch.
The sponge switch is supplied
with a six foot electrical cord fitted with
a standard phone jack plug. The plug
connects directly to most call system
receptacles installed in hospitals and
nursing homes.
In use, the sponge switch can be
placed anywhere on or near the
patient and can then be used by the
chin, head, arm, leg, or
foot. Approximate price: $47.50.
For additional information
contact Herbert C. Dickey, The
Ealing Corporation, 22 Pleasant
Street, South Natick, Mass. 01760.
Electrocardiogram after work I
Conventional electrocardiograms
are made when the patient is at rest.
The "Electrocardiogram after work,"
is recorded in a state of increased
physical strain and offers greater
diagnostic possibilities. Using this
method, it is possible to detect heart
damage which would not have been
evident in a relaxed state.
Siemens has developed a new
medical setup which allows such
examinations to be carried out in any
physician's consulting rooms. The
patient, connected by electrodes to an
ECG unit, sits on a bicycle ergometel
and pedals at a prescribed speed
which can be read on the
speedometer. At intervals of a few
mlnctes, the amount of work is
carefully increased by means of
gradual electromagnetic braking.
After the exercise, an ECG is recordee
on the multi-channel recorder for
about five seconds each time. Durinç,
the exercise, the physician watches
the ECG on an oscilloscope which
simultaneously indicates the patient'!
pulse rate.
For more information contact:
D.G. SChandera, Public Relations,
Siemens Canada Umited, P. O. Box
7300, POinte-Claire, P.Q., H9R 4R6,
New Surgical Instrument
lubricant
Depuy Inc. has introduced a new
concentrated surgical instrument
lubricant.
Stella-Lube lubricates all movin!;
parts of surgical instruments to keepj
them in good working condition. The
lubricant is not affected by normal
sterilization procedures. It is
attractive, homogenous and has a
pleasant smell.
The lubricant comes in a one-hal
gallon easy pour plastic container anq
is to be diluted one part Stella-Lube te I
ten parts water before use.
Continued use of the lubricant
helps prevent spotting, rusting, and
staining. It leaves no sticky residue
and requires no rinsing or wiping after l
application.
For additional information write tel
DePuy, Inc., Warsaw, Indiana 46580. '
The Canadian Nurse November 1976
53
Resumes are based on studies placed
by the authors in the CNA Library
Repository Collection of Nursing
Studies.
Ilp8Ptll-C]1
. Standards
Setting Standards for Patient
Care. Nursing Research at
Saskatoon, Saskatchewan,
1976. Marion R. Jackson and
Eleanor L. Heieren.
How many patients can one staff
member or group of staff members
care for adequately and still retain
their job satisfaction?
In attempting to effectively meet
the needs of patients, various
methods of assignment have been
utilized in hospitals, e.g. the case,
functional and team methods of
assignment have been used
extensively in hospitals, and more
recently, unit assignment has
received some attention. No matter
which system is used, the problem of
identifying the number of patients that
each staff member can manage
efficiently and effectively, continues to
remain with us. As yet, no one has
del/eloped criteria which will
accurately indicate what a desirable
workload would be for an individual
staff member.
determiners reflect nursing activities
that are performed and repeated at
regularly spaced intervals while others
are only performed once or twice per
24 hour period. Being subjected to
wide swings in workload forces the
nurse to contend with the need to set
and reset her priorities so many times
that she is often forced to omit certain
tasks and she recognizes this and
begins to lose sight of her earlier high
expectations and her morale declines.
The investigator found that
nurses were inclined to expect that
someone else would improve their
working conditions. Nurses were
reluctant to identify the care that the
patient required because they were
weighted down with such a large
workload, that they had mixed feelings
about stating what the patient"s needs
were, when they were aware that what
care the patient received would
actually be less than needed. In
coping with this kind of situation dally,
one does not need to wonder just why
nurses leave the work force.
Setting standards for how much
care a patient requires is a must and
can only be done with the involvement
PATIENT CLASSIFICATION FORM
The purpose of this study is to test
the reliability of the Classification
System of patient needs used at the
Saskatoon City Hospital.
When examining the major
components of the System i.e.
Personal Care, Feeding, Observation
and Ambulation (Activity) and the two
major determiners, i.e. Incontinence
and Pre-op., one can readily
recognize that all the "COO determiners
vary greatly in their implication for
nursing care time required in order 10
meet the patient's needs. To a lesser
degree, this is also true of the" A'" and
. B" determiners. The reason for this
variation is chiefly because some
of many general staff nurses along
with nurses from other sectors of the
nursing work force. The general staff
nurse is the most closely involved with
the patient and she probably has the
keenest awareness of how great the
gap is between how much care the
patient receives and how much care
the patient actually needs.
Nurses join the work force full of
high expectations and they quickly
become disillusioned when they
cannot meet their expectations most
of the time. The investigator believes
that the patient needs to be informed
ofthe type of care he can expect when
he enters the hospital. It IS also
important to alert the patient's
relatives to the amount of care that the
patient should receive and to involve
the relatives in the patient scare.
The study concludes that the
guidelines for the selection of the
determiners, by the nurses classifying
patients, should be expanded. This
should and did lead to more
consistency in classifying patients
throughout the hospital. regardless of
the clinical service.
. ICU
Noise in an intensive care unit,
its sources and annoyance to
patients. Toronto, Ontario,
1974. Thesis (M.Sc.N.)
University of Toronto by
Elizabeth Holder.
..
! ...
j (j.
-\ L'
-
\"' "!'WI
- T I
A study of nOise, conducted In a
10-bed surgical intensive care unit
(SICU) of a university teaching
hospital, was centered around the
determination of the sources and
Intensity of sound in the SICU and the
patients perceived annoyance with
the sounds. The hypothesIs was:
those categories of nOise perceived by
the patient as annoying are those
Identified by the investigator as the
primary sources of sound. The
purpose was to provide information on
sound sources in an ICU in order that
nurses might strive to reduce this
stressor In the enVironment.
Data included Information from
two sources, sounds in the SICU and
interviewing of patients. A sound
analysIs record of dates, locations of
recordings, times, and decibel ranges
was devised. Also listed on the record
were the sources of sound divided into
the categories of Conversation, Other
Patients, Equipment and Activities,
Life Supporting Devices and Activities,
and Other. The interview schedule
had the same categories as the sound
analysis record. The two stages In the
methodology were: 1. measunng
sound levels and identifying sources
of sound in the SICU, over a period of
12 days during a span of four hours on
four days, four evenings, and four
nights; 2. interviewing 15 subjects who
had been patients in the SICU, but not
dunng sound level recordings. to
determine their perceived annoyance
with the noise in the Unit
The findings indicated that the
average sound level for 48 hours was
56dB(A) The mean sound intensity
was higher at night (58dB(A)).
Sources of sounds ranked by the
investigator according to pnonty were:
Life Supporting Devices and Activilies
Conversation, EqUipment and
Activities, and Other Patients. It was
found that for this ICU. sound levels
increased as the number of patients
Increased
Recordings showed that a high
sound level, 90dB(A), was obtained
from a confused and vociferous
patient. An aneroid
sphygmomanometer dropped on a
metal shelf, registered 60dB(A);
accidental triggenng of a respiratory
ventilator alarm, 62dB(A). Significant
readings of an isolated sound
occurred when paper bags were
changed in the morning and evening,
the decibel measurement being
70dB(A).
The results of the interview
showed that sources of nOise patients
perceived as annoYing were, in order
of pnonty: Equipment and Activities.
Life Supporting Devices and Activities.
Other Patients, and Conversation.
Sources of noise most frequently
identified by patients were: lowering or
raising bedside rails; humming or
clicking cf life supporting devices.
such as ventilators and wall suctions:
other patients moaning or crying out in
pain; and the conversation of nurses,
especially at report lime at the end of
the evening tour of duty. Sixty-seven
percent of the subjects reported sleep
or rest disturbance from the nOise
during the late evening or night, 13
percent were disturbed during the day.
and 20 percent were unable to identify
any particular times that the SICU was
noisy.
54
The Canadian Nurse November 1976
IJ()olts
How to Read an E.K.G.
Correctly, by Margaret Van
Meter and Peter G. Lavine.
JE;nkintown, Pa., Nursing '76
Books, Intermed
Communication, 160 pages.
1975.
Reviewed by Joan A. Royle,
Assistant Professor, McMaster
University School of Nursing,
Hamilton, Ontario.
The electrocardiogram is a
valuable assessment tool for nurses
only when they are able to use it in
conjunction with clinical observations,
patient history and laboratory findings.
The authors of this nursing skill book
emphasize that cardiac arrhythmias
must be analyzed and acted upon in
the content of their meaning to the
patient.
This text provides a brief
overview of electrophysiology and the
conductive system of the heart. It
contains a step-by-step method for
analyzing any EKG. for rate, rhy1hm,
conduction, configuration and location
of waves. Common arrhy1hmias are
discussed according to their area of
origin in the SA node, atria, A.V.
junction and ventricles. The effects of
potassium imbalances and
myocardial infarctions on the E.K.G.
are concisely outlined. The authors
provide practical tips on dealing with
minor disturbances in the monitoring
system.
A variety of tracings are provided
for self-testing, and this helps the
reader to measure her progress and
determine her strengths and
weaknesses in interpreting EKG. 's.
This short, basic text is clearly
and concisely written. It deals solely
with the skills required to interpret
common cardiac arrhy1hmias by
focusing on several relevan1
questions: Where did the arrhythmia
originate? What effect does it have on
cardiac functioning? Whal treatment
is necessary? What are the
implications of the treatment or lack of
treatment? And what are the
implications for nursing? Patient
studies presented throughou1 the
book provide examples of application
theory and emphasize the importance
of interpreting EKG.'s according to
the total picture presented by the
individual.
This book would be valuable to
students and to beginning nurses in
coronary and intensive care units.
Greater depth in electrophysiology
and conduction systems is required to
enable nurses to analyze and interpret
more complex arrhythmias.
Comprehensive Cardiac Care
3ed. by Kathleen G. Andreoli,
Virginia Hunn Fowkes, Douglas
P. Zipes and Andrew G. Wallace.
342 pages. Saint Louis, The C.V.
Mosby Co. 1975.
Reviewed by Myrna Sherrard,
Director of Nursing, The Moncton
Hospital, Moncton, N. B.
Nurses who are familiar with
the first and second editions of
"Comprehensive Cardiac Care" will
find that the third edition has been
significantly revised.
The first chapter provides a brief
review of the anatomy and physiology
of the heart, basic to an understanding
of the material that follows.
The authors present factual
information on coronary artery
disease, on the physical assessment
of patients with the disease and on its
complications.
The basic principles of
electrocardiography are discussed in
detail. There are a large number of
illustrations and electrocardiograms
related to certain abnormalities seen
in patients with cardiac disease. A
large section of the book is devoted to
cardiac arrhythmias. All
electrocardiogram tracings are new
and there are two examples of
tracings for each arrhythmia
discussed. Included in the material
presented is a series of rhy1hm strips.
A nurse may use these strips to test
her knowledge of arrhythmias by
checking her interpretation with that
printed beneath the ECG tracings.
The final chapter on the care of
the cardiac patient places particular
emphasis on prevention of
complications and on rehabilitation of
the patient. As noted by the authors in
the preface to this text, this chapter is
presented as the final chapter, not
because it is the least important but
because it serves as a
decision-making process based on
the clinical information presented in
the preceding chapters.
A section on cardiovascular
drugs provides a quick and useful
reference on many of the drugs used
for cardiac disorders.
The changes made in this third
edition have enhanced the value of
this book considerably. All nurses
involved in the care of patients with
cardiac disorders should find this book
very valuable, particularly nurses who
work in coronary care units and those
responsible for the management of
patients in cardiac emergencies.
Human Reproduction. by Eric
Golanty, New York, Holt,
Rinehart and Winston, Inc. 1975.
212 pages.
Reviewed by Mona June
Horrocks, Associate Professor,
School of Nursing, Dalhousie
University, Halifax, N. S.
This book is described in the
preface as "a biology book that
contains information in journals
normally used by students and
professionals in the biological and
medical sciences," and that is
precisely what it is.
The chapters clearly outline
human genetics, male and female
anatomy and physiology, embryonic
development of the sexual organs,
sexual behavior, sexual intercourse,
maturation of the sperm and ova,
venereal disease and birth control.
The author presents a valuable
discussion regarding culture and
sexuality. He stresses that many
aspects of sexual behavior are
learned, and that various cultures find
different aspects of the human body
appealing and erotically exciting.
Anyone using this book for a sex
education course would find these
sections useful in leading a discussion
on sex-role stereotyping.
Golanty presents an interesting
bias in the use of past and current
sexuality studies. He uses current
research to validate his statements
regarding the myth of the vaginal
orgasm, the causes of secondary
impotence, and the possible reasons
for infert ility. However, he uses Kinsey
(1948, 1953) in reference to certain
other areas For example, he states
that women are not as interested as
men in visual erotic material- how de
we then explain the booming sales 0
Playgirl, Viva and Foxylady to
women? He also uses Kinsey's
statistics regarding heterosexual,
homosexual, premarital, extramarital
and masturbatory behavior. I would
question the value of using such da!ec
statistics in teaching young adults
today. .
The book seems to be lacking in
some areas. For example the author
literally describes circumcision, bu1
fails to comment on recent research
showing a relationship between
circumcision and the low incidence 0
cancer. The pages on homosexuality
are traditional and stereotyped. The I I
section on VD briefly mentions only
syphilis and gonorrhea although mosl
books now fully cover all sexually I
transmitted diseases.
Perhaps the major flaws of the
book are contained in the section on
birth control. Golanty stresses that I
both birth control information and
prescriptions are to be obtained from
the doctor but does not mention family I
planning clinics, "street nurses," etc.,
In discussing the "pill," he describes
physiological actions in detail, but
makes no mention of
contraindications or the need for
contraceptive screening. Although
future advances in contraceptive pills
for women are mentioned, there is no
discussion of possible treatment for
men. Abortion is included as a method
of birth control, a view meeting
opposition from family planning
clinics, well women centers, etc.
In summary, the author states
that this book is not a "how to," "when
to," or "ought to," book. The book was
written because of the author's
concern that both students and clients
appear to lack all but a rudimentary
knowledge of their sexual and
reproductive biology. However,
biological knowledge alone is not
sufficient. I see this book as being
useful to the leacher of a sex
education course to supply the
biological facts. A well-rounded
course must deal with other factors
including emotional considerations,
mutual responsibility, my1hs and
fallacies. There are now a number of
good education guides that could be
used in conjunction with this book.
The Canadian Nurse November 1976
55
I!
Synopsis of Pediatrics, 4ed., by
James G. Hughes et aI, 1070
pages. C. V. Mosby Company. St.
Louis. 1975.
Reviewed by Linda R. Larson,
Pediatric Nursing Instructor,
Vancouver General Hospital,
Vancouver, B. C.
One of the greatest
challenges and frustrations of
pediatric nursing lies in the
development of a working knowledge
of a great variety of children's
illnesses. This challenge is especially
apparent in a pediatric referral or
specialty unit Nurses in such a setting
would find Synopsis of Pediatrics a
useful reference; those involved more
generally in the care of children may
not.
:synopsis of Pediatrics is written
as a physician's handbook and is
ambitious in its attempt to cover
various aspects of pediatric treatment
Despite the dangers of
oversimplification for economy of
space, the authors have succeeded
well in their task. Synopsis of
Pediatrics though nearly eleven
hundred pages, is light and portable,
an advantage not seen in most
comprehensive textbooks of
pediatrics.
The bulk of the book consists of
descriptive data on diseases of the
pediatric subspecialties, usually
preceded by a brief introduction of
embryologic development or
epidemiology. Because of topic
overlap, it is sometimes necessary to
look for information in several
chapters to obtain a complete picture
of a specific condition. It is unfortunate
that the authors have not facilitated
this by cross-referencing within each
chapter. The initial four chapters bring
out some aspects of humanistic
studies and philosophy which form the
basis of pediatric medicine. The
appendices are concise and valuable
for quick reference on laboratory
values and specific drug dosages.
A word of caution: despite its
recent publication. Synopsis of
Pediatrics should not be used as the
sole information source on any topic.
Though most of the recorded
treatments are similar to those I am
familiar with, some do not seem to be
completely in tune with current trends.
For example, chemotherapy for
osteogenic sarcoma is discouraged in
spite of its increasing use in
contemporary treatment.
In summary, Synopsis of
Pediatrics has value as a reference for
nurses, especially for in-depth
explanations of medical rationale or
information about less-common
childhood illnesses.
Freedom to Die; Moral and
Legal Aspects of Euthanasia by
O. Ruth Russell, Human
Sciences Press, New York, 1975.
Approximate price $14.95
Reviewed by Harriet Hayes,
Director, The Miss AJ.
McMaster School of Nursing,
Moncton, N. B.
This is a well-wntten book which
can be appreciated by anyone. The
author discusses active and passive
euthanasia, differentiating between
the two. She covers both historical
viewpoints and contemporary feelings
and thoughts on the subject.
The author discusses the court
cases of many who were charged with
a criminal act after being involved in
a "mercy killing." The variety of
verdicts arising from similar cases is
thought-provoking
The progress made in the
medical field regarding prolongation of
life and prevention of disease is also
discussed, Presently we have the
power to condemn a person to a
"living death," but we cannot legally
assist them to end this existence we
have created for them - even with
their consent and at their req uest The
historical development of the present
day controversy on euthanasia is
covered in a thorough manner.
The author stresses the
importance of the wording of an
euthanasia law to provide adequate
safeguards. She points out that such a
law should be drawn up by appropriate
legal authorities. The author leaves
any decision for or against euthanasia
to the reader. However, she stresses
the importance of everyone making a
personal decision on the matter: only
when individuals let their decisions be
heard will any definite or decisive
steps be taken to produce a law
covering euthanasia.
This book would be excellent for
anyone involved in the health field and
provides an excellent reference for
student nurses
Nursing Research I edited by
Phyllis J. Verhonick. 240 pages.
Boston, Little, Brown and
Company, 1975.
Reviewed by Dr. Ruth MacKay,
Associate Professor, Dalhousie
University, School of Nursing,
Halifax. N.S.
Ten contributing authors
approach research in nursing practice
from the points of view of theory
building, the research process. and
the aspects of investigations relevant
to nursing practice problems.
The book is divided into two parts.
The first part is addressed to theory
building as it contributes to the
development of a body of nursing
knowledge. Rozella M. Schlotfeldt
examines a number of conceptual
approaches that are gained through
research and used in organizing and
structuring knowledge into a nursing
science. Imogene M. King comments
on a process for developing concepts
used in theory building. James Dickoff
and Patricia James categorize
theories into four types: naming,
correlating, predicting and
prescribing. They discuss the
distinction between a concept and a
proposition, and how propositions
relate to theories.
Part II discusses the research
process in nursing and elaborates on
selected aspects of this. Robert C.
Leonard, Powhatan J. Wooldndge
and James K. Skipper Jr. collaborate
to present an overview of the
investigative process in nursing
practice. To illustrate various points,
they describe studies that use theories
from the behavioral sciences to
suggest hypotheses to explain a
particular set of nursing problems, the
control of stress by nurses caring for
hospitalized patients. The research
process is described in some detail
Significant is the use of both
subjective and objective means for
measuring patient stress as the major
outcome variable.
Howard Leventhal and Sherry
Israel present a practical discussion of
problems of conceptualization,
observation, and analysis, pointing
out strategies that have been
developed in behavioral research,
some of the pitfalls, advantages and
disadvantages of given courses of
action, and ways of obtaining valid and
reliable answers to problems of
nursing practice. A number of
resources are suggested that will
permit the reader to examine a
particular strategy or discourse in
more depth. Throughout, the authors
maintain a point of view that research
decisions must be made which weigh
the gains to be expected in one plan of
action against the concessions this
may demand, for the greatest
additional knowldge to be revealed.
Points discussed in Jeanne Quint
BenolieJ's chapter are Illustrated from
experiences in conducting research
into the phenomenon of death as it
relates to "the lives of three different
groups of people: women adjusting to
mastectomy and the diagnosis of
breast cancer; student nurses
encountering death and dying as part
of their introduction to becoming
nurses; and young diabetics learning
the psychosocial meanings of being
diabetic.' Benoliel also discusses the
important aspect of sponsorship in
gaining access to the research field.
The book is a welcome addillon to
the growing collection of resources
dealing directly with research in
nursing practice. The authors should
be commended for making frequent
connections of the theoretical issues
discussed, to concrete experiences in
nursing investigation The reader is
then able to assimilate the ideas
discussed into a working knowledge of
the application of research
methodology to problems of practice.
Although the book is designed to
meet the needs of the beginning
researcher, it would seem to be more
valuable as a reference in the specific
areas covered. The book does not
give full treatment to all aspects of the
research process, and for the
beginning student this could be a
limitation. It undoubtedly will prove to
be a useful resource to the practicing
nurse-researcher who faces many of
the problems presented here.
56
The Canadian Nurse November 1976
Lil)lellleu (TI)flllte
The following publications, received
recently by the Canadian Nurses
Association Library, may be borrowed
from the Library by C.N.A. members,
schools of nursing, and other
institutions. Publications marked R
however, include reference and
archive material and are not available
for loan. Theses, also marked R are on
reserve, and are loaned on an
interlibrary basis only.
Loans from the C.N.A. Library
may be requested by a letter stating
the title of the publication, the author's
name, and the item number specified
in the following list, or by a standard
Interlibrary Loan form. Three
publicatIons may be borrowed at one
time. Borrowers are requested to
cover mailing charges for sending and
receiving loaned publications.
" you wish to purchase a book,
contact your local bookstore or the
publisher.
Books and documents
1. The Administrative aspects of
education for librarianship: a
symposium edited by Mary B.
Cassata and Herman L. Totten.
Metuchen, N.J., Scarecrow Press,
1975. 407p.
2. Agence canadienne de
developpement international.
Rapport annuel, 1974-1975. Ottawa,
1976. 108p.
3. Association des Hôpitaux du
Canada. Annuaire des hópitaux du
Canada, vol. 24 . Toronto, 1976, 360p.
R
4. Bernard, Jessie. Women, wIves,
mothers: values and options.
Chicago, Aldine, c1975. 286p.
5. Burton, John Lloyd. Aids to
medicine for nurses. Edinburgh,
Churchill, Livingstone, 1976. 136p.
6. Canadian Association for Adult
Education. Manpower training at the
crossroads. Toronto, 1976. 64p.
7. Canadian Hospital Association.
Canadian hospital directory, vol. 24.
Toronto, 1976. 360p. R
8. Canadian International
Development Agency. Annual Review
1974-1975. Ottawa, 1976. 108p.
9. Canadian NGO Conference on
Human Settlements, Ottawa, Dec.
11-13, 1975. Report. Ottawa, The
Canadian National Committee; The
Canadian NGO Participation Group,
1975, 106p.
10. Carter, Frances Monet.
Psychosocial nursing: theory and
practice in hospital and community
mental health. 2ed. New York,
Macmillan, c1976. 538p.
11. Cave, Roderick. Rare book
librarianshlp. London, Clive Bingley,
c1976, 168p.
12. Étude Sommaire de la "Méthode
d'Ovulation" de Billings (ESMOB).
Rapport final. Ottawa, SERENA,
1976. 51p.
13. Flanders, James P. Practical
psychology. New York, Harper &
Row, c1976. 310p.
14. Foundation Center. The
foundatIon directory, Edition 5,
SUpplement no. 1 New York,
Columbia Universitv Press, 1975
79p. R
15. French, Derek. Dictionary of
management, by.. and Heather
Saward. New York, International
Publications, c1975. 447p. R
16, Handy metric conversion tables.
Toronto, Coles, 1975. 57p.
17. Institut canadien d'éducation des
adultes. La formatIon professionnelle
en question. Montréal, 1976. 70p.
18. Institut Marguerite d'Youville,
Montréal. Le soin des malades;
principes et techniques. 2ed.
Montréal, 1955. 893p.
19. Institute of Health Services
Administrators. The hospitals year
book, 1976. London, 1976. 1156p.R
20. Maternity nursing case studies:
53 case studies related to maternal
and mfant care in 13 families, by
Mildred A. Disbrow, . . et al. Flushing,
N.Y., Medical Examination Pub. Co.,
c1976, 215p,
21. Mayes, Mary E. Nurse's aIde
study manual. 3ed. Philadelphia,
Saunders, 1976. 283p.
22. National League for Nursing.
Acco 'ntability: accepting the
challenge. New York, c1976. 90p.
(NLN Pub. no. 16-1621)
23. Nursing and the aged, edited by
Irene Mortenson Burnside. New York,
McGraw-Hili, c1976. 654p.
24. The Nursing Clinics of North
America, v. 11, no. 2, June 1976.
Teaching and rehabilitating the
cardiac patient. Toronto, Saunders,
1976. p. 211-387.
25. Organisation mondiale de la
Santé. Activite de ,.OMS en 1975
Rapport annuel du Directeur général
à /' Assemblée mondiale de la Santé et
aux Nations Unies. Genève, 1976.
362p.
26. Pillitteri, Adele. Nursing care of
the growing family; a
maternal-newborn text. Boston, Little,
Brown & Co., c1976. 445p.
27. Providing safe nursing care for
ethnic people of color, edited by Marie
Foster Branch and Phyllis Perry
Paxton. New York,
Appleton-Century-Crofts, c1976.
272p.
28. Psychology of deafness for
rehabilitation counselors, edited by
Brian Bolton. Baltimore, University
Park Press, c1976. 156p.
29. Roper, Nancy. Clinical
experience in nurse education: a
survey of the avaIlable nursing
experience for general student
nurses in a school of nursing in
Scotland. Edinburgh, Churchill
Livingstone, 1976. 119p.
30. Rozenbaum, Henri. La
contraception. . . en images,
par. . . et Bernard Tardieu. Paris,
Maloine, 1975. 1 v.
31. Sousa, Marion. Childbirth at
home. Englewood Cliffs, N.J.,
Prentice-Hall, c1976. 208p.
32. Swansburg, Russell C.
Management of patient care services.
St. Louis, Mosby, 1976. 414p.
33. Weisman, Marilee. So get on with
it; a celebration of wheelchair sports,
by. . . and Jan Godfrey. Toronto,
Doubleday, 1976. 159p.
34. Worley, Eloise. Pharmacology
and medications for vocational
nurses. 3ed. Philadelphia, Davis,
c1976. 175p.
35. Yerby, Alonzo S. Commumty
medicine in England and Scotland;
an evolving specialty and its
relationship to the reorganization of
the national health service. Bethesda,
Md., National Institutes of Health,
1976. 80p. (U,S. DHEW Pub. no.
(NIH) 76-1061)
36. Zahourek, Rothlyn. Creative
health services; a model for group
nursing practice, by. . . et al. Saint
Louis, Mosby, 1976. 142p.
Pamphlets
37. Alberta Association of Registered
Nurses. Response to the Alberta Task
Force on Nursing Education.
Edmonton, 1976. 9p. R
38. Block, Irwin. Gun control: one way
to save lives. New York, Public Affairs
Committee, c1976. 24p. (Publicaffair
pamphlet no. 536)
39. British Columbia Medical Centre.
Advisory Committee on Joint
Appointments in Nursing. Report.
Vancouver, 1976. 1v.
40. Brown, James W. ERIC: What it
can do for you/how to use it, by. . . et
al. Stanford, Ca., ERIC Clearinghouse
on Information Resources, 1975. 22p
41. Canadian Council for International
Cooperation. Report 1975-1976.
Ottawa, 1976. 1v. (unpaged)
42. Canadian Library Association.
Annual report 1975-76. Ottawa, 1976.
39p.
43. Canadian Society of Respiratory
Technologists. The role of the
respiratory technologist. Winnipeg,
1976. 4p.
44. Canadian Teachers' Federation.
Industrial relations periodicals; a
selected and annotated directory of
general and teacher-oriented
periodicals. Ottawa, 1976. 20p.
45. Dartnell Corp. What a supervisor
should know about. . . 'cost
improvement'. Chicago, c1975. 24p.
46. Dawson, Margaret O. Developing
a day center for physically disabled I
adults: the Kenny experience.
Minneapolis, Mn., Sister Kenny
Institute, 1976. 29p.
47. Gérin-Lajoie, Paul. The longest I
journey, . . begins with the first step.
Ottawa, Information Canada, 1976.
24p.
48. Gérin-Lajoie, Paul. Le voyage Ie
plus long. . . commence par Ie
premier pas. Ottawa, Information
Canada, 1976, 27p.
49. Hallock, Grace T. Florence
Nightingale, by. , . and C.E. Turner.
New York, Metropolitan Life Insurance
Co., 1948. 24p.
50. National League for Nursing.
T eachin . learning strategies in
baccalaureate nursing education.
New York, 1976. 34p. (NLN Pub. no.
15-1622)
_I
.1
12 76
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12 76
Input
News
Names and Faces
Calendar
Research
The Canadian Nurse
The official Journal of the Canadian
Nurses Association published
monthly in French and English
editions.
Volume 72 Number 12
4
6
43
44
45
46 Difficult Babies John A. B. Allan 11
47 Idea Exchange Debbie Burke. Janet Horvath,
Barbara MacNeIll,
Mary Anne Waddell 17
New Concepts in
Infant Nutrition Emily Rozee 18
An Unusual Obstetrical
Case in Papua, New Guinea Dolores Hall 22
Towards Independence
for Paraplegics Ane Mane Hansen 24
The Pandemic
Influenza of 1918 Gladys Morton 32
The Market for Nurses Gabrielle Monaghan 38
Clinical Word search # 3 Mary Bawden 42
- . The views expressed in Ihe articles SubSCription Rates: Canada: one
"'?
. are those of the authors and do not year, $8.00; two years, $15.00.
.. necessarily represent the policies of Foreign: one year, $9.00, two years,
the Canadian Nurses Association. $17.00. Single copies: $1.00 each.
Make cheques or money orders
ISSN 0008-4581 payable to the Canadian Nurses
W Association.
Books
Library Update
:
. ..
... ...
"
..
.
'x./
r
;.
Christmas is for children... and
holidays in the sunny south or on the
ski slopes, for getting together with
families and friends - old and new.
We join the little girl on this month's
cover in wishing all of our readers a
happy holiday season wherever they
may be. (Cover photo courtesy CNA
Library Archives)
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
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accompany all manuscripts.
A Canadian Nurses Association,
50 The Driveway, Ottawa Canada,
K2P 1 E2.
Change of Address: Notice should be
given in advance. Include previous
address as well as new, along with
registration number, In a provinCial I
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.
eCanadlan Nurses Association
1976.
2
The CanadIan Nurse December 1976
-
/I-
I)___I-HI)___(-t it'e
As I write thIS, the crisp, colorful days
of October have turned into the
shorter, darker, ones of November.
Here in Ottawa, the first few traces of
snow have already touched the fallen
leaves, making it clear that winter is
just around the corner. I realize that,
by the time that most of you read this,
the Christmas holiday season will be
in full swing. Christmas is a time for
thinking of others so it seems
appropriate that in this month's
column I should convey some of the
messages of appreciation that have
been left unsaid all year.
All of us associated with The
Canadian Nurse, would like to say to
all of you: "Season's Greetings,"
"Merry Christmas" and "All the best in
1977." This expression of goodwill
comes, not just from the editorial staff.
but from all of those involved in
producing this journal - the people
who design the book, take the photos.
sell the ads and keep track of
subscribers. It goes out, first of all, to
all our readers - whether they are in
Newfoundland, Saskatchewan,
Australia, Africa or wherever. We have
reason to think that you are coming to
identify yourselves more closely with
your professional journal. We trust
'
'- * . "
-,-"v...'
\-
j' " . . .
. 0;
II e.-pi 11
This month we're reviving a
feature that many readers will
remember from years gone by. "Idea
Exchange" is your chance to share
your unique brand of expertise or
original thinking with your colleagues,
This month on page 17 four students
describe their foray into the world of
the very young school child. If you
have a procedure or experience that's
a little different or better than most, let
us know about It and we'll spread the
word.
that next year you will not hesitate 10
make your needs and concerns
known to us so that we can share
these thoughts, experiences and
observations with your fellow-nurses.
Above all, this greeting goes out
to everyone who contributed in any
way at all 10 the content of the last
twelve issues ofthis journal. At the top
of this lengthy list are all the people
who submitted articles during the year
- published and unpublished authors
alike. The selection process
eliminated many contributors from the
file of accepted authors. This does not
mean, however, that their efforts went
unnoticed. We hope that they will be
encouraged to try again.
To the authors, illustrators and
photographers whose works were
published - thank you more than we
can ever say for sharing your time and
your talents.
To all the contributors whose
names did not appear in print, to our
book reviewers, people who sent in
information on news events, calendar
items and people in the news -
another sincere note of appreciation.
We need you!
To all the nurses in the various
provincial associations that I visited
during the year - thank you for
making me feel at home wherever I
went and for sharing your ideas will
me. It was great meeting you and I
look forward to seeing you all again il
1977.
-M.A,,,"
Editor
M. Anne Hanna
Assistant Editors
Lynda Ford
Sandra LeFort
Production AssIstant
Mary Lou Downes
Circulation Manager
Beryl Darling
Advertising Manager
G eorgina Clal1<e
CNA Exe c utive Director
Helen K. Mussallem
'-
'\
..
6'
"-..
Psychologist John Allan believes that
the signs of behavior problems to
follow are apparent at a very early
stage to the sharp eyes of a
knowledgeable observer. Public
health nurses, according to Dr, Allan,
are in an ideal position to warn parent!
of the danger signals exhibited by the
"difficult baby" and to help them
modify this behavior by means of
some very simple and practical
suggestions. "Difficult babies" is an
article that any nurse or mother who IS
concerned about child development
will want to read. It begins on page 11.
,
Conventional wisdom indicates
that, in this life. only two events are
inevitable: death and taxes. Next
month, financial columnist, Mike
Grenby takes a look at how nurses car
save themselves some money wher
they find they can no longer put off
settling their account with Revenue
Canada.
Here
are
20
Nursing Titles:
Falconer et al.: Current
Drug Handbook 1976-78
By Mary W. Falconer, H. Robert
Patterson and Edward A.
Gustafson. 279 pp. Soft cover
$6.70. Order #3567-9
Gillies & Alyn: Patient
Assessment and
Management by the Nurse
Practitioner
By Dee "nn Gillies and Irene B.
Alyn. 236 pp. $9.80. Order #4133-4.
Howe: Basic Nutrition in
Health and Disease, 6th
Edition
By Phillis S. Howe. 454 pp. Soft
cover. $7.50. Order #4788-X.
Kron: The Management of
Patient Care, 4th Edition
By Thora Kron. 247 pp. Soft cover.
$5.15. Order #5528-9,
Simmons: The
Nurse-Client Relationship
in Mental Health Nursing:
Workbook Guides to
Understanding and
Management, 2nd Edition
By Janet A, Simmons. 248 pp. Soft
cover. $6.70 Order #8286-3
I
Textbooks for
Student Nurses:
Anderson: Clinical
Anatomy and Physiology
for Allied Health Sciences
By Paul D. Anderson. 485 pp.
$11.85. Order #1234-2.
Anderson: Laboratory
Manual and Study Guide
for Clinical Anatomy and
Physiology for Allied
Health Sciences
218 pp. Soft cover $6.70.
Order #1236-9.
Falconer: Patient Studies
in Pharmacology: A
Guidebook
By Mary W. Falconer. 147 pp. Soft
cover. $5.15. Order #3545-8.
Mayes: Nurse's Aide
Study Manual, 3rd Edition
By Mary E. Mayes. 283 pp Soft
cover. $6.20. Order #6191-2.
Miller & Keane:
Encyclopedia and
Dictionary of Medicine
and Nursing, Student
Edition
By the late Benjamin F. Miller, and
Claire B. Keane. 1089 pp.
$11.30. Order #6356-7.
Saunders' 1976 Nursing Titles:
.
-
æ
Guyton: Textbook of
Physiology, 5th Edition
By Arthur C. Guyton. 1194 pp.
$24.75. Order #4393-0.
Page et al.: Human
Reproduction: The Core
Content of Obstetrics,
Gynecology and Perinatal
Medicine, 2nd Edition
By Ernest W, Page, Claude A. VII-
lee and Dorothy B. Villee, 471 pp.
$16.00. Order #7042-3.
Robbins & Angell: Basic
Pathology, 2nd Edition
By Stanley L. Robbins and Marcia
Angell. 705 pp. $18.05.
Order #759
9.
Solomon & Plum: Clinical
Management of Seizures:
A Guide for the Physician
By Gail E. Solomon and Fred Plum,
152 pp. Soft cover. $7 75.
Order #849S-5.
Stein: The
Electrocardiogram: A
Self-study Course in
Clinical
Electrocardiography
By Emanuel Stein. 405 pp. $1445.
Order #8585-4
i i
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-, 8
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that Saunders helped nurses this year.
111:;1-
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Practical Nursing
Texts:
Chabner: The Language
of Medicine
By Davl-Ellen Chabner. 582 pp.
Soft cover. $11.85. Order #2480-0.
Jacob & Francone:
Elements of Anatomy and
Physiology
By Stanley W. Jacob and Clarice A.
Francone. 251 pp. Soft cover.
$6.95 Order #5088-0,
Thompson: Pediatrics for
Practical Nurses, 3rd
Edition
By Eleanor D. Thompson, 378 pp.
Soft cover. $6.70. Order #8842-X_
Medical Books
Useful to Nurses:
ACS: Early Care of the
Injured Patient, 2nd
Edition
By the American College of Sur-
geons. 443 pp. About $12.40.
Order #1161-3,
Applebaum & Bruce:
Tracheal Intubation
By Edward L. Applebaum and
David L. Bruce. 97 pp. $9.80.
Order #1311-X.
:^'\ W. B. SAUNDERS COMPANY CANADA L YD.
833 Oxford Street, Toronto, Ontario MaZ 5T9
-c
761
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4
The Canadian Nurse December 1976
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.
1111)u1
Nursing research papers
Due to popular demand, there
has been a second printing of
Development and Use of Indicators in
Nursing Research, the Proceedings
of the 1975 National Conference on
Nursing Research. Contents indude
(1) major papers by: Professor Lisbeth
Hockey (University of Edinburgh), on
Social Indicators, Dr. June Abbey
(University of California at San
Francisco), on Physical Indicators,
and Dr. Jack Hayward (Department of
Health and Social Security, London),
on Psychological Indicators; (2) major
papers and critiques regarding
fourteen Canadian nursing research
projects; and (3) a paper on issues
and alternatives regarding
organization for nursing research in
Canada. Copies are available at $2.00
(prepaid) through: University of
Alberta Bookstore, Edmonton,
Alberta, T6G 2J7.
Would you please let your
readers know about this?
- Shirley Stinson, RN, Ed. D.,
Faculty of Nursing, University of
Alberta, Edmonton.
Canadian nurses at the
Olympics
Montreal still appears to be riding
out the glory of the summer Olympics.
For two weeks, the city was a sea of
enthusiastic, happy citizens, athletes
and visitors, all experiencing the birth
of Mayor Drapeau's billion dollar baby.
From July 17th onward. little was
heard of the exorbitant costs from
those who will bear the brunt of such
costs .... the citizens of Quebec.
News media most critical of the
whole Olympic scene since the idea of
Montreal's hosting the games was first
conceived, came out in favor of the
movement the day of opening
ceremonies. Hopefully their critical
enthusiasm before the games will not
be lost in sentimental euphoria in the
post Olympic search into exorbitant
costs.
The aftermath of the games offers
a lime for reflection and placing
priorities in their proper perspectives.
We would like to raise the subject
of members of the medical team
(nurses, doctors, physiotherapists)
who volunteered their services in
exchange for seeing the games.
According to Dr. Georges
Létourneau, in charge of COJO health
services, the original games health
program, estimated at $720,000 for
six hundred (600) nurses, was
considered "too expensive." COJO's
recruitment committee cut down its
allotment and decided to ask for
volunteers. It is ironic that health
service budgets were cut while costs
in other areas which soared beyond all
belief were simply Ignored.
Forty-four Canadian nurses were
chosen out of the 150 who offered
their services in exchange for travel
and lodging (for those outside of
Quebec), and a $25. per day stipend
to cover meals and small expenses.
Twenty-five physiotherapists were
recruited under the same stipulations,
while 220 doctors (half from outside
Montreal), were recruited for $40. per
day plus travelling expenses. Since
they were all volunteers, one wonders
whether the meals cost more for
doctors than for nurses, hence the
$15. difference .... or was it not the old
double standard at work again?
COJO claims it cost as much to
lodge the nurses who came from
outside Montreal at a $25. per day
stipend as it would would have cost to
hire nurses at the going rate. At the
same time it stated that all the nurses
had eight or nine years' experience in
speciality areas such as ICU and
Emergency.
The daily basIc rate for a nurse with
this experience is just about $56.
excluding shift, responsibility or
speciality differentials, fringe benefits
and vacation pay (which must be paid
to salaried employees according to
minimum wage requirements).
Nursing services cost COJO
about $23,100 apart from lodging,
(2 weeks of games plus 1 week
training). Under Quebec's negotiated
rates, which are still lower than some
Canadian provinces, this would have
cost approximately $51,744 if each
nurse worked one shift per day, which
we are told they did not, as they were
given days off. We doubt that it cost
COJO $28,644 to lodge the nurses
who came from outside Montreal.
As to whether or not the nurses
actually saw many of the events
(presumably one of the most enticing
reasons for offering their services) -
Dr. Létourneau explained that "most
worked at the Olympic Village Clinic
and did not see the games." He said
that they did see parts of the opening
and closing ceremonies and those
who worked at the Velodrome saw
some events.
An estimated 15,862 spectators
and athletes in all were given medical
treatment. With only 44 nurses
working shifts, we assume they had to
be busy most of the time.
One can argue in favor of the
volunteer aspect of the Olympic
Games. It is not every day your
country or city hosts an Olympics, so
why not take advantage of being at the
heart of where it wás all happening? It
was an exciting time to be in Montreal.
After all, it is a free country, so why
should people not volunteer services if
they please?
All true ...but the fact is that
nurses as a group have been
volunteers for so long, they're still
expected to be volunteers.
COJO knew it could save money
by getting nurses to work for next to
nothing. Everyone would have been
surprised if nurses had not
volunteered .... they would not have
been handmaidens to COJO had they
not done so. Nurses never turn away
from the needs of mankind whatever
the price - or lack thereof. Where
else, outside of heallh services would
the Olympic program dare recruit
volunteer workers?
Last year while the Olympic
installations were being built,
newspapers carried reports of
construction workers and foremen on
the site earning in some cases $1 ,000
and more per week. At the same time,
a first echelon nurse working in a
life-saving situation in a Quebec
hospital earned a basic salary of $136.
per week.
Was the life-saving intensive care
situation not worth as much in terms of
value as the construction of the
Olympic Installations?
Professional and union
organizations repeatedly find their
efforts hampered by such situations
as they work strenuously to uncover
and rectify existing inequalities
between different categories of
workers, upgrade salaries, social
benefits and working conditions.
- Marie Mullally, Syndical
Consultant, The Umted Nurses Inc.,
Montreal, Quebec.
Ontario Orthopedic Nurses
As a result of tremendous
enthusiasm from Ontario members for
the Orthopedic Nurses' Association,
Inc., Atlanta, Georgia, two Canadian
interest groups have been formed in
association with the national
organization. The original interest
group from Toronto assisted with the
initial phase, of starting the Hamilton
Interest Group and has maintained
close co-operation with us. Today,
both are thriving.
The purpose of these interest
groups is to assist R.N.'s and R.N.A.'s
involved in the care of the orthopedic
patient with maintaining current
knowledge through a variety of
continuing education activities. Our
programs are open to other members
of the Health Team who share similar
interests on behalf of the orthopedic
patient. Basic to the programs is the
theme of physician management and
nursing care, planned co-operatively.
As the yearly congress of the
Orthopedic Nurses' Association has
been attracting nurses from several
other provinces, we are interested in
learning of other Orthopedic Interest
Groups. We would like to hear from
nurses who are now involved in or
anticipate forming local chapters.
Please contact: Mrs. N.
Campbell, 1244 Richmond Rd.,
Burongron,Onmri
L7S 1K
Bare Surnames
Since I have received The
Canadian Nurse for over 25 years,
am sure I would be described as an
"old-timer," and as such I am taking
exception in your literature to the IJse
of last names throughout all articles.
I find myself cringing while
reading articles in case I will come
upon the "bare surname.'
I appreciate that this is no doubt
the modem trend in literature. but find
it very abrasive in "our" professional
magazine.
- M.A. Wickham, R.N., Director of
Nursing Services, Ontario Crippled
Children's Centre, Toronto, Ontario.
Editor's note: Titles such as Miss or
Mrs. are omitted to comply with a
resolution from CNA membership
(June, 1974) that applies ro all CNA
communications. We would,
however, welcome comments on this
topic from other readers.
GENEROUS NEW GROUP DISCOUNTS on all
items shown, for group purchases, graduation gifts. favors. etc.
6,11 Same Items, Deduct 10%; 12-24 Same Items, Deduct 15%
25 or More Same Items, Deduct 20% K
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No. 237761 Nurses' Watch.. ., 19.95 ea.
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letteru1g 0. 2 90 6 . 9 9
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MRS. R. F. JOHNSON
SUPERVISOR
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CHARLENE HAYNES
.
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11.
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NURSES PERSONALIZED SPHYG.
Now in Fashion Colors!
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Stethescoøe (s,lvtr) an" Scope Sack
included (see photo left). FREE gold
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I OFFER EXPIRES JANUARY 15, 1977 .
I *s..., dllCeHts dl ..t "'" II Ws lIIICiII ...,. I
TO: REEVES CO., Box 719-.C
Attleboro, Mass. 02703
ORDER NO. ITEM COLOR QUANT PRICE
Use extra sheet for additional items or orders.
INITIALS as desired, _ _ _
TO OROER NAME PINS, fill out all InformatIon In box, top
left, clip out and attach to thiS coupon.
\ Please add 50( handlinE/poslaEe
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No COO"s or billing to individuals Mass residents add 3% S. T
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Send 10
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6
The Canedlan Nurse Oecember 1976
Xe'
s
CNA to provide
consultation
service
in labor relations
Effective January 1, 1977, the
Canadian Nurses Association will
establish a Consultation Service in
Labor Relations to provide information
and relevant education to its
members.
According to the Board of
Directors of CNA who met in Ottawa
October 21 and 22, the prevailing
social and economic climate has
precipitated the need for such a
service in the nursing field. It will be
available to all CNA members,
The structure of the organization
will be developed in conjunction with
the national Collective Bargaining
Conference, which is composed of
representatives from CNA member
associations, the nursing group of the
Professional Institute of the Public
Service of Canada and collective
bargaining groups for nurses at the
provincial level.
President Joan Gilchrist,
commenting on the decision, said:
"CNA supported the initiation of
collective bargaining for nurses in
Canada and has always approved the
principle of optimum working
conditions in order to provide high
standards of patient care."
Special meeting planned
Concern over the need to provide
direction and guidance to the nursing
profession at the nationallevel,
prompted CNA Directors to call a
special "work session" of Board
members to take place in Ottawa
January 10 and 11, 1977. The meeting
will explore "Regulation of the
Profession" as it relates to nursing
directions: the power and purpose of
the nursing profession in Canada
today.
Participants will discuss current
issues and trends and attempt to
assess the current..power existing in
nursing, establish directions for the
future and to identify external forces
influencing the profession. Careful
study will therefore be made of nursing
education, practice, administration,
research, legislation and social and
economic welfare.
Priorities for the 1976-78 Biennium
CNA Directors have a clear mandate
for the 1976-78 Biennium, to continue
work on the development of standards
for nursing education and practice, the
preparation of the comprehensive
exam, the establishment of the
Consultation Service in Labour
Relations and Workshop on Research
Methodology in Nursing Care. Other
priorities may be identified following
the next meeting of the Board of
Directors, March 30 and April 1 , 1977.
Health happenings
in the news
Grant MacEwan Community College
in Edmonton, Alia., has been given
approval by the Department of
Advanced Education and Manpower
to implement an Extended Care
Nursing Certificate Program, the
first of its kind in Canada. Areas of
care to be covered, will include
geriatrics and rehabilitation,
convalescence and care of persons
with long-term or chronic illness.
The two-trimester Extended Care
Nursing Program is designed to
provide opportunity for registered
nurses to gain and/or upgrade the
knowledge and skills required in a
variety of extended care settings. On
completion of the program,
candidates will obtain a certificate in
Extended Care Nursing.
Nurses are being asked by the
Registered Nurses' Association of
B.C. to document situations which
indicate that provincial government
fiscal restraints may be affecting
patient care in hospitals.
President Thurley Duck notes
"there is continuing talk about poorer
patient care because of funding
problems. This is an appeal for more
than talk. If there are things wrong. we
need facts. Without these facts, it must
seem that cost containment is not
threatening the quality of patient care.
Hopefully, that is true. But we need
your help to be certain."
She reminds nurses that Health
Minister Robert McClelland earlier this
year restored some public health
cutbacks, following his receipt of
nurses' and other documentation on
the adverse effects on patient care.
"As things stand now, however, no
such documentation has been
received about conditions in public
hospitals. "
Donna Lynn Smith, director of
nursing at Lethbridge Rehabilitation
Hospital, received a $5,000, grant
from the Alberta Mental Health
Advisory Council this past summer to
conduct research into mental health.
Dr. C.P. Hellon, director of mental
health services for the province said
that approximately 60 applications
were received this year. The grants
program is the result of
recommendations contained in the
1969 Blair report which urged more
research for mental health topics in
Alberta.
Smith intends to develop a
program whereby social service or
health workers are trained 10
recognize "health potentials" in clients
and to reinforce them, rather than the
symptoms of ill health taught in the
medical model of treatment. An
important part of the research,
conducted at The University of
Alberta, will involve devising methods
of teaching the health workers to
'value aspects of mental health' and to
recognize what constitutes mental
health.
,
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Medical staff at Moose Factory
General Hospital near James Bay are
taking part in an experimental study
using a hig, ily advanced
communication system that may
foreshadow future modes of health
serVIce. Nabila Lowe, B.N., B.Sc.N.,
(left) and Debbie Gooding RN,
B.Sc.N., both Public Health Nurses,
were among the first to take
advantage of the space age
communications technology while
installation work went on around
them. They are seen here conversing
by satellite with colleagues at
University Hospital, London, Ontano
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about methods of patient education in
the management of diabetes. The
system was specially engineered in
Ottawa for the federal Department of
Communications. It is designed to
give medical personnel an
unparalleled degree of contact
regardless of distance. In addition to
the link to London, Ontario, there is
access to the remote nursing station
at Kashechewan on the Albany River
The experiment is one of a series
using Canada's Hermes satellite to
probe the social impact of satellite
communications.
The Canadian Nur.a Dacember 1976
7
Don't hold your breath
A one-day seminar sponsored by the
Toronto Nurses' Section ofthe Ontario
Lung Association focused sharply on
I meeting the needs of the patient with
chronic obstructive pulmonary
disease- in the hospital, in the
intensive care unit, and in the
community.
The October seminar directed
attention to the assessment, nursing
management, and meaningful
teaching of patients with the disease,
and was emphatically practical in
nature.
Dr. Reuben Cherniack, M.D., of
the University of Manitoba and Health
Sciences Centre in Winnipeg, began
the program by reviewing the
physiology of the lung and aspects of
functional assessment of the patient
with chronic obstructive pulmonary
disease. In his introduction, he
differentiated the disease processes
and manifestations of chronic
bronchitis, emphysema and asthma.
His discussion provided a baseline
from which the needs of the C.O.P.D.
patient cDuld be discussed.
USing a detailed patient care
I plan, Sandra Truesdell, Critical Care
Supervisor at St. Joseph's Hospital In
London, discussed the needs of the
C,O.P.D. patient in the hospital
setting. She reviewed these needs as
the patient perceives them, as the
nurse observes them, and as the
nurse assesses them and evolves a
plan for care and teaching.
Truesdell's plan emphasized the
importance of the teaching role of the
nurse regarding medications,
complications (infection and
congestive heart failure), and activity
of the patient. She said that in order to
teach breath control measures
effectively, both the nurse and patient
must know "what the patient does to
aggravate his shortness of breath."
The way to modification of
behavioral patterns begins with the
patient's examination of his activities
of daily living. Knowledge of what
makes him short of breath will
determine his specific activity
limitations and help him to control his
anxiety. "In hospital," Truesdell said,
"the nurse is just scratching the
surface," adding that home care
referral is a necessity in helping the
patient to pace his activities on a daily
basis.
A panel discussion dealt with the
needs of the patient in ICU. Ruth
Kitson, Head Nurse, Maureen
Morrison, Physiotherapist and
Natwarlal Naik, Respiratory
Technologist, talked about the team
approach to the care of a long-term
intensive care patient-from acute
care, through weaning from the
ventilator, rehabilitation and transfer
to a medical ward Their presentation
was illustrated by slides showing the
progress of one of their long-term
patients at the Toronto Western
Hospital.
Lee Robinson, Clinical Specialist
at St. Joseph's Hospital in Hamilton
follows respiratory patients on an
on-going basis in their homes, at the
out-patient clinic, and in the hospital,
through the McMaster Regional
Respiratory Program. Her contribution
to the seminar involved showing how
effective teaching can help patients to
attain behavioral change and an
acceptable level of health, in spite of
permanent changes inherent in
chronic lung disease. She discussed
practical measures to help the patient
learn how to control his breathing and
to increase his activity gradually
through teaching him specifically
"what to do and how to do it."
A responsive audience of close to
200, including nurses,
physiotherapists, respiratory
technologists, medical students and
social wor:';ars attended the seminar in
Toronto. It was the second seminar on
chronic obstructive pulmonary
disease to be sponsored by the
Toronto Nurses' Section ofthe Ontario
Lung Association.
Did you know...
French investigators say they have
developed a vaccine against hepatitis
B, tested it clinically and first results
indicate it is protective. (The Lancet,
June 26).
Its only use so far is in one
hemodialysis unit to protect patients
and staff but the investigators say that
it could be given to others at high risk.
Order of Nurses of Quebec holds
annual meeting in Montreal
The Order of Nurses of Quebec has
joined most of the other provincial
nursing associations across Canada
in raising its annual membership fee.
The decision by the ONQ Bureau to
increase the yearly fee for active
members from $55 to $80, effective
1977, was announced at the annual
meeting of the Order In Montreal in
late October.
The 48,000-member ONQ, in
budgetary provisions for the fiscal
period of April, 1977 to March 31,
1978, anticipates expenditures of
more than $2.75 million for the next
fiscal year.
According to ONQ officials, the
Increase is needed to cover additional
expenses Incurred by application of
the new Professional Code and
nursing legislation. In answer to a
question from delegates, an ONQ
spokesman cited figures to show that,
even with the increase, nurses will pay
less for membership in their
assc-::iation than almost any other
professional group in Quebec.
As a result of legislative changes,
there has been an increase in the
decision-making power at the level of
the Bureau (which consists of an
administrative committee, one
representative from each district, and
three directors appointed by the Office
des professions du Québec) and a
corresponding loss of power at the
level of the General Assembly.
Delegates asked that officials of the
Order endeavor to obtain government
approval for changes in the
Professional Code that would promote
increased membership participation in
the decision-making process.
Delegates also discussed a wide
range of resolutions, including one
previously adopted by the Bureau that
the Order's newsletter, "Nursing
Quebec," become a unilingual French
publication. Opposition to this move
resulted in a recommendation that the
Order continue to publish in two
languages to meet the needs of both
French and English members
Other resolutions included
recommendations that:
a the ONQ request the Régie de la
langue française to define
"workIng-knowledge of the French
language" and establish the criteria
pertaining thereto, as these relate to
implementation of the Official
Language Act;
a the ONQ require that all
candidates to the practice of the
profession be tested to detect any
anomalies in their color perception,
(color-blindness) to be followed by a
qualitative and quantitative diagnosis,
if necessary:
. pressure be brought to bear on
the Department of Social Affairs by the
ONQ so that an appropriate test to
detect anomalies in color perception
may be given to all kindergarten
children by
he school nurse.
IDRC awards
Ten awards for "mid-career
professionals" are being offered
again this year by the International
Development and Research Centre.
These awards are designed for
professionals or practitioners with no
specific experience in international
development as well as for those who
are already working in this field. They
offer a "sabbatical year" for research,
specialized training, personal study or
updating of skills. Candidates may
present projects In any of the
numerous areas dealing with
international development, such as
agriculture, nutrition sciences, health
sciences, engineering, social
sciences, communications,
information sciences, education, etc.
Each award includes a stipend of
up to $18,500, return travel for the
award holder and family to the place of
tenure, field travel up to $1000, actual
training costs, if any, and research
funds up to $2000.
Deadline for applications IS 15
February 1977. Apply to:Research
Associate Awards IDRC, P.O. Box
8500, Ottawa, Ontario.
8
The Canadian Nurse December 1976
Xt.>>"-S
Emergency health nurses
Federal, Provincial and Territorial
representatives met on October 6, 7
and 8 at Arnprior, Ontario to report and
discuss Emergency Health Services
in Canada. Agenda items included:
ambulance services; level or training
in cardiopulmonary resuscitation in
small centers; and, emergency plans
in the event of airport disasters such
as poisoning or plane crashes.
At present. only three provinces
employ nurse consultants for
Emergency Health Services -
Carolynne Ross (R.N.; B.Sc.
(nursing)), nurse consultant, Alberta
Emergency Health Services; Julia
Roberts (R.N.; Dip. P.H.), consultant,
Emergency Health Services, Ontario
Ministry of Health; and Carol Beazley
(R.N.; B.Sc.N.) nursing and planning
officer of Emergency Health Services
for the Nova Scotia Department of
Public Health. Their duties include:
_ reviewing and revising hospital
disaster plans and coordinating them
with community disaster plans;
_ conducting inservice education,
seminars and workshops in hospitals
about disaster nursing;
_ casualty simulation exercises ego
in June, a plane crash simulation
exercise was conducted at the
Toronto International Airport.
Lorraine Davies, Director of
Emergency Health Services on the
federal level, is a former nurse
consultant for Nova Scotia.
Mandatory registration
of federal nurses
Because of the large number of
federally employed nurses working in
the Northwest Territories, the N.W.T.
Registered Nurses' Association has
become concerned with the federal
policy which does not require current
registration status for employees.
The NWTRNA has written to all
federal nurses holding current
registration in the Association asking
them to write to PIPS (Professional
Institute of Public Service of Canada)
saying that they support mandatory
annual registration in the jurisdiction in
which they are employed and feel that
this issue should be included in
current contract negotiations.
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Four of the nurses attending the
Ontario OccupatIonal Health Nurses
Association Conference in Niagara
Falls: (from left to right) Laura Raynor
from Collingwood Shipyards,
Collingwood, Ont.; Dorothy Clarke,
Committee Member of Union
"You've come a
long way nursie"
Since Olive Bradley became the first
industrial nurse in Canada, back in
1908, occupational health nursing has
come a long way. Irene Robertson,
supervisor of Nursing Service for
occupational health nurses with
Imperial Oil across Canada, and
keynote speaker for the Ontario
Occupational Health Nurses'
Association October Conference in
Niagara Falls, traced the development
of the occupational health nurse from
a dispenser of bandaids to a
professional specialist with a hand in
safely, prevention of illness, initiating
health programs, home visiting, group
teaching, and counselling.
The Ontario association of
occupational health nurses has also
experienced groW1h. Marjorie Gohm,
president ofthe Niagara Occupational
Health Nurses Association, said that
since the association was begun five
years ago, the organization has grown
to include 613 members. About 300 of
these members attended the four-day
conference.
Ontario has the only provincial
association of occupalional health
nurses in Canada and guests to the
conference came from British
Columbia, Alberta, Quebec, Nova
Scotia, and the United States. Nurses
in attendance were an enthusiastic
blend - from industry, business and
commerce, hospital health services,
community colleges, and the Ontario
Carbide, Weiland, Ontario; Claire
Masters, Committee Member of the
Ontario Paper Company in Thorold,
Ontario; and Sally MacDonell,
General Motors, St. Catharmes,
Ontario.
Ministry of Health. The program
developed for the conference had a
strong educational emphasis and was
prefaced by a one-day workshop
offering three content choices. The
Ontario Heart Foundation presented a
workshop on cardiovascular health in
induslry, emphasizing risk factors,
evaluation procedures, and education
for the prevention of cardiovascular
incidents. "Foresight Prevents
Blindness" presented by the Ontario
DivisionoftheC.N.I.B. focused on eye
safety, on-the-job hazards to the eyes,
and treatment of eye injuries. R.M.
Brown of R.M. Brown Consultants in
Ottawa, spoke to an enthused and
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Participants in the recent O. O. H. N.A.
Conference in October also included:
(from left to rtght) Cathertne Napier of
the Ontario Paper Company in
Thorold, Ontario; Audrey Saary,
Beaver Wood Fibre Co. Ltd., Thorold;
Claire Masters, Committee Member
of the Ontario Paper Company,
Thorold; Sally MacDonell,
responsive audience about
management concepts and
interpersonal relationships in the work
setting. The three workshops were
very practical in nature; they were
well-attended and provoked
discussion long after the workshop
day was over.
The conference itself indicated a
wide range of concerns and interests
to occupational health nursing as a
profession. Laura Legge,Q.C. of
Toronto discussed the legal aspects 0' I
occupational health nursing in I
Ontario. Emergency care of patients
was included in the program I
specifically the care of those Injuries I
occurring in work settings.
One of the highlights of the
conference was Dr. Ned Cassem's
discussion of death, dying and dealing
with grief. Dr. Cassem, Associate
Professor of Psychiatry at Harvard
Medical School and Massachusetts
General Hospital in Boston, told of his
experiences dealing with dying
patients and grieving relatives and
brought forward suggestions of what
nurses can do to help those who are
dying or suffer loss.
The fifth conference of the
O.O.H.N.A. was more than an
educational update and enjoyable
social gathering. The theme of the
conference - "You've come a long
way, nursie" - brought to light some
challenging questions of which
perhaps the most challenging was
"Where do we go from here?"
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of General Motors in St. Catharines,
Ontario; Violet Heard, of Mansfield
Denman General Ltd., Weiland,
Ontario; Lauree Gruber, Port Weller
Dry Docks, St. Catharines; Bonme
Reine and Isabelle Glendon of
Chrysler Canada in Windsor, Ontario;
and Vivian Frankel, of Kellogg-Salada
in Rexdale, Ontario
The Canadian Nurse December 1976
9
Self-reliance in
health care
Ivan IlIich, philosopher, teacher,
linguist and author, headed the list of
guest speakers at The Professions
and Public Policy conference held in
Toronto recently. Addressing a group
of professionals that included many
from the health care field, he took a
philosophical look at the health care
system in our society and came up
with some thought-provoking ideas.
Describing the mid-twentieth
century as the Age of Professional
Dominance, lIIich stated that human
beings have come to feel that they
must relinquish all control over their
well-being, their treatment or
non-treatment to the sole judgment of
professionals, and that this
dependency leads to ill-health. The
individual loses his self-reliance with
the result that everyone is to some
degree a patient who has "needs."
Medicine has become so powerful that
it can dictate what constitutes a health
need for entire classes of people. If
more health care really meant
improved well-being for the individual,
then, perhaps the loss of individual
liberty could be rationalized. However,
the opposite happens - "medicine
engenders helplessness, anguish,
infirmity, impairment, pain and outright
disease. ..
Quoting from his latest book,
Limits to Medicine, Dr. lIIich stated,
'The prevailing 'religion' is
industrialization .... an epoch in which
learning is planned, residence
standardized, traffic motorized and
communication programmed. In such
an intensely industrialized society
people are conditioned to get things
rather than to do them. . They want to
be taught, moved, treated or guided
rather than to learn. to heal and to find
their own way... Healing ceases to be
considered the task for the sick. It first
becomes the duty of the individual
body repairman and then soon
changes from a personal service into
the output of an anonymous agency."
"The medical estabhshment has
become a major threat to health ..,..
Born in Vienna in 1926, Ivan lIIich
went to the United States in 1951 and
now lives and works in Mexico.
Kay Keith directs
Public Health study
The Canadian Public Health
Association has announced the name
of the person who will coordinate the
current study on Statement of
Qualifications for the Practice of
Public Health Nursing. She is
Catherine W. (Kay) Keith, formerly of
Health and Welfare Canada, Medical
Services Branch, regional nursing
officer, Northern Region, and nursing
officer, Staff Development.
The study is directed towards
revision of the existing CPHA
"Statement of Functions and
Qualification for the Practice of Public
Health Nursing in Canada," published
in 1966. Work on revision of the
original document was begun by a
core committee set up in 1975 under
the chairmanship of Marie loyer,
Dean of the School of Nursing,
University of Ottawa. Other members
of the committee included: Olivette
Gareau, community health consultant
(nursing), Health and Welfare
Canada; Laurette Sutton, assistant
director at National Office, Victorian
Order of Nurses; Jane Henderson,
former assistant executive director
Canadian Nurses Association; and
Ethel Irwin, senior consultant, Public
Health Nursing, Health Promotion
8ranch, Community Services
Division, Ontario Ministry of Health.
Specialty scholarship
The International Association for
Enterostomal Therapy is accepting
applications for its annual scholarship
grant from nurses interested in
working in this specialty. The
scholarship, valued at $1,500, is
available to registered nurses with two
years recent experience currently
employed in a hospital or other related
health facility.
The applicant must have a
sincere interest In total rehabilitation of
the ostomy patient, be utilized in her
employment in direct patient care and
in staff teaching and be willing to share
her expertise and knowledge in the
community. Applications are available
from: Aileen E. Barer, RNET,
chairman, Scholarship Committee,
Enterostomal Therapy Centre, Royal
Jubilee Hospital, Victoria, B.C.
V8R 1J8. Deadline is June 1, 1977,
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Recent visitors to CNA House in Ottawa presented a replica 01 a jug from
a Spamsh galleon (found in 1692 at Port Royal, JamaIca) to the CanadIan
Nurses' Association. Margaret Brayton, (left) Executive Secretary 01 the
Commonwealth Nurses' Federation, and Edna Tulloch (right), Executive
Secretary 01 the Caribbean Nurses' OrgamzatlOn, General Secretary 01 the
Professional Institute 01 Jamaica. and C.N.F. member, look on as CNA
executive director. Helen Mussalem (center) admires the vase. The guests to
C. N.A House were in Canada to attend the Dalhousie Conference "The
Commonwealth and Non-government Organizations," on October 29, 1976.
Thyroid supplements - cancer risk?
Prolonged use of thyroid supplements
seems to be related to an increased
risk of breast cancer according to a
report in the Journal of the AmerIcan
Medical Association.
In the study reported by two
doctors in DetroIt, it was found that:
- the incidence of breast cancer
among patients receiving a thyroid
supplement was 12.1 compared with
an incidence of 6.2 percent in a control
group not taking the supplement
- the likelihood of breast cancer
generally increased with the number
of years a patient had been on thyroid
supplements
- the incidence of breast cancer was
higher among those who had never
given birth than among those who had
borne one or more children.
Commenting on the report, Dr.
W.R. Barkley, edrtor of JAMA
emphasized that most women taking
thyroid supplements did not develop
breast cancer. The supplements are
so essential for those with inactive or
sluggish thyroid glands that
physicians should continue to
prescribe them when indicated - but
with proper counselling to inform
patients of risk.
The doctors who conducted the
study stated that they were not sure
whether the Increase was due to
deficient activity of the thyroid gland
itself or to prolonged use of the
medication. They further stated that If
their fIndings were accurate. it would
support the contention that the
hypothyroid state tends to protect
against the development of breast
cancer.
10
The Canadian Nurse December 1976
Xt.>>\\-S
Representatives of professions
study crisis in public confidence
Are the professions really protecting
the public interest? Debate and
discussion on this and other related
questions set the tone for a two-day
national conference on The
Professions and Public Policy. The
meeting was sponsored by the Faculty
of Law, University of Toronto, in
cooperation with the Ontario Institute
for Studies in Education and took
place in Toronto, October 15 to 16.
Approximately 300 delegates,
representing a variety of professions
including the health care field, social
work, engineering, architecture,
teaching and others were in
attendance with a sizeable turnout by
nurses from B.C., Alberta, Ontario and
Quebec. They came together to listen
to many eminent speakers discuss the
future of the professions in Canada.
The first plenary session was
addressed by The Hon. Claude
Castonguay, Ch airman of the Québec
Commission of Inquiry on Health and
Social Welfare and presently a
memberofthe Anti-inflation Board, on
the subject of the future of
self-regulation for the professions. He
described legislation enacted in 1974
in Québec to govern professional
practices and to protect the interests
of those receiving professional
services Thirty-eight organizations,
known as Professional Corporations,
are now recognized by the
Professional Code of Québec.
Prior to 1974, professional
corporations were granted wide
powers without any form of
government control over how these
powers were used. Although the new
laws strongly maintain the principle of
self-regulation of the professions,
they also call for the appointment of
public representatives to the boards of
the corporation; the creation of a
"professions board" whose main role
is to ensure that the professional
corporations carry out their functions
adequately: and the establishment of
criteria for new professional
corporations. Another feature of the
legislation is to make a distinction
between protecting the public interest
and defending the professions
economic interests In what he termed
a "tentative conclusion," Castonguay
stated that the reform of the
professions has made steady
progress since 1974 in Québec and
that it is "accepted, in that it has in no
way been called into question."
Looking to the future, he suggesteo
that tighter controls over professional
incomes might have to be introduced if
existing control mechanisms
designed to eliminate abuses do not
work.
Dr. L. Robillard, president of the
Federation of Medical Specialists of
Q
ébec, responded to Castonguay's
remarks. He suggested that there
were not enough members on the
Professions Board to properly
exercise their functions. and that
some groups, such as insurance
adjusters who have a significant public
im pact, escape public control. He also
pointed out that it is the role of the
professional corporation to establish
the quality of work.
Dr. R.E. Olley, chairman of the
Board, Consumers' Association of
Canada, felt that the system being
tried in Québec, although beset with
problems, was a "laudable first step,"
in finding a way to capture the benefits
of self-regulation and, at the same
time, to keep in touch with the
consumers interest.
Reflecting on the question of
self-regulation in the United States,
Jethro K. Lieberman, legal affairs
editor for Business Week, expressed
a sceptical view of the self-regulated
professions, stating that the power of
self-regulation carries with it "the
power to transcend the limits of the
professional s expertise" especially
when they are allowed to police
themselves.
Presenling the federal
government s viewpoint, Dr. Sylvia
Ostry, Deputy Minister, Federal
Department of Consumer and
Corporate Affairs addressed the
second plenary session on the recent
decision to extend competition policy
to me self-regulating professions.
In a carefully worded document
on present government policy, Ostry
stated that the focus of concern was
the effect of the behavior of
professional groups and the cost that
this imposes on a society. If market
forces were allowed to assert
themselves over the professions, she
stated, improved performance,
efficiency and superior productivity
would probably result. This has not
been allowed to occur under
self-regulation.
Recent federal legislation (Bill
C-2) has brought the professions
under Canada's Combines Law. This
amendment focuses directly on the
activities and rules of professional
bodies and will try to ensure that these
are in the public iñterest. Activities
under current investigation include the
restriction on professional advertising,
professional fee setting and licensure.
Ostry strongly questioned the wisdom
of licensure rather than less costly
alternatives such as registration or
certification since licensing tends to
raise the price of professional services
without necessarily influencing the
quality of services given. She
concluded by stating that the greater
involvement in the professions by
government is a reflection of the
change in public attitude towards
self-regulation.
Reacting to Dr. Ostry's paper,
J.w. Younger, a.c., vice-president
and general counsel of the Steel .
Company of Canada Ltd., argued in
favor of professional self-regulation
over government regulation but only
as it applies to the 'learned
professions' ego law, medicine and
dentistry .
Professor Gorden E. Kaiser,
Faculty of Law, U. of T., stressed that
there IS ' a real crisis of confidence in
the professions today." He suggested
three supply-oriented remedies:
certification of specialists; and
consumer representation on licencing
boards. He warned that if the
professions fail to initiate change, then
there is no doubt that the government
will do so Professors Lee and
Alexandra Benham, Department of
Economics, Washington University at
St. Louis, heartily endorsed increasing
public knowledge of professional
services by advertising, and agreed
with Ostry's critical comments on
licencing.
Eight afternoon workshop
sessions dealt with topics such as who
qualifies for self-regulation, the use of
para-professionals, universal access
to professional services, manpower
planning, professional unions,
continuing competence, discipline
and liability and government restraint
on professional incomes, and
education.
Dr. Dorothy Kergin, Associate
Dean of Health Services (Nursing)", on
the panel for manpower planning,
stated that before manpower planning
can be carried out in the health field
federal and provincial governments
must decide what kind of a health
system we want and how much we are
willing to pay for it. Until then, the role
of professionals such as the
nurse-practitioner remains in doubt.
Others on the panel questioned the
value of manpower planning since, in
the past, no action has been taken to
alleviate manpower shortages or
surpluses. Five years ago, for
example, manpower forecasts I
indicated a surplus of nurses by 1976
according to one Ontario Ministry of
Health official. No action was taken
since those in the ministry did not
believe their own forecast!
Dr. J.F. Mustard, Dean of Health
Sciences, McMaster University,
speaking on Health Professional
Education, touched on many timely
problems in the university medical and
nursing schools. He stressed that
there will be increased attempts by
government to control health
manpower and the cost of health care.
To counteract this, he recommended
the establishment of " a public body
with the power to review government
action and to make public
recommendatio:1s to which the
government must respond within a
stipulated period of t'me If we are to
avoid the educatio:1 and policy
development Ir "'9
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by a small gr.:>up.'
that there still - b
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decision from the Or. ",,-
Health concernIng the future of
nurse-practitioners.
Both the plenary sessions and the
workshoPs prompted lively discussion
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a '^,el.:;ome forum for a self er,tlcallook
at the professions.
The C..adhln Nu..a December 11178
11
The identification
and treatment of
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· Parent-Infant Attachment Bonds
John A.B. Allan
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The "difficult" baby can grow into the difficult child unless the early signs of behavior disruption are
identified and treated. The best person to spot these warning signals and to aid and educate the new
mother in techniques for overcoming them Is the public health nurse. In her home visits and pre-and
postnatal classes she ;s the key figure in an important preventive exercise.
.....................................................................
Several years ago when I worked as a
psychotherapist in a child guidance clinic I was
often struck by the way the parents of these
older children would refer to their child's
behavior as an infant. "Johnny was dIfficult
from !he moment he was born," a parent would
tell me. Or, "Susan was different from our
other babies - she never smiled or let uS
cuddle her."
It seemed to me that these children - five
years old and up - had all shown clear
symptoms of their later disturbances in lt1eir
behavior as tiny mfants. They had, in other
words. been "difficult" babies. 1f only it had
been possible to identify and help these
difficult babies in the first few weeks of their
lives how much pain and suffering might have
been saved them and their parents.
What is a Difficult Baby?
Difficult babies are babies whose
behavior does not lead to the strong
attachment bonding to their mothers that is
achieved by "normal" babies. Difficult babies
may be spotted by disturbances in the five
major reflexive actions so important to the
development of the child. These behaviors-
sucking, crying, clinging, eye-following and
smiling - are the biological precursors to
many important developmental skills. Their
absence, or their presence in only weak form,
may be a danger signal that this particular
baby and its mother need help.
12
The Canadian Nur.. Dacember 1976
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Mothers can be shown how to reinforce crying by
picking up the infant while he is crying, comforting
him and holding him until relaxation occurs.
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The impairment of these reflexive
behaviors in the difficult child show up in these
ways;
.Poor or weak suckinQ response which
may give rise to subsequent feeding difficulties
and a preponderance of negative
mother-infant interactions.
.Poor or weak crying response which may
result in poor babbling and, later, poor speech
patterns.
.Poor or weak clinging response which may
lead to poor physical attachment to the mother
and a poor ability to grasp objects.
.Poor or weak eye-following response which
may give rise to poor eye contact or lead to
eye-avoidance behavior.
.Poor or weak smiling response which may
result in a failure to chorUe or laugh in infancy
or to receive, enjoy and give pleasure.
These behaviors are initially elicited on
an involuntary, reflex basis. They form the
biological foundations out of which other
attachment behaviors emerge. The failure of
an infant to show these behaviors could be
perceived as a sign of a weak attachment bond
and an indication that special help should be
offered to this mother-infant couple.
There are other behaviors a baby
manifests that can interfere with the
establishment of a satisfactory attachment
bond to his mother-behaviors that tend to
reflect extremes in muscular tension or
arousal levels. Among these I would include:
. the hyperkinetic or excessively "irritable"
baby
. the hypotonic, limp or excessively
"passive" baby
. the hypertonic, stiff or excessively "rigid"
baby
The Normal Baby
Compare the normal baby to the difficult
baby described above. The normal baby sucks
hungrily and well, cries lustily, clings to his
mother when he is picked up, engages in
eye-following, and smiles and coos at its
parents in later infancy. In short, he is a warm,
cuddly, relaxed baby - a baby that makes the
attachment bond so much easier to establish.
The Importance of the Attachment
Bond
An infant's behavior essentially becomes
organized and socialized through the
parent-child attachment bond. It is through this
relationship that an infant's energy becomes
regulated, channelled and transformed into
socialized behavior. As a baby grows its
reflexes mature, become stronger and more
clearly defined, and then go through a period
of disorganization; afterwards the behaviors
return on a voluntary basis.
A very important stage of attachment in
our species spans the period from birth to
three years. During this period a number of
important developmental sequences occur.
Through their interaction with their baby,
parents playa critical role in helping him
discharge his energy into appropriate
socialized behavior. A specific attachment
bond grows between parents and child that
provides the child with feelings of trust and
security. His first imitative Jehaviors gradually
change to a movement away from his parents
into play with other children and interaction
with other adults.
The reverse pattern - the weak or broken
attachment bond characteristic of the difficult
child - also affects the organization of
behavior, but it results in an unregulated and
poorly discharged flow of energy, the
internalization of feelings of distrust and
uncertainty, and a preponderance of
avoidance and negative behavior towards
parents. It also leads to a failure to move into
successful play with children and a later
reliance on maladaptive attention-seeking
behavior to establish primitive forms of
attachment to adults.
In other words, attachment IS necessary
for growth and normal behavior. Disturbed
behavior then can be viewed as reflecting a
break in the parent-child attachment bond.
This concept has important implications
regarding prevention, identification and
treatment of disturbed behavior in children. In
essence, it means that where repeated
patterns of disturbed behavior in young
children are observed, the question needs to
be asked: What went wrong in this parent-child
attachment bond? How can it be
strengthened or re-established? How can this
mother (orfather) and child be helped to come
together and enjoy each other?
The Role of the Public Health Nurse
The difficult baby causes the mother to
feel inadequate about her mothering
capacities. What is needed in these cases is
the awareness by the professional of the
difficulties this baby could cause the mother, I
and the provision (or opportunity) for
professional help and guidance until a
satisfactory and pleasurable mother-infant I
attachment bond is established. In some
cases this may mean daily or weekly personal
help for two or three months. The professional
best equipped to deal with these questions is
the public health nurse durin.g her postnatal I
home visits and at weekly chIld care centers.
The Cenadlan Nurse December 1976
13
................................................eo...................................
In some cases, just making parents aware
of the importance of certain attachment
behaviors will lead to parental reinforcement of
these responses. In other cases parents might
have to be shown ways of holding Or
interacting to stimulate certain behaviors or to
overcome unusually strong muscular tensions
in their children. The public health nurse during
her pre-and postnatal classes and in her home
visits could keep parents informed about
possible "difficult" behaviors and teach them
techniques for overcoming or at least
ameliorating them. I suggest the following as
being the most important:
1 . A discussion of the attachment bond and the
implications this has for the socialization of our
children Parents should be told the age at
which a baby will show specific attachment to
the infant while he is crying, comforting him
and holding him until relaxation occurs.
Mothers need to know that it is important to
reward the infant's assertive behavior and let
him know (on a non-verbal level) that he has
some say over his life and that through his
actions he can control his world and bring relief
from discomfort.
. Mothers should be taught the importance
of eye-following and eye contact. The amount
of reinforcement a mother gives her baby will
directly affect his eye contact and
eye-following behavior.
Mothers have observed that their infants
spend considerable time searching and
scanning their faces, usually with the result
that eye contact is established. When this
happens, the infant frequently breaks into a
smile response which seems to provide a
pleasant sensation of tension reduction.
They should be told that picking up an infant,
smiling, talking to him and patting him all
reinforce smiling
3. An explanation of how proper holding can
help the excessively rigid, irritable or passive
baby to relax is especially important. These
babies are the ones I would describe as
unusually difficult babies and I have found two
approaches helpful. One is for the parents to
be helped to learn what "works" with this baby,
what interactions satisfy him, what games he
likes to play. These can all be used to reinforce
his positive behavior. The other approach
entails teaching the parents special holding
procedures that are designed to lower or raise
the level of arousal, or to reduce muscular
tension so that attachment is facilitated. I think
these holding techniques are very important
and I have described them in detail here:
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Proper holding blocks or prevents the random
discharge of energy through body movements; it
forces energy to move even when locked mto stiff
tensional posture and it results m a peak experience
of rage and sobbing which is followed by a period of
its mother and the effects this bond will have
on exploration and learning.
2. An elaboration of the five major behaviors
that facilitate attachment and the ways these
behaviors can be reinforced:
. The failure to establish a strong sucking
behavior can lead first to considerable tension
between mother and child and later into other
feeding difficulties. Some mothers need
considerable support in order to establish a
mutually satisfying relationship. The public
health nurse might encourage the mother to
let her infant take the initiative in when he
wants to feed, how he wants to feed and, later,
what he wants to eat.
. Crying facilitates attachment In that it
frequently brings mother and, consequently,
comfort and relief from distress. Mothers can
be shown how to reinforce crying by picking up
--
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relaxation. Here, the mother, with the baby facing
her on her lap, demonstrates a fluid but firm grip on
the baby's arms and hands.
If the child is in great distress, the mother may
place the child sideways across her lap wIth one
Eye-following and contact seems to
orientate the infant to his mother's face and,
therefore, is important in the development of
the mother-infant bond.
The clinging response is first produced
reflexively but comes under voluntary control
at about six weeks of age. This response can
be reinforced by giving the baby opportunities
for practice, such as placing a finger in the
palm of a baby s hand so he can grip it and
then tightening the finger slightly so that a
pleasant tensional relationship is established
and maintained,
Mothers can help strengthen clinging by
giving their babies ample opportunity for
practice. It is important to teach a mother how
to hold her baby comfortably so that his head,
neck and back are supported and he is not
held too tightly.
. Mothers can also be shown how to
encourage smiling by various sensory stimuli.
. . . .
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shoulder tucked up against the mother. In this case,
the mother places her outside hand on one arm and
hand of the baby, and the other on the child's lower
legs and feet
. The Irritable Baby - This term applies to
the baby who constantly whines, who will not
cuddle or relax on the lap, who over-responds
to most stimulation and who shows excessive
fear or crying (usually without tears) I am not
referring to the "colicky" baby but to conditions
of irritability that persist well beyond the third
month and to states that do not respond to
normal comfortmg procedures. A mother can
be taught to hold her irritable, tense and
"whiney" baby fluidly yet firmly in her arms or
on her lap. It is important that she hold both the
baby's arms and hands in her hands and not
disengage them until the baby is relaxed. The
holding must be of a very sensitive nature: if
14
The CanadIan Nurse December 1976
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The mother should spend five or ten minutes him up and down and back and forth and smiling
holdmg the mfant up (lifting him up underneath both mto his face
arms and keeping his head slightly forward) moving
....................................
.................. ...............................
the baby stiffens and tenses the mother gently
increases her tactile pressure to a point equal
to, but then slightly greater than, the child's so
that the arms and legs will bend at the joints
into a relaxed position. This will probably result
in a rage response from the baby, followed by
more extension of the limbs and stiffening The
mother must be taught to give her baby a
moveable barrier to rage against, that is, her
hands and arms do not act as a straitjacket
type of restraint, but are firm enough to provide
some flexible opposition. After a few minutes
of stiffening and rage reaction, the baby should
begin to relax muscular tension and start to
sob. At this point the mother should relax her
hold and begin to comfort the baby and to
encourage the sobbing, This can be achieved
through tone of voice and by tilting his chin
forward onto his chest. After sobbing, a baby
may fall asleep or lie contentedly in the
mother's arms. In some cases, it may take
several cycles of the rage-sobbing-relaxation
pattern before prolonged relaxation is
achieved.
What this method tries to effect is a
transformation ofthe way an mfant discharges
impulses or energy. Proper holding blocks or
prevents the random discharqe of energy
through body movements, It forces energy to
move even when locked into stiff tensional
posture and it results in a peak experience of
rage and sobbing which is followed by a period
of relaxation, Some mothers will be able to
follow this holding procedure quite readily
while others might have to be shown several
times. One nurse told me that she conveyed
holding instructions to a distraught mother
over the telephone and when she checked
back later she found it had worked very well.
. The Rigid Baby - This is the baby whose
muscular tonus is characterized by states of
unusual rigidity or stiffness. These babies are
not comfortable to hold, they do not mold to
the mother's body nor do they relax when held
but tend to remain stiff or fight free. If these
responses are allowed to continue the child
may, later on in childhood, find himself locked
into a pattern of response where he is unable
to comply and where he attempts always to
control and manipulate his parents. Mothers of
these infants should be shown that by proper
holding It becomes possible to transform or
reduce these unusually stiff or rigid muscular
states. With some babies this can be done
simply by stimulating the smile and laughter
(chortling) responses, as these rapidly reduce
tension. The mother should be instructed to
spend live or ten minutes holding the infant up
(lifting him up underneath both arms and
keeping his head slightly f('lrward) moving him
up and down and back and forth and smiling
into his face. Most babies cannot resist this
stimulation and even in the midst of a rage
reaction they will start to smile and chortle
although in extreme cases of muscular tension
the release that comes is only very temporary.
In these ca
es the mother should be taught to
move the baby's body about like an accordion,
that is, the mother should extend and flex the
trunk and limbs gently and rhythmically. This
will initially result in increased dorsal arching
and extension responses until the infant rages
and sobs. The stronger the rage and the
deeper the sobbing the longer the period of
relaxed attachment. What is being striven for
here is an open-coupled system between
mother and infant. Usually the rigid baby is
locked into a "closed" system with his own
body - hands gripped together and legs
crossed. Through time and with persistence
the baby will become more sociable, more
smiling and more "cuddly" and the need for
this type of holding will diminish.
Mothers should also be advised to lie the
stiff and rigid baby on his stomach. In this way
his tension and energy can be used to push
against the mattress in lifting his head,
shoulders and trunk.
. The Passive Baby - These infants tend to
emit weak clinging responses and also
fail to mold or cuddle to the mother's body.
They prefer lying alone in their crib to
being with people and they tend to under-react
to stimuli. This lack of social attachment during
the first year of life leaves their energy
relatively unregulated. They seem to be
"perfect" babies until they start to crawl or walk
at which time the lack of prior learning and
control becomes apparent. The mother of one
"passive baby" described her toddler as a
"little hurricane.' Mothers should be warned
that "perfect" babies need additional input and
stimulation and that it may be detrimental to
leave them lying in their cribs for long periods.
The lack of crying and their quietness should
be viewed as a cue for attention They need to
be carried about by parents so that they can
receive an abundance of tactile and
kinesthetic sensations These sensations will
greatly help to change the state of passivity
into one of lively and alert activity and set the
stage for mutually satisfying interactions.
The Canadian Nurse December 1976
15
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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The mother should be taught to move the baby's
body about like an accordIon, that IS, she should
extend and flex the trunk and limbs gently and
rhythmically.
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......................................................................................
Prevention is the Key
The public health nurse is in a position to
advise parents of the disturbances and
techniques described above. The problem of
Identifying the difficult child might also be
helped if "difficult baby clinics' were held at
hospitals. public health or mental health
climcs, so that parents who are worried about
their baby's behavior could drop in, talk over
their fears and receive some practical help.
If many of the behavior problems
encountered when a child is five or six are
rooted in their behavior as mfants, it becomes
clear that the detection and modification of
these unsuitable behaviors is of the utmost
importance. Of course later behavioral
disturbances do not all stem from the difficult
baby. The trauma of a parent's death, a
serious illness or hospitalization, the birth of a
new baby m the family or even the parents
inability to cope may all affect the later
behavior of a child. Likewise, allergic reactions
in infancy (especially to milk and eggs) can
have a devastating effect on behavior.
Obviously, holding is not indicated here but a
change in diet.
But the difficult baby sends out clear
signals to those experienced in infant
behavior, and 'Nith help and support the new
mother may be able to ameliorate her baby's
condition, Through her close contact with the
new mother the public health nurse is in a
position to playa vital teaching role. She can
warn parents of danger signals and show them
how they can help improve their infant s
behavior so that it will not interfere with the
forging of the attachment bond, so important to
the development of the child s relationship with
his parents, his peers and his world.
Sympathetic and careful guiding in the
early weeks and months of an infant's life may
make the difference between a baby who
builds a satisfying relationship with his parents
- leading to a healthy and successful
'coping' with life in later years - and the child
who is plagued with the emotional
disturbances associated with weak
attachment bonding. '"
ThiS article is based on a paper presented at the
Inter-Agency Refresher Course for PublIc Health
Nursing Supervismg Nurses. Vancouver General
HospItal. December 1973.
Many of the ideas expressed in this paper
stem directly from the author's training with
Dr. Robert W. Zaslow, of the PsyChology
Department, Califorma State University at San
Jose, California. The author is mdebted to Dr.
Zaslow for making him aware of the
importance of the attachment relationship and
of the possibility of the reduction and
transformatIOn of maladaptive levels of
arousal ând muscular states by the use of
holding.
John A.B, Allan, Ph.D., is a member of the
Department of Counselling PsyChology, of the
Faculty of Education, Umversity of British
Columbia.
Bibliography
1 Ahrens, R. Beitrag zur entw/cklung des
physiognomie und mimikerkennens. Z Exp.
Angew. Psychol. 2:412-454, 1954
2 Allan, John A.B. The modIfication of an autIstIc
child's behaviour by holding Paper presented at
the British Psychological Society, London, 1969.
3 Allan, John A B. Charactef/stlcs of autistIc
behavior. ThesIs - Univs. London, 1971.
Unpublished.
4 Andrew, R.J. Evolution of facial expression.
SCIence 142:3595:1034-1041, Nov. 22, 1963.
5 -, The origins of facial expressions. Sci.
Amer. 213:88-94, Oct. 1965.
6 Bowlby, J. The nature of the child s tie to his
mother.lnt. J. Psychoanal. 39:350-373. 1958.
7 Brackbill, Yvonne. Extinction of the smihng
response in Infants as a function of reinforcement
schedule. Child Dev. 29:1:115-124, Mar. 1958
8 - The use of social reinforcement In
conditioning smiling. In Brackbill, Y. ed. Behaviour m
infancy and early childhood ed. by... and G.G.
Thompson. New York. Free Press 1967. p
616-625.
9 Brossard. L.M. Comparative reinforcement
effect of eight stimulations on the smiling response
of infants, by... and T.G. Decarie. J. ChIld Psycho!
Psychiatry 951-59, Oct. 1968.
10 Douglas, V.I. A pilot study of Rlmland s
diagnostic check list with autistic and mentally
retarded children. J ChIld Psycho!. PsychIatry
9:105-109, Nov. 1968.
11 Goodenough, Florence. Anger in young
children. Minnesota, Greenwood, 1931. Repnnt
1975.
12 Greenman, G.W. VIsual behaviour of
newborn Infants. In Sol nit, Albert J ed. Modern
perspectives in chIld development, ed. by... and
Sally A. Provence. New York, In!. UOIVS. Press,
1963
13 Gunther, M./nfant behavIour atthe breast. In
Foss, B.M. ed. Tavistock semmar on mother-Infant
mteractlon. Vol. I-IV. 1961-1969. Determinants of
infant behavour; proceedings. London, Methuen,
1961-1969. Vol. 1. p. 37-44.
14 Jones, H.E. The galvanic skin reflex as
related to overt emotional expression. Amer. J.
Psychol. 47.2:241-251, Apr. 1935.
16
The Canadian Nurse December 1976
..........................................................
IS' -t
--
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-
----
} 1 '"
\ ,. . .
0
.......
.......
15 Krech, David Elements of psychology: a
briefer course, by... and R. Crutchfield. New York,
Knopf, 1970.
16 Laroche. J.L Phases de somineil et sour ires
spontanés par ... et F. Tcheng. Acta Psychol.
(Arnst.) 24:1:1-28,1965.
17 Lenneberg, Eric H. Biological foundations of
language. New York, Wiley, 1967.
18 Lorenz, K. On aggression, by... and
Marjorie K. Wilson. New York, Harcourt, Brace &
World, 1966.
19 Mahler, Margaret On human symbiosis and
vicissitudes of individuation. Vol. I Infantile
psychosiS. Int. Univs. Press, 1968.
20 McGraw, Myrtle B. The neuromuscular
maturation of the human infant. New Jersey, Hafner,
1945. R
print 1963.
21 Middlemore, Merrell Philippa. The nursing
couple. Hereford, Austin 8. Sons, 1941-
22 Montagu, Ashley Touching: the human
significance of the skin. New York, Columbia U.
Press, 1971.
23 Newson, John Infant care in an urban
community. by... and Elizabeth Newson. Chicago,
Aldine, 1963.
24 Prechtl, H.F.R. The mother-child interaction
in babies with minimal brain damage (a follow-up
study). In Foss, B.M. ed. op. cit. Vol 2. p. 53-66.
25 Rimland, Bernard Infantile autism: the
syndrome and its implications for a neural theory of
behaviour. New York, Appleton-Century-Crofts.
1964.
.....
"'
....'
.
..
'-t-
"
/
.,
. ......
'
'
. -
,
(
26 Robson, K.S. The role of eye-to-eye contact
in maternal-infant attachment. J. Child Psychol.
Psychiatry 8:13-25, May 1967.
27 Sontag, LW. Implications of fetal behaviour
and environment for adult personalitiesAnn. N. Y.
Acad. SCi., 134:782-786, Feb. 28, 1966.
28 Stechler, G. Some observations on attention
and arousal in the human infant, J. Amer. Acad.
Child Psychia;ry 5:517-525, Jul. 1966.
29 Tanner, J.M. Education and physical
growth. New York, Int. Univs. Press, 1970.
30 Twitchell, T.E. The automatic grasping
responses of infants. Neuropsychologia
3:3.247-259, 1965.
31 Wing, J.K. Early childhood autism: clinical,
educational and social aspects. London,
pergammon, 1967.
32 Wolff, Peter H. Observations on newborn
infants. Psychosom. Med. 21 :2: 11 0-118, Mar.! Apr.
1959.
33 Zaslow, R.W. A theory and treatment of
autism, by... and Louis Breger. In Breger, Louis ed.
Clinical-cognitive psychology: models and
integrations. New Jersey, Prentice-Hall, 1969.
,
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)
Mothers can remforce the clingmg response by
giving the baby opportunities for practice, such as
placing a finger in the palm of a baby's hand so he
can grip it and then tightening tIJe finger slightly.
--
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The Canadian Nurse December 1976
17
Learning is a two-way street for the nursing students and
school-age youngsters involved in this experiment. For the
children, there's the chance to learn more about keeping
I healthy. And for the aspiring R.N., there is the opportunity to
change her public image from "the person who hurst you" to
"The person who helps you and wants to be your friend."
1(let! Exellt
Jlge
Health Helpers
Debbie Burke, Janet Horvath, Barbara MacNeill, Mary Anne Waddell
Two years ago, a kindergarten teacher contacted the Cambridge
Nursing Division of Conestoga College to ask if some student nurses
could come to her class. They were to portray 'health helpers' during
a week the kindergarten teacher had devoted to this topic, As a result
I of this call, a whole new pediatric community experience evolved at
I ' our school of nursmg, and many nursing students have since had the
: opportunity to interpret the nurse's role to school children from
I nursery school to grade three.
I School presentations, organized and planned by nursing
students, were usually based on the format used for the pediatric
preop classes at South Waterloo Memorial Hospital, our clinical
facility. The pediatric staff there were most helpful in recommending
I methodology, suggesting audiovisual aids, and lending books or
pictures to the students for their presentation.
Two students shared the teachi ng experience, setting their own
objectives, and using their own ideas in planning a program. For
example, some objectives drawn up by students instructing a grade
two class included:
. to clarify the children's perception of the hospital, health team
members, and hospital equipment,
. to learn to teach seven and eight-year-olds about health in an
understandable way,
. to gain insight into assisting children of this age to adjust to the
hospital environment, so that hospitalization is less traumatic,
. to gain insight into the child's perception of the hospital, health
leam, and separation from his family,
. to convey an image of the nurse as an approachable and
helping member of the health team.
These objectives indicate the two-way nature of the learning
experience, - both the child and the student f!llrSe had something to
gain from the project.
Student nurses arranged and organized their own experience,
independently contacting the school principal and the specific
teacher involved in the project. This encouraged the student to use
her own initiative and taught her about lines of communication and
organization. Often the students arranged for one student to wear a
uniform to the school presentation while the other student wore
street clothes. This demonstrated to the children that not all nurses
wear uniforms.
It was left to the students to decide how they wished to introduce
their topic, A grade two class was found to respond to a discussion
about reasons for going to the hospital with surprising contributions.
This article was a combined effort on the part of four second year
students during their pediatric clinical experience, All were
members of the 1976 and final graduating class of the Cambndge
Nursing Division of Conestoga College of Applied Arts and
Technology.
Preschool groups responded better initially to a display of
hospital-related equipment that they could ask questions about or
play with.
A play session gave the children an opportunity to see how
hospital equipment is used. They pretended to give needles to the
nurses and to each other. They had the nurses look into their eyes
and ears and take their blood pressures, One little boy was very
anxious about having his blood pressure taken until he was given the
opportunity to pump the cuff himself. Student nurses were given the
opportunity to use their initiative and creativity in explaining the
equipment, and in settling any arguments that arose during the
children's play.
Story books and posters were used as part of the students'
presentation. Depending upon the age group of the children, the
student nurse read a book like "Curious George Goes to Hospital" or
provided narration to a series of posters depicting a child's
admission to hospital. The hospital play therapist lent posters to the
student nurses for specific presentations. During the stories or
poster narration, the children were invited to ask questions, and the
nurses received feedback about the children's level of awareness.
Art projects usually followed the nurses' presentation - these
ranged from drawings to making nurses' caps and stethoscopes.
The artwork also reflected the way in which the child perceived the
experience of hospitalization, Often the drawings depicted hospital
staff in gargantuan proportion to tiny hospitalized patients.
After their school visit, each nursing student was required to
write a report that included objectives (whether or not they were
realized) and recommendations for change. They evaluated the
teaching project as a learning experience and applied what they had
learned to caring for a hospitalized child.
Some of the observations made by the student nurses as a
result of their teaching experience included:
. Valuable feedback from the children could be drawn out through
the use of stories and posters. The children's responses to stories
gave the students an opportunity to reinforce or clarify certain pomts.
. Initially, the children addressed more questions about hospital
equipment to the student dressed in her nurse's uniform. As the
nurse in street clothes demonstrated her ability, she was
approached more readily by the children,
. Play therapy proved a valuable agent in reducing the children s
anxiety - they discovered that their own friends could peer out from
behind disposable masks. ...
The Canadian Nurse December 1976
18
nlUj
co:nl(fPTS
In IIInfflM1
UT
ITI'ON
I
r...
Emily Rozee
Breast? Bottle? Spoon? Table foods?
Vitamins? When? Why? How? These
are important questions for the new
mother who is usually bombarded by
suggestions and criticism from
well-meaning friends and neighbors,
not to mention professional advice
from her doctor and community health
nurse.
In the face of so much - often
conflicting - advice, it is hardly
surprising that some mothers adopt
feeding practices that are not
conducive to the optimum growth and
development of their baby.
As a public health nurse working in a north err
community, it sometimes seems to me that thE
job we are least prepared for in this day of the
nuclear family is parenthood.
Many of the parents who attend our
weekly child health conferenæs admit to bein!
at a complete loss when it comes to
introducing their offspring to solid foods.
Others follow their own instincts, often to thE
detriment of the child's health and sometimes
with amusing results. One couple, obviously
satisfied with their job of parenting, let their
baby dictate what she would or would not eat.
At five months, her diet consisted solely of milk
and fruit.
Another, whose degree of pride and
pleasure in his young son was obvious, told
me that his three-month old baby was eating
table foods already. When I enquired about
how he prepared the fOOdS the father stated
proudly that he chewed the food first himsel
and then fed it to the baby.
j
The Canadian Nurse December 1976
19
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Breast or bottle?
Uncertainty about what to feed, when and
how, precedes the first hunger cries of the
newborn. The relative merits of breast feeding,
as compared to bottle feeding, have been hotly
debated for many years. One agency that has
recently come out in favor of breast feeding, if
the mother is physically and emotionally able
to nurse her child, is the Metropolitan
Vancouver Department of Health in British
Columbia. The Department cites these
reasons:
. Breast milk has the correct ratio of
carbohydrates, protein. and fat, sUited to the
digestive system of a human infant. (Cow's
milk has the correct ratio for a baby calf).
. Breast milk is more convenient.
. Breast milk is sterile,
. Breast milk is cheaper,
. When a mother breast feeds her infant, she
has no visual idea in terms of ounces how
much her baby has eaten. She assumes he is
satisfied after he has nursed for a reasonable
length of time. She does not try to urge him to
"finish" as she might if there were an ounce or
so remaining in the bottle. Therefore, there is
less anxiety, and less chance of the baby
being over-fed. Overfeeding in the first months
of life shows high correlation to obesity in later
life.
. Breast milk possibly provides antibody
protection for the infant.
. Breast feeding speeds up involution of the
uterus.
Forthe mother who is unable to nurse her
child, there are a variety of commercial milk
formulas available that approximate breast
milk very closely, "An adequate formula can
also be made using evaporated milk, although
it must be altered by adding water and a form
of sugar to provide the infant with the proper
ratio of protein, fat, and carbohydrates. These
PnOIO DY Le Dro'l PhOlolhèque
formulas are especially good for mothers who
have certain illnesses or have to take certain
drugs, or who simply do not Wish to breast
feed. They are also very handy for the working
mother who wishes to breast feed - a bottle
can be given at noon if she cannot be there to
feed her baby. However, breast milk can also
be expressed and stored in the refrigerator for
this same purpose.
By the age of seven or eight months, the
natural iron stores that the baby was born with
are depleted. Unless this supply of iron is
replenished by the addition to the diet of
cereals, meat, or egg yolk, there is a definite
danger of anemia developing. When I see an
overweight, pale, listless baby I suspect that
this is a baby who is receiving only cow's milk,
with few solíd foods added to his diet. If he is
receiving any solids at all, they are usually in
the form of mashed potatoes and gravy.
At the other end of the scale, are the
mothers who give their babies a vitamin
enriched formula to which they add vitamin
drops, thus over-dosing with unnecessary
extra vitamins.
20
The Canadian Nurse Decembar 1976
Introducing solids
For a long time now, solids have been
introduced as early as two weeks, usually in
the form of cereal. A more recent concept is
the idea of waiting until the baby is three to four
months of age before giving solids, as the
infant's digestive system is unable to handle
these foods until then, Another reason for
waiting is that physiologically, the infant is not
capable of transferring food to the back of the
mouth by tongue action until about this age,
Salivary secretion also begins about this time
enabling the infant to taste dry foods. It is
recommended to start by giving the three
month old one of the least allergenic forms of
cereal - i.e. rice or soybean cereal, and to
begin with one teaspoon mixed with a little
boiled water or formula. This can gradually be
increased in amount and thickness as the
baby tolerates it.
Many mothers think that if they wait until
he is three or four months old before
introducing solid foods they must be depriving
their baby of some of the essential
nourishment he needs. In fact, the opposite is
the case since too early addition of solids
reduces the intake of milk which is superior to
solid baby foods in the nutrients it contains. A
well-balanced formula provides the baby with
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almost all the nutrients he needs for the first
three or four months of life. Breast milk,
providing that the mother is eating a
well-balanced diet and that the baby receives
sufficient volume of milk, also supplies almost
all the essentials for growth.
The exception to this general rule is
Vitamin 0, Almost all homogenized milk and
commercial formulas have been fortified with
this vitamin but the breast fed baby and the
baby whose formula does not contain added
Vitamin 0 should have it added to their diet. All
babies, regardless of whether they are breast
or bottle fed should be given a Vitamin C
supplement, either in the form of vitamin drops
or by the addition of diluted, strained orange
juice or vitaminized apple juice to their diet.
These juices may be given by spoon or bottle
and, if diluted, should be mixed with boiled
water.
In areas where the local water supply has
not been fluoridated, the addition of a fluoride
supplement to the baby's diet will help to
prevent decay in the teeth now being formed in
the gums. Authorities recommend that tnis
fluoride be given in several small doses in juice
or water during the day rather than one daily
dose.
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The first strained baby food to offer might
be either fruit, vegetables, or meat. Often
babies will accept fruit readily, but having first
tasted the sweetness of fruit, will not be
enthusiastic about the "bland" taste of
vegetables. For this reason, it is often a better I
idea to start slowly with a variety of vegetables
New foods, regardless of the type, should be
introduced when the infant is well-rested and
feeling well and hungry. If you satisfy his
hunger with formula first, he will not be hungry
for solids. Each new food should be given over
a five to seven day test period before adding
another new food, In this way, foods that may
cause an allergenic reaction can be avoided.
Mixtures such as dinners and soups
should be avoided when first introducing baby
to new foods. It is a good idea however, to take
advantage of the baby's appetite at his age
and familiarize him with as many different
foods as possible. At about seven to eight
months of age he is likely to become finicky
and refuse those foods which he hasn't
previously been introduced to.
With regard to the infant refusing a new
food, it is wise to wait a couple of weeks before
trying it a second time. Babies, after all, are
...
The Canadian Nurse Decembar 1976
11
! individuals and have a right to their likes and
dislikes. Mothers should know that this attitude
is to be expected. especially in the beginning
when introducing the new taste and feel of
solids, and should not be intimidated by it. All
babies react to solids in a
"negative-appearing" way at first, although,
this reaction may just be surprise at the taste
and feel of solid food, and the fact that it does
not taste remotely like milk. The parent, then,
should not abandon the attempt to introduce
I a new food, but should wait for a week or so
I and then try again. Indefinite postponement,
. however, solidifies the infant's resistance to
I change and should be avoided. Gentle
persuasion usually does the trick, and both
mother and infant have the satisfaction of
having crossed another bridge. If the child
continues to refuse an item, it should then be
I assumed that he definitely does not like it, and
the parent should not continue to try to get the
child to "like" it. Like the adult, he has his
preferences.
@ Growing up
Another question often asked by parents
is when to switch from formula to
homogenized milk, It is now recommended
I that the introduction of cow's milk be deferred
until the infant is eating about eight ounces of
strained foods daily - usually, about six to
nine months. By this time, the baby will be
obtaining enough vitamins and iron from these
foods to make up for the loss of the extra
nutrients in commercial infant formulas.
When the baby's first teeth begin to come
through, or when he begins to make biting or
chewing movements, the baby is ready for his
introduction to lumpy foods. These may be
commercial "Junior" foods, or mashed table
foods. Often, table foods are a better choice,
not only because they are less expensive, but
also because they serve as an introduction to
the foods he will soon be eating regularly. The
mother who chooses foods that she has
prepared has the satisfaction of knowing
exactly what they contain and can make sure
that no unnecessary fillers, spices, salt or
sugar are added. Babies will readily accept
foods that do not contain unnecessary salt or
sugar if they have not acquired a taste for
these additives.
The mother who has successfully
maneuvered her way through the obstacles of
the first few months of feeding her baby can
now afford to relax in the knowledge that she
has successfully laid the foundation for a
lifetime of good eating habits, ...
Emily Rozee is a Public Health Nurse workmg
with the Skeena Health Unit in Terrace, B.C,
She is a graduate of Sydney City Hospital
School of Nursing in Sydney, N. S. and
received her diploma in Public Health Nursing
from Dalhousie University. After graduation,
she worked for the Department of Preventive
Medicine as a Public Health Nurse at the
Victoria General Hospital in Halifax, N.S.,
before deciding to travel across Canada. The
article grew out of the feeling she had that too
many parents are confused or lack basic
knowledge about the growth and
development of their child.
References
1 Blake, Florence G. Nursing care of
children, by... et al. Philadelphia, Lippincott,
1976.
2 Wolczuk, Patricia D. Infant nutrition;
current teaching concepts. Vancouver, B.C.,
Vancouver Branch, Dept. of Health, 1974.
3 Infant nutrition. Draft, Vancouver, B.C.,
Vancouver Branch, Dept of Health, 1974.
A three-hour closed-circuit symposium,
"Infant Nutrition: A Foundation for Lasting
Health?" will be televised simultaneously
and live to 19 major cities in the United
States and Canada on March 23, 1977.
The symposium consists of graphically
supported presentations and ninety
minutes of questions and answers
between the audience and the pane/.
Canadian locations are Toronto,
Vancouver and Montreal (where the
program will be broadcast in both French
and English).
A professor will be available at each
location to moderate the program and
coordinate the questlOn-and-answer
sessions. The program is sponsored by
The University of Iowa College of
Medicine, in cooperation with the
National Heart, Lung and Blood Institute;
the National Kidney Foundation; and the
Committee on Atherosclerosis and
Hypertension in Childhood, CouncIl on
Cardiovascular Disease in the Young of
the American Heart Association.
At Last...
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The Canadian Nurse December 1976
22
An unusual
obstetrical case
in Papua
New Guinea
Dolores Hall
Madang General Hospital is a 300-bed center situated in a
coastal town on the tropical island of Papua New Guinea. It is
the base hospital for Madang, a province with a population of
about 200,000 people scattered throughout 17,880 square
kilometers. People with medical problems that prove too
difficult or complicated to be handled at rural health centers
are transferred to Madang General Hospital for treatm
nt.
mb Mundi was one s ch person.
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Ombu Mundi is a 38-year-old woman
from Aranam village in the subprovince of
Bundi in Papua New Guinea. On the
moming of April 11 , 1976, in herown village,
Ombru delivered a premature stillborn
infant, a breech birth. She went to the
Bundi health center because she had not
delivered the placenta. The health worker
there examined her and found that there
was still a live fetus in utero, so he
arranged transportation to take Ombu to
Madang General Hospital. She arrived at
the hospital some three days later in no
immediate distress.
Ombu was para 5, gravida 6. Her
initial physical examination atthe hospital
revealed:
. BP 100/60
. Chest
- clear
. CVS
- no acute distress
. Abdomen
- 32/40 weeks gestation
- fetus in high vertex presentation
- fetal heartbeat regular
. Pelvic
- old cord of first twin
still in place
Ombu was to remain at Madang
General Hospital for over a month. The
following describes her clinical course
and treatment regime at the hospital;
April 14, 1976
Initially the prescribed treatment was
concerned with induction of labor,
antibiotic therapy, and antimalarial
treatment.
. Artifical rupture of the membranes
was attempted unsuccessfully as the
patient's cervix and vertex were high, and
pus was draining from her vagina.
. The first attempt was made at
induction of labor. Syntocinon 2 and 112
units in 1000 cc 5% 0 /W was begun at 10
gtt/min and increased q 15 minutes by 10
gtt, up to a maximum of 60 gtt/min. The
doctor was then notified that Ombu was
not yet in established labor. Medical
induction of labor was therefore
discontinued, but intravenous fluids were
continued as ordered.
The Canadian Nurse December 1976
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. Antibiotic therapy was initiated to
combat Ombu's infection. She was given
Crystapen 2,000,000 units intravenously
q6h, and Chloramphenical 750 mg IV
q6h.
. Chloroquine was ordered - 3 tabs
(750 mg) stat, and daily for two days - as
antimalarial treatment.
April 75
. Lab results indicated that Ombu's
hemoglobin was only 6.4gm o o. She was
therefore grouped and crossmatched and
given 2 units of whole blood.
. Medical Induction of labor was
attempted a second time, using
Syntocinon 10 units in 1000 cc 5 0 0 D/W at
10 gtt/min and increasing to 60 gtt/min.
Ombu did not respond to this treatment.
April 76
. Ombu was still not in labor, but
showed no signs of distress. She was
allowed to rest for 24 hours. Intravenous
fluids were continued lor the
administration of antibiotics.
April 77
. A third attempt to induæ labor met
with no success.
April 18
. A lower uterine segment cesarean
section was done under general
anesthesia, and a live male infant was
extracted using Wrigley's forceps. There
was little evidence of intra-uterine
infection. Because there was no previous
consent obtained from her husband,
sterilization was not performed. The
wound was closed in two layers.
. Post-operatively, intravenous fluids
were continued along with antibiotic
therapy. Ombu was given Pethidine 50
mg q4-6h for incisional discomfort Her
vital signs were observed and recorded,
and proved stable.
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April 79
. Ombu s ambulation was begun to
prevent the development of postoperative
complications.
. Medications were ordered and given
as follows;
Imferon 5 ml 1M daily x 3 days
Ferrous Sulfate 300 mg p.o. twice daily
Folic Acid 5 mg p.o. daily
Vitamin C 50 mg p,o. dally
Vitamin B 1 tablet p.o. twice daily
Chloroquine 500 mg p.o. every Monday
April 27
. Intravenous Crystapen was
discontinued and Ombu was given
900,000 units of Procaine Penicillin
intramuscularly for five days. Intravenous
Chloramphenical was changed to oral
Chloramphenical 500 mg q 6h for five
days.
. When the intravenous was
discontinued, Ombu took care of her
child,
. Ombu developed a wound infection
which was cleansed daily and covered
with a dry dressing,
May 20
. Ombu and her baby went home from
Madang General Hospital. She appeared
to be in good spirits and quite
unconcerned about her unusual
experience. She seemed to accept the
birth of her stillborn child and the birth of
her son by cesarean section a week later
as something qUite normal, something
that could happen to anyone, anywhere,
at anytime.
The Infant
The infant cried within a few seconds
of delivery and was pink in color. He
weighed 1,910 gm. The following
medications were prescribed and given:
23
'"
The doctor in charge of the obstetrical
ward at this tIme was Dr, Greg 0 Con neff,
a CUSO volunteer The nurse in charge of
the obstetrical ward is Sister A. Toyola
from Samarai, Milne Bay Provmce,
Papua New Guinea
The photo on the left shows: (left to
fight) SIster Toyo/a, Ombu and her
baby, and B. MunuJu. the f"st male
nurse-midwIfe In Papua New Gumea
. Vitamin K (Konakion) 1 mg
intramuscularly. This medication is given
immediately after birth as a prophylaxis
against coagulation defects related to
Vitamin K deficiency,
. Crystalline Penicillin 125,000 units
1M BID x 7 days
. Streptomycin 50 mg 1M daily x 7 days
. Antibiotic eye ointment daily x 5 days
The baby was led with expressed
breast milk every three hours, so that he
wouldn't tlfe sucking at his mother's
breast. When he grew stronger he
breastfed each day, gradually increasing
the number of times. Tube feedlngs were
slowly decreased in number until he was
able to be breastfed all the time.
On April 23, the child became quite
jaundiced. and his total bilirubin showed
13.2 mg/1 00 ml. He was placed under the
photo-light four times a day for one to two
hours at a time. Subsequently, his total
bilirubin results were: April 26 - 16
mg/100 ml; April 29 - 14.4 mg/100 ml;
May 5 - 12.8 mg/100 ml,
The child was given a B.C.G.
vaccination. He weighed 2,200 gm when
he went home with his mother on May 20.
Dolores Hall of Erickson, Mamtoba,
graduated from St Boniface School of
Nursing in 1963. "I worked in Manitoba
and Alberta before coming to Papua New
Guinea with Lutheran Mission in
7966-7970 as a general duty nurse. In
1971/ graduated from Frontier Graduate
School of Nurse Midwifery, Kentucky,
havmg completed the required course in
Family Nurse Practitioner and Nurse
Midwifery. In 1971, I returned to Papua
New Guinea, and for two years I was in
charge of a large T. B. hospital with a
large general outpatient clinic Most of
the time we were without a resident
doctor. In 7973,IreturnedtoCanadaand
attended DalhousIe University, from
which I graduated in May, 1975 with a
Bachelor of Nursmg degree. In February,
7976, I returned to Papua New Guinea to
join the faculty of the Lutheran School of
Nursing in Madang. At present I am the
instructor, both classroom and clinical for
Obstetn'cs. ..
24
The Canadian Nursa December 1976
I
TOWARDS
INDEPENDENCE
FOR PARAPLEGICS
Ane Marie Hansen
Remarkable gains in the quality of life of
paraplegics result from achieving successful
rehabilitation, from living at home and from a
productive occupation. Meeting these
challenges is well worth the time and effort of
everyone involved.
Good rehab;Hlation ;5 a complex and
difficult process that requ ires constant
evalu ation. It can make the difference betweer
the successful or unsuccessful return of the
paraplegic to a full and active life. The goal of
rehabilitation is to restore in the paraplegic é
sense of confidence in his own abilities so that
he can achieve a level of self care and
independence. Withdrawal, denial and anger
can be an expression of fear of facing reality. I
To overcome this fear and to come to accept
the reality of his disability and his physical
limitations, the paraplegic needs support from
the health team and from his family. His
capabilities must be emphasized, encouraged
and developed if he is to gain a maxi mum level
of personal independence. These goals can
be achieved with help from a team of many
skilled people - physicians, nurses,
physiotherapists, occupational therapists,
social workers and vocational counselors-
who should be flexible and focus on the
individual by assessing and responding to his
needs.
Rehabilitation starts the minute the
patient sustains an injury. In spinal cord injury
patients who are usually immobilized for a
period of time, initial rehabilitation is based on
the prevention of complications such as
decubitus ulcers, urinary tract infections,
bowel impaction, thrombophlebitis, muscle
contractu res and mental depression. At this
early stage, the physical management of the
patient is primarily the responsibility of the
nurse and therapists. Once the patient
becomes increasingly mobile, the role of the
nurse takes on new dimensions. The
caretaker role decreases and she now
assumes the role of teacher, counselor and
facilitator.
One of the most challenging
responsibilities for the nurse lies in her ability
to teach the patient self-care, which includes
the prevention of complications. He needs to
know the signs and symptoms of impending
problems, to be alert for them, and to take
Ine Lainaa.." Nurse uecemoer 1V/b
25
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Once the spinal cord injured patient is
allowed up in the chair, he IS elevated
gradually usually wearing a brace
such as this Jewltt Hypertension
brace. Tensor bandages or
anti-emboli stockings and an
abdominal binder are also used to
alleviate the problems of orthostatic
hypotension.
Historical Perspective
The earliest recorded reference to injury
of the spinal cord resulting in paraplegia
can be found in the Edwin Smith Papyrus
in the possession of the New York
Historica: Society.
Written some 3,000 years ago, the
author suggested that no treatment
should be undertaken.'
This approach towards paraplegia,
and subsequent gloomy prognosis,
continued throughout the centuries, up to
the second world war. Mortality rate was
high. Statistics for World War One show,
that over 80 0 0 of the paraplegics died
withi'l the first few months following
injury.2
The need for better treatment
methods was recognized by a
neurosurgeon, Sir Ludwig Guttman. In
1944, the National Spinal Injuries Centre
was opened in Stoke Mandeville Hospital,
England, under his leadership. 3
Similar centers are now found all over the
world. With the advanced understanding
and treatment of paraplegia and the
introduction of antibiotics, the mortality
rate over a period of more than 20 years
has been reduced to just under 18 0 '0. 4
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basic measures to prevent their progression. If
the patient can achieve preventive self-care,
then the rehabilitation process can be
considered a success.
In teaching fundamental care to the
patient, the nurse muSI consider the many
factors which will influence his behavior and
learning. Such factors include: the level of
disability, the patient's potentials, motivation,
intelligence. cultural background, social
status, emotional status, changed body
image, response of family and friends to his
disability and perhaps most important, his own
perception of how his disability is going to
govern his future. The nurse should teach with
a realistic approach. Successful rehabilitation
will not be achieved by denying the existence
of a disability or by minimizing the hard work
needed to achieve a level of independence.
One of the best ways for the patient to learn is
to have him actively participate with the team
in his plan of care. Involvement and
accomplishment are the key factors in
stimulating and maintaining the patient's
interest and in motivating him to achieve self
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management. A program emphasizing self
care is now in operation in the Rehabilitation
Unit, St. Michael's Hospital, Toronto. Nursing
care and teaching cover a number of areas.
Aspects of Self-Care
One of the most important aspects of
rehabilitating the paraplegic patient lies in
teaching bowel and bladder management.
The loss of voluntary control of these functions
often produces in the patient a feeling of
shame, which later may present itself in the
form of anger, frustration and hostility. The
nurse should listen with sensitivity to spoken
and unspoken cues and should encourage
him to accept what he cannot alter. At the
same time she can stress that with
persistence, interest and careful
management. he will be virtually "accident
free. .. Achieving control not only is important to
his self-esteem, but is crucial to his future
vocational re-establishment. as well as to his
social integration and participation in various
activities.
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26
The Canadian Nurse December 1976
Bowel
A history of his previous bowel habits is
taken, and a regime of emptying the bowel
every forty-eight hours is commenced.
Anticipating that the patient will get back to
work or school, the most convenient time to
establish a routine is immediately after supper.
This also leaves the evening free for social or
recreational activities. Explanations are given
to the patient about the physiolgical functions
of the bowel and about how paralysis has
affected the voluntary control of this
mechanism. Initially, the routine consists of
having the patient take either 30 cc of Aromatic
Cascara, 3 Cascara Sagrada 300 mg pills or
15 cc Cascara and 15 cc of Milk of Magnesia
every other morning after breakfast. This is
followed by a Dulcolax suppository in the
evening, usually inserted just before supper to
take advantage of the gastrocolic reflex. Once
the patient is allowed up, he is taken to the
bathroom on a commode chair. As his balance
and transfers improve, he can transfer directly
to the toilet for evacuation. Digital stimulation
is essential especially at the beginning of the
regime. Reasons are explained to the patient,
since it is often difficult for him to accept this. It
is important that he check the color, amount
and consistency of the stool since he may
have to alter his laxatives accordingly, may
need a second suppository or perhaps a stool
softener. With proper and consistent
management, enemas are usually not
necessary, and are given only as ordered by
the doctor. As a regular routine is established,
the laxative is gradually decreased, and a
natural laxative such as prune juice may be
substituted; a glycerine suppository is used
instead ofthe Dulcolax suppository and finally,
a well-lubricated gloved finger for digital
stimulation may be sufficient for bowel
evacuation,
-
.,....
-4
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._
Dietary instruction is also important to
inform the patient of the various foods that act
as a laxative, provide bulk Or cause
constipation. A well-balanced diet with
sufficient bulk is advised. The patient soon
gets to know what he can or cannot tolerate.
He is made alert to the possible development
of hemorrhoids due to continuous
constipation, and to the symptoms of
impaction - i.e. frequent passage of liquid
stool, not to be confused with diarrhea. He is
told to watch for symptoms such as abdominal
distension, slight difficulties in respirations
(increasing intra-abdominal pressure
interferes with the expansion of the
diaphragm), increasing spasticity, headache
and general malaise.
Bladder
Management of the neurogenic bladder
varies from center to center. I shall attempt
here only to discuss the management as it is
carried out in the Rehabilitation Unit of St.
Michael's Hospital.
Insertion of an indwelling catheter, Foley
or Gibbons, is initiated upon the patient's'
admission to hospital. Since an indwelling
catheter is a constant contributing factor to
urinary tract infection, the sooner it can be
removed and the patient placed on intermittent
catheterization, the lesser the chances of
infection. A large intake of fluid (3,000 cc in 24
hours) reduces the chances of infection, as
well as decreasing the incidence of renal and
bladder calculi. Cranberry ju ice can be given to
help acidify urine, (therefore decreasing the
odor), but usually Ascorbic Acid 500 mg qid is
given for this purpose, Urinary antiseptics are
given only if indicated. With decreased muscle
activity and decalcification taking place, the
intake of milk is restricted for use in tea and
coffee only. This helps prevent formation of
To make an economical
"Texas type" condom for a
urinary drainage system:
1) cut a 2-inch piece of rubber
tubing and a 1/4 inch piece of
enema tubing.
2) place condom over the rubber
tubing with condom rolled inside.
Ir.sert enema tubing inside the rubber
tubing forcing the condom down until
the edges are even.
renal calculi and deposits of calcium in
muscles, jOints or soft tissue. Adherence
to a strict "controlled intake" routine is well
established before an intermittent
catheterization program is started.
All patients with a neurogenic bladder are
placed on intermittent catheterization as soon
as possible. An Intravenous Pyelogram (IVP)
is done to evaluate kidney function and to
ensure that no reflux is present. A
cystometrogram is not routinely done. When
an estimated bladder volume of approximately
500 cc has been reached, the patient initiates
voiding. Specific times for voiding vary greatly
with each individual and an appropriate regime
is reached only by trial and error. Usually,
patients try to empty the bladder before or after
each meal and at bedtime. Certain patients
who have a low output during the day, may
have diuresis during late evening and night,
and subsequently will have to be catheterized
at 2 a.m. or 6 a.m. as indicated.
Controlled Intake
Time
0800
1000
1200
1500
1700
Day intake
Amount
600 cc - Breakfast
400 cc - Midmorning
600 cc - Lunch
400 cc - Midafternoor
600 cc - Supper
2600 cc
1800 - 2400
0600
Night intake
200 cc
200 cc
400 cc
24 hour total intake
3000 cc
/
3j make a cut in the condo"'? large
enougn for urinary flew
The Can-.llan Nurse December 1976
27
Due to the disruption of the normal
physiological function of the bladder, the
voiding reflex center in the spinal cord is
explained in detail to the patient. It is important
that he is aware of the goal of the bladder
regime since his cooperation is essential to its
success. The dangers of overdistending the
bladder by exceeding his intake during the
evening or night (without the knowledge of the
nursing staff) is stressed. He is expected to
keep a close eye on signs of bladder fullness. If
his lesion is at or above T6, he may suffer from
autonomic dysreflexia, which presents itself in
the form ofthrobbing headache, dilated pupils.
perspiration above the level of the lesion, high
blood pressure, low pulse. stuffy nose and
increased spasm. Convulsions and
intracranial hemorrhage may occur if action is
not taken to empty the bladder.
Ways to initiate the voiding reflex vary
from patient to patient. Tapping of the lower
abdomen just above the symphysis pubis.
stroking the inside of the thighs or genitalia
may trigger this response. In lower motor
neuron lesions, Credé method* may be used;
or creating intra-abdominal pressure by
pushing as if to have a bowel movement may
be the only way to stimulate the voiding reflex.
Most effective of all is rectal stimulation, as the
pudendal nerve innervates both the external
urinary and rectal sphincter. However, this
method is rarely used. as it tends to interfere
with the bowel routine.
After approximately fifteen minutes of
stimulation and after the patient has voided, if
possible, a sterile catheter is inserted under
strict aseptic technique to obtain the residual
urine. The bladder is then irrigated with 1/4%
* Pressure applied above symphysis pubis to empty
bladder.
r
..
4) attach condom to a straight plastic
connector, then to rubber tubing, then
to a leg bag.
Acetic Acid until returns are clear. The bladder
volume is calculated by adding the amount
voided with stimulation, plus residual urine. A
note is also made of how much, if any, urine
was collected in the leg bag since the last
catheterization. This regime is continued until
the residual urine is well under 100 cc which
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may take many weeks. In fact, it may never be
successful without surgical intervention.
If no response is seen after several
weeks, a radiological examination by Dynamic
Voiding Cystourethrogram is performed to
determine the level and cause of dysfunction.
It may be due to spasm of the external
sphincter, urethral strictures, bladder calculi or
reflux. A cystoscopy is generally performed to
rule out prostatic enlargement, lithiasis, and if
present, these are surgically treated.
To improve the reflex contractions of the
detrusor muscle, a course of Urecholine 15 to
30 mg may be given 45 minutes prior to
voiding. In other cases, Probanthine may be
used in an attempt to reduce excessive
bladder contractions. After many weeks,
sometimes months. on intermittent
catheterization, the patient may need an
external sphincterotomy in order to weaken
the sphincter muscle to facilitate voiding. After
a period of ten days to two weeks following the
sphincterotomy, the indwelling catheter is
removed and intermittent catheterization is
started again, until the residual urine is
substantially under 100 cc. The
sphincterotomy may have to be repeated and
partial resection of the bladder neck may be
necessary. Condom drainage is needed for
most patients.
Once a reflex micturition with low residual
urine has been established, the strict
controlled intake is relaxed, but the patient is
instructed to continue with a minimum intake of
3,000 cc per 24 hours and to empty his blarlder
four or five times a day as indicated and
according to intake.
Self-catheterization
To carry out such a bladder program for
many patients at the same time is very time
consuming for the nursing staff. Partly for this
reason, but moreso to adhere to the total self-
care concept of this unit, we have recently
begun to teach patients how to perform their
,
own intermittent catheterizations and have
found it to be most successfu I. Not only did the
patients show an enthusiastic response to this,
but it has enabled the nursing staff to start
patients much sooner on such a program.
Needless to say, not all paraplegic patients are
candidates for self-catheterization. Careful
selection of patients, instruction and close
supervision of their technique is required.
Occasional "spot checks" are needed to
ensure that they are maintaining good sterile
technique. No increase in urinary tract
infection has been noticed in patients
performing self-catheterizations in our
rehabilitation unit.
Self-medication
The total self-care concept is also
extended to include medication, except for
PRN medicines. The patient IS issued a weekly
supply of medication; he is taught tt">e actions
and side effects of the drugs and is instructed
when to take them. He is responsible for
keeping a record of his medication on a special
sheet. A weekly assessment by the nurse is
done with reissuing of medication to see how
he is managing.
Skin Care
One of the most dangerous problems of
paraplegia lies in the lack of sensation below
the level of the lesion. Since uncomfortable
stimuli are not felt, the automatic response to
move, or investigate the cause of the
discomfort is not present. Consequently, the
paraplegic must be on the lookout for
complications, especially decubitus ulcers.
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The Canadian Nurse Deçember 1976
He is informed that prolonged pressure
diminishes the blood supply, and thus the
nutrition to the underlying cells. This, in turn,
may lead to necrosis and ulceration. The areas
he should observe are those over the sacrum,
coccyx, trochanters, ischial tuberosities, and
the heels and knees. If a pressure sore does
occur, great care should be taken to pre\/ent
infection, a development which could lead to
osteomyelitis and gram-negative septicemia,
, .
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,
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Pressure sores are completely
preventable. When the patient is in bed, it is
absolutely esc:ential that he is turned and
properly posllioned every 2-3 hours. If the
patient sleeps on his abdomen, however, he
can stay four hours or more in one position.
When up in the wheelchair, he must lift himself
up or shift position to relieve the pressure a few
times each hour. It must become a new and
relearned habit, since it is the only means by
which pressure sores are prevented. He is
taugrt to inspect his skin every night for
redness, blisters or bruises or to look for a
rash, A hand mirror is used for the inspection of
the sacrum and buttocks. "The rear view
mirror check." He is instructed to massage the
skin well with cocoa butter or lotion. Alcohol
should be avoided as it tends to only dry the
skin. He should be careful not to drop or
scratch his legs during transfers, not to burn
himself on the water pipe at a sink, to watch
that hot water is not dripping on his feet while
relaxing in a bath. The list goes on and on...
Thrombophlebitis
Another potentially dangerous problem
the patient should recognize is the possibility
ofthe development of thrombophlebitis, which
could easily go undetected because of his lack
of sensation. He must check for unusual
swelling especially in the loose connective
tissue of the popliteal space, ankle Or
suprapubic area as well as checking for
unusual warmth or redness of an area.
Contractures
The prevention of foot drop and hip and
knee flexion contractu res is initially the
responsibility of the nurse. Proper positioning
and body alignment as well as range of motion
of all joints is carried out until the patient is able
to do this for himself.
'"
Spasm
A condition most paraplegics experience
is that of involuntary muscle spasms. If the
patient can learn to utilize the spasms to his
advantage, ego to help support the trunk,
during turning or transfer or even if the patient
is able to walk with long leg braces, spasms
can be of positive value. Unfortunately, muscle
spasms usually present a great problem to the
patient since they can be severe and
occasionally painful. They can throw him off
balance in the wheelchair, complicate
dressing, and present other problems, since
they are apt to occur at any time, any place,
with occasional embarrassment to the patient.
Muscle spasms, however, can also act as
warning signals of impending problems if there
is suddenly a change in their frequency and
severity. They alert the patient to be watchful
for signs of bowel impaction, urinary tract
infection, epididymitis, renal and bladder
stones, appendicitis, thrombophlebitis or other
complications.
Until now, anti-spasmodic drug theråpy
has proven to be of relatively little value in the
control of muscle spasms. In severe cases it
may be necessary to inject alcohol into the
spinal canal. Other surgical means such as
longitudinal lateral myelotomy, interrupting the
reflex arc, or anterior spinal root rhizotomy are
only done as a last resort. 5
Pain
In spite of the fact that the paraplegic
patient has lost sensation below the level of
the lesion, frequent occurrence of pain in the
anesthetized area of the body is experienced
by many patients, The pain is often aggravated
by such conditions as bladder infection, or the
presence of calculi, pressure sores,
constipation, other underlying physiological
causes, or by depression. Most patients,
however, are able to endure the pain; others
may require a mild analgesic, and only in
very severe cases where the pain interferes
greatly with the patient's rehabilitation and
vocatiooal re-establishment is surgical
intervention required. 6 Relief of chronic pain
has occasionally been successful through the
use of dorsal column stimulators.7
One of the best ways to alleviate the pain
is to have the patient engage actively in his
rehabilitation program. In understanding and
meeting both his physical and emotional
needs, most patients learn to accept and live
with their pain.
Sex-related Problems
One major concern of the paraplegic
patient is to what extent his injury wi II affect his
sexual function. For male paraplegics,
physical sexual potential is related specifically
to the level and extent of the lesion. Most men
with an upper motor neuron lesion experience
reflex erections, but these may be of too short
a duration to allow for coitus. In patients with
complete lower motor neuron lesions, 75% are
unable to obtain an erection, 25% may
experience psychogenic erections produced
by mental and physical stimuli, but few are
able to complete intercourse. For incomplete
lesions, the percentage of successful coitus
increases.
Female paraplegics have the potential to
resume sexual activity and to become
pregnant, although the ability to experience
orgasm is usually lost. 8
The loss of sexual prowess may be a
great blow to the male's ego. In the past, much
emphasis has been placed on "performance"
rather than on the psychological factors
involved in satisfying a mate in sexual
relations. Counseling that emphasizes these
psychological factors and openly discusses
alternative ways of achieving sexual
satisfaction for both partners will be valuable in
helping them adapt to the changes. By
stressing the worth of the person as an
individual and by helping them to understand
their problems and limitations, sexual
adjustment is possible.
Vocational Re-establishment
Helping the patient to recover his earning
power is an important aspect of his return to
the community and meets a strong
psychological as well as practical need. Work
gives a person the opportunity to find his own
identity and gives him the feeling of being
useful. With an increasing number of
accidents each year, more people become
paraplegics. With increased life expectancy, it
is of utmost importance financially, as well as
for their own sense of accomplishment, that
paraplegics eventually be gainfully employed.
Plans for future vocational
re-establishment are discussed with the
physiatrist and social worker. The social
worker, establishes contact and registers the
patient with Vocational Rehabilitation
Services. A psychological assessment of
intellectual functioning, aptitude and interest is
usually required. A vocational counselor will
then assess the patient's motivation and
potential capacity for future vocational
achievements, and will follow the patient after
discharge from hospital. Necessary home
alterations, ie. widening of doorways, building
of ramps, installation of hand controls in the
car, arrangements for transportation to school
or university, on-the-job training, are all part of
their services.
Patients are encour
ed to jOin the
Canadian Paraplegic Association, which
provides valuable information and assistance
to them and their families.
Sports and Recreation
The independence learned through
rehabilitation and the use of new, more easily
maneuvered equipment such as collapsible
lightweight wheelchairs and hand-controlled
cars, has liberated the paraplegic from the
The Canadian Nurse December 1976
31
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dependency role. He can extend his
vocational, social and recreational activities
into fields previously considered out of
bounds. Sports and recreation play an
important role in the social integration of the
disabled back into the community bringing to
the person a sense of belonging and
self-fulfilment. With prior planning, paraplegics
can now travel extensively and can participate
in sports activities such as basketball, weight
lifting, bowling, archery, rifleshooting, fishing
and hunting, boating and swimming, dart and
ping-pong contests and others.
Summary
Good rehabilitation emphasizes the
abilities rather than the disabilities of the
paraplegic and promotes the greatest level of
self-care and independence possible,
However, even with a level of independenre,
there still exist societal barriers that prevent
the disabled from assuming a greater
involvement in the community.
Educating the government and the public,
about the need for more aiïd bett6 3;Jit&.bls
housing, more vocational opportt. "
;3 ::;''''er
physical barriers such as high curbs. ;::"zirs ar,j
narrow doorways that prevent access'c pub,
and commercial buildings and trying to
encourage positive attitudes toward the
disabled will help bring the paraplegic out of
isolation and allow him to develop a full,
active life. ..
a
-............
Ane Marie Hansen (S,R.N" New End Hospital.
England) is head nurse of the Rehabilitation Unit, St.
Michael's Hospital, Toronto. She prepared this
article whIle taking a course In "Advanced
Rehabilitation" given by George Brown College,
Toronto. She states "I would like to acknowledge
my gratitude to Mrs. Hazel White for the directions in
writing this article and to Dr. J. M. Houston for many
years of guidance in working with spinal injured
patients".
References
1 Walsh, J J. Undf'rst - ng paraplegia. New
York, Lippincott, 1964. p. 1.
2 Ibid.
. 3 Ibid.
4 Geisler, W.O. Early management of the
patient with trauma to the spinal cord, by... et al.
Med. Servo J. Can. 22:512-513, Jul./Aug. 1966. p.
514.
5 Geisler, W.O. Management ofthe spinal injury
patient, b} ." and A.T. Josse. Mod. Med. Can.
23:12:24, L)ec. 1968.
6 Botterell, E.H. Pain in paraplegia - clinical
management and surgIcal treatment, by... et al
Proc. R. Soc.
"'!Jd. 47:284, Apr. 1954.
:j-\o;
. :: Mid C. Handbook of spinal cord
mea;c -", vy and Duncan Murray. New York,
Raven 1975 p. 54.
8 Cornarr, A. Estin Sexual function in traumatic
paraplegia and quadriplegia, by... and Bernice B.
Gunderson. Amer. J.Nurs. 75:2:250-251, Feb.
1975.
Clinical Wordsearch
Answers
Puzzle # 3 (appears on page 42)
1 Asthma 24
2 Pneumothorax 25
3 Pulmonary FunctIon 26
4 Respirations 27
5 Blood Gas 28
6 Tidal 29
7 Lung 30
8 Alveoli 31
9 Medulla 32
10 Bronchogenic 33
11 Tumor 34
12 Neoplasm 35
13 Clubbing 36
14 Cheyne-Stokes 37
15 Oxygen 38
16 Breathing 39
17 Embolus 40
18 Ribs 41
19 Cystic FibrosIS 42
20 Bronchus 43
21 Tracheitis 44
22 C.OLD. 45
23 C.HF 46
Rales
Crepitus
Pleurisy
Pleural Rub
Cough
Smoke
Cancer
Apnea
Sputum
Dyspnea
Atelectasis
Influenza
Postural Draln- Je
Humidifier
HaemoptYSls
Mucus
Oral
Nasal
Nares
Air
Pain
Prn
Q.S.
Hidden Answer: No smoking: lungs at work
THE UNIFORM SHOP
TWO STORES
TO SERVE
ALL YOUR
UNIFORM NEEDS
BRAMPTON
160 MAIN ST. S.
BRAMPTON MALL
PETERBOROUGH
441 1 12 GEORGE ST. N.
32
The Cenadlan Nurse December 1976
The pandemic
il1fluenza of
Gladys Morton
I
,
.
An elusive virus is claiming appreciable newspaper space these days, sti
ring up a good deal of controversy.
The well-publicized threat of 'Swine Flu' has launched plans for mass immunization agamst the virus and
brought sceptical sneerS from those who term it a 'phantom' epidemic. But the death of the young man in Fort
Dix, New Jersey, early this year was attributed to Swine Flu, reputedly a descendant of Spanish Influenza, a flu
virus with the distinction of causing the greatest epidemic of flu in modern history. The following is a reprint of an
article about that epidemic printed in The Canadian Nurse in December, 1973.
On November 11, 1918, the First World
War came to an end. While millions
danced in the streets, millions more were
dying of Spanish influenza. It was to be
the most destructive pandemic ever
known on this planet. The London Times
of that day reported: "Never since the
Black Death has such a plague swept
over the face of the world. Never perhaps
has such a plague been so stoically
accepted. "
Sir McFarlane Burne
, an Australian
virologist who is possibly the most
eminent authority alive, estimates that
between 25 and 50 million died of Spanish
influenza, most in the brief period
between the beginning of October and the
end of December 1918. 1 Beside it the
Black Death pales, with 25 million dead
over a period of two years, 1348-50.
The Encyclopedia Britannica
reports: "In the autumn of 1918 much of
the northern hemisphere was blanketed
in influenza in approximately one month."
In fact, few places on the globe escaped;
St. Helena and New Guinea were among
them. 2
Symptoms
The incubation period and onset of
the disease were so short that apparently
healthy people were suddenly overcome,
and within an hour could become helpless
with fever, delirium, and chills. Severe
headache, pains of varying intensity in
muscles and joints, acute coryza,
inflammation of the upper respiratory
tract, accompanied by temperatures of
101 0 to 105 0 , were common but not
unusual for influenza. 3 What was unique,
however, was the often fatal viral
pneumonia that quickly followed even
slight exertion. It could occur at any time
during the illness - a patient could be
convalescing one day and dead the next.
Dunng an Inte:view with Dr. Charles
Mitchell, honorary professor, Department
of Microbiology and Immunology,
University of Ottawa, I asked about this
phenomenon: "Was there an explanation
for the pneumonia? Did the virus behave
differently than in other pandemics?"
"Yes," he said, "in the majority of
specimens of Spanish influenza that I
examined, the virus had attacked the
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parenchyma of the lung. Normally, Type
A Influenza virus infects the mucous
surface of the lung, but in 1918 it entered
the organ itself. This was undoubtedly the
cause of the swift, often fatal, pneumonia
that frequently followed exertion."
He continued," I was a young
pathologist stationed at Lethbridge.
Alberta, when flu broke out, and was soon
up to my elbows in influenza specimens
One day the porter brought me a kidney
and a piece of lung. I asked him if the
patient had died recently."
"Yes," he said, "just this morning.'
"Do you know his name?" He did.
"My God," I said "that's my insurance
agent. I called him two days ago and I
have an appointment with him tomorrow.'
The man had been sick less than a day.
Wiser than most to the tragedy of
exertion, Dr. Mitchell and his wife took
precautions against coming down with flu
by stocking the shelves with fluids,
placing their beds in front of the fire, and
arranging that the caretaker look in on
them should the inevitable day arrive,
which it did. And throughout their illness,
-
The Canadian Nurse December 1916
33
Influenza Bulletin
The following are recommendations from
an I nfluenza Bulletin which was published
in The Canadian Nurse in January of
1919. The bulletin appeared as a result of
a meeting of the Public Health
Association in Chicago. Illinois,
December 9-12, 1918. In its entirety, the
bulletin dealt with the etiology of
influenza, suggestions for organized
prevention measures and public
education, the use of volunteer help,
social and relief measures, provision for
fatalities, and interestingly - the pros and
cons of preventive vaccines The few
recommendations presented here are
concerned with prevention of the disease,
and indicate some practical concerns
posed by the epidemic.
"The preventive measures
recommended by the committee are as
follows:
A. Efficient organization to meet the
emergency, providing for a centralized
coordination and control of all resources.
B. Machinery for ascertaining all facts
regarding the epidemic:
1. Compulsory reporting.
2. A lay Or professional canvass for cases,
etc.
C. Widespread publicity and education
with respect to respiratory hygiene,
covering such facts as the dangers from
coughing, sneezing, spitting; and the
careless disposal of nasal discharges; the
advisability of keeping the fingers and
foreign bodies out of the mouth and nose:
the necessity of hand washing before
eating, the dangers from exchanging
handkerchiefs: and the advantages of
fresh air and general hygiene. Warnings
should be given regarding the danger of
the common cold, and possibly colds
should be made reportable so as to permit
the sending of follow-up literature to
persons suffering from them....
D, Administrative procedures:
1, There should be laws against the use of
common cups, and improperly washed
glasses at soda fountains and other public
drinking places. which laws should be
enforced.
2. There should be proper ventilation
laws, which laws should be enforced.
3. Closing - Since the spread of
influenza is recognized as due to the
transmission of mouth and nasal
discharges from persons infected with
influenza .... gatherings of all kinds must
be looked upon as potential agencies for
the transmission of the diseases....
Non-essential gatherings should be
prohibited. Necessary gatherings should
be held under such conditions as will
insure the greatest possible amount of
floor space to each individual present,
and a maximum of fresh air, and
precautions should be taken to prevent
unguarded sneezing, coughing, cheering
etc.
Where the necessary activities of the
population such as the performance of
daily work and of earning a living, compel
considerable crowding and contact, little
is gained by closing certain types of
meeting places. If .... the community can
function without much contact between
individual members thereof, relatively
much is gained by closing or preventing
assemblages.
Schools - As to the closing of schools,
there are many questions to be
considered:
. Theoretically, schools increase the
number and degree of contacts between
children. If the schools are closed, many
of the contacts which the children make
are likely to be out of doors. Whether or
not closing will increase or decrease
contacts must be determined locally.
Obviously, rural and and urban conditions
differ radically in this regard.
. Are the children, in cOming to and
gOlOg from school, exposed to inclement
weather or long rides in overcrowded
cars?
. Is there an adequate nursing and
inspection system in the schools?
. Is it likely that teachers, physicians,
and nurses can really identify and
segregate the infected school child before
he has an opportunity to make a number
of contacts in halls. yards. rooms, etc.?
We suggest that children suspected of
having influenza, and held in school
buildings for inspection, should be
provided with and required to wear face
masks.
. Will the closing of schools release
personnel or facilities to aid in fighting the
epidemic?
. If schools are kept open, will the
absence of many teachers lower the
educational standards?
. If a number of pupils stay at home
because of illness or fear, will they not
constitute a heavy cfrãg upon their classes
when they return?
. If schools are closed, is there likely to
be an outbreak in any case when they are
reopened?
Churches - If churches are to remain
open. services should be reduced to the
lowest number consistent with the
adequate discharge of necessary
religious offices, and such services as are
held should be conducted in such a way
as to reduce to a minimum intimacy and
frequency of personal contact.
Theatres - As regards theatres, movies,
and meetings for amusement In general, It
seems unwise to rely solely or in great
part upon the ejection of careless
coughers. In the first place, It is difficult to
determine who IS a careless cougher, and
after each cough. danger has already
resulted. Discrimination as to closmg
among theatres, mOVies etc. on the basis
of efficiency of ventilation and general
sanitation, may be feasible.
Saloons, etc. - The closmg of saloons
and other drinking places should be
decided upon the basis of the probability
of spread of the disease through drinking
utensils and the conditions of crowding.
Dance Halls, etc. - The closing of dance
halls, bowling rooms, billiard parlours and
slot-machine parlours, etc. should be
made effective in all cases where their
operation causes considerable personal
contact and crowding.
Street Cars, etc. - Ventilation and
cleanllOess should be insisted upon in all
transportation facilities. Overcrowding
should be discouraged. A staggering of
opening and closing hours in stores and
factones to prevent overcrowding of
transportation facilities may be cautiously
experimented with. In small communities,
where it is feasible for persons to walk to
their work, it is better to discontinue the
service of local transportation facilities.
Funerals - Public funerals and
accessory funeral functions should be
prohibited, being unnecessary
assemblies in limited quarters, increasing
contacts and possible sources of
infection.
4. Masks - The wearing of proper masks
in a proper manner should be made
compulsory in hospitals and for all who
are directly exposed to infection. It should
be made compulsory for barbers,
dentists, etc. . Persons who desire to
wear masks in their own interests, should
be Instructed as to how to make and wear
proper masks...
5. Isolation - The isolation of patients
suffering from influenza should be
practiced. In cases of unreasonable
carelessness, it should be legally
enforced most rigidly.
6. Placarding -In cases of unreasonable
carelessness and disregard of the public
interests, placarding should be enforced
7. Coughing and sneezing - Laws
regarding coughing and sneezing seem
to be desirable for educational and
practical results.
8...
34
The Cenadllln Nurse December 1976
<JIS...
neither budged from the bed until their
temperatures were again normal.
Not so wise was my own uncle,
Russell Main of Pincher Creek, Alberta.
While convalescing from flu in hospital, he
hopped out of bed to assist a nurse with a
delirious patient and died 48 hours later of
pneumonia. His two brothers arnved
home from overseas to face, not the warm
welcome they expected but the shock of a
sudden tragedy.
Age of incidence
Although influenza has occurred in
epidemics since recorded time, easily
diagnosed by its symptoms, it has
traditionally been considered a
minor,even humorous ailment. In the
seventeenth century it was known as "the
jolly rant," "the new delight," and "the
gentle correction. "4 But, for the very
young and the very old who have always
provided the mortality statistics, it was a
wry form of humor. In the 1918 pandemic,
a cunous reversal occurred and the "joke"
was on the healthy young adults, those
between the ages of 20 and 40, who
provided 60 percent of the deaths. 5 This
phenomenon was unique to Spanish
Influenza and has never been explained.
Where it began
No one knows where the disease
started. In his book I Remember Him,
Hans Zissner suggests that it began over
the course of several years from a large
number of points of origln. 6 Or, it may
have started in an overcrowded army
camp In Kansas, March 11, 1918. On that
day, 107 patients were admitted to
hospital suffering from a sudden acute
form of flu that quickly enveloped the
26,000 personnel. many of whom were
destined for the war of France?
But, for those over 60 who
remembered the event, the harbingers of
Spanish influenza were the cold,
exhausted troops in the filthy trenches of
France.
Whatever its origin, the pandemic did
not begin In Spain. However, since the
King of Spain was one of the early victims,
his country, by implication, was saddled
with the responsibility and the name. 8
Canada
With a population of eight million,
Canada lost 30,000, including 108
doctors from Ontario and the prairie
provinces alone. Deaths in Ontario had
reached 5,000 by November. 9
The musty pages of The Ottawa
Journal of October 1918 report; "Street
cars rattle down Bank Street with
windows wide open and plenty of room
inside. Stores open at 10 a.m. and close
at 4 p.m. Civil servants are let off at 3 p.m.
for last-minute shopping. Schools,
vaudeville theatres, movie palaces are
dark: pool halls and bowling alleys,
deserted.'
One eager group confronted the
mayor with a request that liquor
prohibition be eased for those who
needed a little "nip" to calm the nerves
But the only strong thing In Ottawa was
the formaldehyde used to disinfect the
street cars. A black-edged notice from the
Bell Telephone Company urged its
customers to make emergency calls only,
since most of their staff were sick. A front
page plea for nurses and women to make
pneumonia jackets and masks fought for
attention with the exuberant news of the
last days of the war.
United States
Influenza was first reported in
America August 28, at a naval hospital in
Chelsea, Massachusetts.'o It spread
rapidly over the entire United States
attacking possibly 20 million" and killing
548,000. Life insurance claims from
October 1 to December 24 were $52
million.
Although virulence was constant
across the nation, it vaned widely in local
areas, with adjacent communities
reporting enormous differences In death
rates. Curiously, a change in the weather
at the time of onset affected mortality in
eastern American cities. When the
temperature and humidity rose. the death
rate rose. and when they fell the death
rate also fell: no change in weather
caused no change in mortality.'2
Philadelphia had the highest mortality In
the east. with 650 dying in a single day,
and an overall rate of 21 0 per 1 00,000, as
compared to Milwaukee, with 21 per
100,000. 13
Schools, churches, and theaters
were closed. There was public concern
about isolation techniques in hotels where
sick and dead were removed from rooms
that were then cleaned with general mops
and dusters.
Teachers became nUl3es, and
doctors were run off their feet and Into
their graves. In parts of Wisconsin, every
doctor was sick. Police and social workers
found entire families helpless, children
neglected, and the dead unattended. In
some cases, whole families were found
dead. For want of care, healthy children
were taken to hospital with their sick and
dYing parents. A New York City doctor
made 50 calls in one city block in a day
and had to refuse more.
The only protection advised, or
indeed known, by the medical authontles
- isolation and face masks (improvised
by stretching three layers of butter muslin
over a tea strainer) - was, according to
one doctor, as much use as a diver's suit
and handcuffs. 14
My search for material in the medical
journals of the day was hampered by the
absence of volumes for 1918 and 1919.
However, the American Journal of Public
Health IS extant and helped fill the gap
with such reports as this:
"The epidemic is known to have caused
so many fatalities within a few days, that it
is safe to say that morbidity preceded
mortality by a few days at most. "IS
And then this surprising observation:
"The cause of the lower incidence of flu
among colored people dunng the
epidemic may have been due to the
prevalence of tuberculosis among
negroes. There seems to be some
unexplained resistanæ to flu among
tubercular patients. "16
As for those unfortunate enough to
be pregnant during those few months, the
American Journal of Medical Sciences
reports: In a study of 1350 cases of
pregnant patients with influenza, almost
half developed pneumonia and of these
50 percent dled. 17
The American Journal of Public
Health also reported that mortality aboard
troop ships was twice that on land.
Possible reasons for this were: the food
was poor; the men ate little and then
washed their mess kits in a communal tub
of tepid water, using their hands to wipe
off the food, they slept badly on unfamiliar
hammocks in brightly lit holds: and, for
their two compulsory showers during the
crossing, the men were lined up naked on
deck to await a sloshing of icy sea water.
Needless to say, when this report was
made public, future troops fared
considerably better. 18
For those who were sick at
disembarkation. mortality was in direct
ratio to the distance from the nearest
hospital. 19
Europe
The disease spread just as quickly in
Europe, with a death rate to match. Every
member of the tiny Swiss army had to take
to his bed. American doctors in France
treated 70,000 of their own troops, with 32
percent mortality. England suffered
150,000 dead in November and
The Canadian Nurse December 1976
35
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36
Tha Canaollln Hurse
December 1976
çtIS...
December. Half the population of
Manchester became sick with 7.9 percent
mortal ity. 20
I was fortunate to find an eyewitness
with firsthand experience. Margaret St.
Louis. an articulate senior citizen of
Ottawa, was, In 1918, an 18-year-old
volunteer army nurse stationed at
Reading, England. Even today, she
remembers with sadness the events of
those months, although her future
husband was one of her patients.
"It happened so suddenly. In the
mcrning we received an order to open up
a new unltforflu and by night we'd moved
Into a converted convent. Almost before
the desks were out the stretchers were in
- 60 to 80 to a classroom. We could
hardly squeeze between the cots. And oh.
they were so sick!
"They came from a nearby air force
base. boys from all over the Empire.
Some had been lying unattended for
days. They all had pneumonia. We knew
those whose feet were black wouldn't live.
"Two classrooms were made into
morgues and they were always full. At the
time of the Armistice on November 11 , the
epidemic was at its height. and between
15 and 20 died In each ward every day. It
was awful!
"But we did what we could, and they
were wonderful patients. We fed them
beef tea and brandy every two hours.
They all had to be fed. And we applied
linseed poultIces and gave them liquid
aspirin every four hours There was only
time for a bed bath every second day, but
we sponged the sickest (patients) as often
as we could.
"Pneumonia jackets were so scarce
that we grabbed them from the
convalescent and the dead, washed them
by hand, and hung them to dry by the
open fires. My hands were raw from
washing these jackets.
"But the sickest boys I have ever
seen were those who had just been
burned with mustard gas and then took
flu. Their eye sockets were burned; the
insides of their ears were burned, and, of
course, their lungs. We put those poor
lads outside for extra oxygen."
Elsewhere
Bad though it was in the western
hemisphere, Spanish influenza was many
times worse in ASia. although records are
hard to find. The mortality rate for India
was six times that of the United States,
with 12,500,000 dead, or 4 percent of the
population. More Indians died than during
all the active combat of the First World
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The Canadian Nurse December 1976
War. Journalists reported that bodies
littered the streets. and cemeteries were
piled high with corpses. The flu swept like
a tidal wave through China. but few had
either time or training to record it.
The death rate for South Africa was
27 per 100.000 and, In the ghettos of
Cape Town, 2,000 children were
suddenly orphaned and destitute. 21
Tangiers was reduced to the level of
starvation, and the roads to the
cemeteries were blocked with funeral
processlons. 22
But the highest incidence of all was
on the island of Samoa, where 80 percent
of the population was sick at the same
time, with 25 percent mortality. A medical
unit from Australia could do little more
than feed the living and bury the dead. 23
Conclusion
Like the hurricane it seemed,
Spanish influenza had spun itself out by
the beginning of March 1919. For those
who survived, it took a full year to feel
entirely well again. But recover they
eventually did. Dr. Mitchell says that for
months after he was up and around he
wore his socks over his pant legs to keep
out the draft. Extreme exhaustion,
feelings of weakness, and fragility made
the work day long and tiring.
The virus itself, Type A Influenza,
was not discovered until 1 933. Before that
time influenza was thought to be caused
by Pfeiffer s bacillus. But even today, with
our advanced knowledge of viruses, we
have no effective prevention or cure for
influenza.
Because the virus was most VICIOUS
in the stratum of population that carried
the greatest responsibility - the wage
earners and the parents of young ct>lldren
- it caused more disruption to family life
than the war itself.
For those who remember, Spanish
influenza was a tragedy of unforgettable
proportions. vivid forever in their minds.
But for the rest of us, It IS a vague name
from the past, with no poems, no novels,
no plays - just a few scattered statistics
to mark its place in history."
The author, now a free-lance woter,
earned her R. N. during World War 11 at the
Royal Victoria Hospital school of nursing,
Montreal, Quebec.
I
References
1 Burnet, Sir McFarlane Natural
History of infectious diseases. New York
Cambridge University Press, 1962. p.
308.
2 Burnet, op. cit., p. 298.
3 Darling, Chester A. Epidemiology
and bacteriology of Influenza. Amer. J.
Pub. Health. 8:10:752, Oct. 1918.
4 Burnet,op. cit., p. 294.
5 Tuesday morning joint session of
laboratory and public health sections.
Influenza discussions. Amer. J. Pub.
Health, 9:2:134, Feb. 1919.
6 Zissner, Hans. I remember him.
Boston, little, Brown. 1940 (?). p. 250.
7 Turner. Barry. Europe 1919: The
influenza pandemic. In History of the 20th
Century. London, Purnell for BPC Pub\.
Ltd., n.d. vol. 2, p. 896.
8 Ibid., p. 896.
9 The influenza epidemic of 1918.
Canadian Annual Review 1918. p. 574.
10 McConnell, Guthrie. The relation
of the bacillus influenza to the recent
epidemic. Amer. J. Med. Sci., 158:48, Jul.
1919.
11 Turner, op. cit.. p. 896.
12 National Research Council,
Washington. D.C. Bulletin No. 34 (vol. 6,
part 3) July 23, 1923. Prepared for the
Division of Biology and Agriculture and
the Division of Medical Sciences, National
37
Research Council, and presented by
Elsworth Huntingdon, Chairman Report
of the Committee on atmosphere and
man.
13 Davis, William H. Influenza
epidemic as shown In the weekly health
index. Amer. J. Pub. Health, 9:1 :51
Jan., 1919,
14 Maloney. Thomas E Thursday
morning special influenza conference.
Amer. J. Pub. Health, 9:2:137 Feb. 1919
15 David,op. cit.. p. 50.
16 Frankel, Lee K. and Dublin,
Louis I. Influenza mortality among wage
earners and their families. Amer. J. Pub,
Health. 9:10;734, Oct. 1919.
17 Hams. Influenza complicating
pregnancy. JAMA 72:978, 1919.
18 Lynch, Charles and Cummings.
James G. The distribution of influenza by
direct contact - hands and eating
utensils. Amer. J. Pub. Health, 9:1 :25.
Jan. 1919.
19 Meader, F.M. et al. Account of an
epidemic of influenza among American
troops in England Amer. J. Med. Sci"
158:396,1919.
20 Turner,op. cit.. p. 896.
21 The influenza epidemic of 1918
op. cit., p. 574.
22 Turner.op cit., p. 896,
23 The Influenza epidemic of 1918
op, cit., p. 574.
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The Canadian Nu..... Oacember 1976
lffE M
RKET
FOR NURSES
We've come a
ong way!
Gabnelle Monaghan
The oldest and largest segment of nursing
manpower is the diploma educated R. N. This
year, several thousand R.N.'s across the
country are actively seeking work and are
unable to find it. Many of these unemployed
nurses are in the province of Ontario. A look at
the Ontario expeflence in the area of nursing
manpower offers some interesting insights
into developments in other provinces and
territories.
The Ontario Experience
. 1962 - Ontario Minister of Health, under
public pressure to "do something" about the
"growing nursing shortage in Ontario," sets up
special committee with representatives from
Ontario Hospital Association. College of
Nurses. Ontario Medical Association,
Registered Nurses Association of Ontario and
Ontario Hospital Services Commission (Ewart
Committee) RNAO suggestion that major
statistical study be done is vetoed by
committee members.
. 1963-Ewart Committee Report finds
evidence of "definite shortage of nurses" and
recommends that number of nursing school
graduates be doubled from 2,500 to 5,000
within five years. Nurse members of
committee suggest shortage may not be as
acute as report suggests. 1
. 1967 -Chairman ofthe OHA Committee
on Hospital Schools of N ursi ng, Ch arl es Black,
says: "The greatest single problem facing our
hospitals today is an acute and increasing
shortage of nurses. Statistics indicate beyond
any contradiction the critical nature of the
present shortage. "2
. 1972 - active unemployment among
R.N.'s entering labor market for first time
(September, 1971) less than four percent
according to "Report of a preliminary survey to
explore the nursing employment situation. "3
. 1974 - reports persist through summer
months of shortage of R.N.'s in Metro Toronto
area.
. 1974 - Ontario College of Nurses
predicts widespread unemployment among
nurses in that province. 4
. 1976 - approximately 4,300 persons
expected to qualify as R.N.'s after writing
CNATS exams in Spring. Approximately 200
Tha Canadian Nu... December 1976
39
job openings available. Reports indicate
number of nurses looking for nursing positions
could reach close to 10,000 by end of year. 5
Supply and Demand
The demand for nursing manpower is an
offshoot of the demand for health manpower
and should, therefore, be considered within
the context of the health services system.
These services, like other public services such
I as roads and schools, compete among
themselves for their share of the tax dollar. In
recent months it has become increasingly
evident that there are definite limits on these
I resources and competition has become more
active.
Spending priorities are determined by
many factors, some of them only remotely
related to health. Two of the variables that
influence demands upon the health services
include the perceived needs of the population
and their perception of the efficacy of medical
care since, for the most part, the consumer
continues to receive these services at the
order of a physician. Implementation of
universal federal medicare in the late 1950's
removed price as a mechanism for rationing
the allocation of health care. The effect of this
move is still being felt by the health sector as a
whole and by the nursing profession as part of
this system.
The Burgeoning Health Field
Before 1960 the health sector was a
traditional service industry with a ceiling on
attainable output, limited technology and the
potential of science poorly applied in its
organization. However, a value reconciliation
occurred In the implementation of the various
Medicare Acts; the idea that health care could
and should be delivered to all as a right, and
that this was a necessary condition for a
democratic society, became generally
accepted. The provincial government, as a
central decision-making body, took a
leadership role in building hospitals and
encouraging hospitals to upgrade. The
industry took off in rapid expansion, new
technology was adopted as quickly as it
became available and there was an enormous
increase in the demand for personnel. In some
instances government consultants
encouraged hospitals to increase the nursing
complement on their staff, There was a
subjective feeling that the demand curve for
nurses was rising very rapidly However, it
would seem that the growth in nur In("
opportunities was less vigorous the..
appeared.
New Health Occupations
Each wave of technological growth
brought ItS own group of staff: technicians in
cardiopulmonary assessment, renal dialysis,
etc. But nurses, who should have had a
comparative advantage in these occupations,
did not co-opt thr
"'ilthouyh the work
often offered Siglllll-..c:" It oUvdntages over
nursing for some women, e.g. the absence of
week-end and shift duty. Why nurses did not
move into these occupations has not been
given much attention but a case could be
made that they are members of a traditional
authoritarian occupation subject to arbitrary
control and organization. It has been widely
held that members of such a society are
stunted in creativity and do not adapt well to
changes in the social, economic or technical
climate. 6
The Authoritarian Profession
Weir (1932) found that "the discipline in
training schools is unnecessarily severe. "7
Robson (1967), in a study of the
characteristics of women recruited into
nursing, found that less than half were lower
class girls with high grades, and more than half
were upper class girls with low grades. He
found also that security was mOre important to
these women than creativity or self
development and that nursing directors felt
that raising academic standards would attract
women into the profession who would not
make good bedside nurses. Personality traits
disapproved of in the nurse applicant were
"skittishness" and "not sufficiently
respectful. "8
Mussallem (1965) deplored the fact that
nurses were required to leave school when
"their marriage became known to the school
authorities. "9
As a group, then, nurses have been
judged to be obedient, conservative, neither
adaptive nor creative. Their superiors appear
to feel that these are desirable attributes in the
nurse. It is little wonder that during the 1960's
the sphere of nursing activities in hospitals,
where most nurses are employed, became
relatively narrower, rather than more varied,
The demand for nurses did increase, as the
health care system expanded, but nurses
were restricted to the nursing service area of
the hospital. It is even possible that many of
them, unable to cope without further training
, A study of turnover rates for all female employees
of one large Canadian bank In 1966 shows an
overall rate of 38% as contrasted with 60% for at!
graduate general duty nurses in Canada in 1965.
with the increasing complexity of the hospital,
left the profession and contributed to the
phenomenon known as nursing turnover.
Turnover in Nursing
In his report to the Committee on the
Healing Arts, (1970) Murray equates turnover
with a "pseudo-shortage." He found that the
feeling among hospital administrators that
there was a shortage of nurses arose from the
fact that they were continually seeking R.N.'s
to replace those who quit after a relatively
short period of employment and that although
the vacancies were quickly filled (except in
summer) the psychological impact of the
quitting caused a subjective sense of
shortage. 10
Atthattime (1965), Ontario had the fourth
lowest turnover rate' (57.3%) for graduate
nurses in Canada. 11 A look at the national
turnover rate reported by Statistics Canada
shows that, with few exceptions, it has been
dropping each year since then. The Canadian
Nurses Association, in a submission to the
Royal Commission on the Status of Women in
1968 referred to the shortage of nurses as
"fictitious." In retrospect, it seems that the
CNA was right.
In his Report, Murray comments on the
"ambiguous and scanty facts permitting very
little in the way of well-supported conclusions"
concerning nursing manpower supply and
demand and points out that "it seems to be a
foible of human nature that the fewer facts that
are known about a particular issue, the more
emotional is the reaction to i1."12
Lacking relevant data, any number of
theories may be cited to explain why hospitals
were always looking for staff:
. It was the era of the Feminine Mystique
and work for married women was not socially
approved.
. Wages were low; there was no standard
remuneration for experience, and hospitals
Figure 1
Professional nurses registered in Canada, by employment
status and highest level of educational preparation, 1974
Highest level
of educational preparation
Diploma prograrT' lea<..,ng to R.N.
Post-basIc dlp'- "l1a/certlflc.ate
Baccalaureate degree
Master's or higher degree
Total
Source: Research Unit, CNA
Employed In nursing
Number
105,532
12,705
9,719
719
128.675
Percent
82.0
9.9
7.6
.5
100
. ..... ....
:' : ::::.:: :.: :
...... .... .... : .. .
Year No Year No I Year No Year No
1963 1749 1967 2439 1971 2338 1975 1343
1964 1229 1968 2650119i
-637
1965 1487 1969 2406 1973 1065
1966 1992 1970 210611974 941
: :::::::::::
:::
:::::::
:
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:
:
:
:
:
:
:
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t
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.................. ..... .... ... ................................................-.-.-.
40
paid different rates.
. Nurses are traditionally considered a very
mobile group - but this mobility may have
been the result of nurses moving from one
hospital to another in the same area in search
of better salaries or quitting to avoid working
during a pregnancy, since maternity leave was
the exception rather than the norm. Or. their
geographic mobility may have been related to
that of their husbands.
Mulling over these theories makes it
obvious just how far we have come..,
Discontented Nurses
There is some evidence that nurses DaVe
often been unhappy in their jobs. Mitchell
(1971) found that only 66% of R.N.'s would
choose nursing if the choice could be made
again, compared with 93% of university
professors. 13 Advancement within the system
was limited by their lack of education. In 1968
only .5% of nurses were qualified to the
Master's level, and only .01 % had doctorates
(See Figure I). Pepperdene (1976) showed
that nursing careers are determined by the
system and the extent and ki nds of choices the
system offers, 14. It seems clear that the nature
of the market for nu rses in the sixties was not
well understood, The shortage was fictitious.
Wages were too low to encourage many
women into the nursing workforce. Turnover
was a symptom of poor working conditions, the
absence of standardization and the lack of
maternity leave and child care facilities.
However, toward the end of the sixties, nursing
-90-
-80-
f-70-
-60-
The Cenedlan Nurse December 1976
began to catch up with other occupations. Four
factors involved in this "catching up" process
can be singled out. These include:
1. Collective Bargaining
With the advent of collective bargaining,
wages increased and, probably, employment
also increased. Turnover in Ontario hospitals
began to drop in 1967, about the time that
maternity leave was being written into
contracts.
2. Staffing Campaigns
The Toronto hospitals brought an influx of
R.N.'s from outside the province - mainly
from the United Kingdom. Initial registrants
from outside the province formed a significant
percentage of total initial registrants - as high
as 50% in 1968 (See Figure 2). That there was
still a shortage of R.N.'s in summer can be
explained by a price offer curve applied to
nurses - as the wage rate rose, R.N.'s
desired more work initially but as it continued
to rise they could afford to shift to less hours of
work and more leisure, Other factors such as
the extension of Unemployment Insurance
benefits to nurses meant that nurses who
needed it had the same income maintenance
as other workers.
3. Specialization and Economies of Scale
The introduction of modern management
and production techniques in hospitals
allowed the use of less highly specialized
workers and reduced the number of R.N.'s
f- 50-
- 40- I%
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.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:. :.:.:.:.:.:.:.:.:.::.:.:.:.:.:.:.:.:..:.:.:.:.:.:.:.:.:.:
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o 1963 1964 1965 1966 1967 1968 1968 1970 1971 18?2 187;) 1874 1875
\
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Fig. 3
Total Nursing Assistant Registered in
Ontario 1963-1975
(Source: College 01 Nurses)
ttf
(
:
:
:
:
I
f:
:
tttr
f
1963 8,103
1964 9,541
1965 10,959
1966 12,223
1967 13,988
1968 14,907
1969 18,358
1970 23,044
1971 24,413
1972 26,213
1973 27,277
1974 :::;:;:::;::: 28,911
197 5 r.... ...... 30,544
..... . .................__.._--:..-.:.:.:
Fig. 2
Initial Registration of Out-ot-Province
Graduates in Ontario 1963-1975.
The Cenedl8n Nurse December 1976
required. Nurses found that demands for their
labor were restrrcted to areas where legislation
prevented those workers from working. The
number of these areas tended to shrink.
(See Figure 3).
4. Nursing Education Moves to G.A.A. T.S.
At the end of the sixties hospital training
schools began to be phased into the Colleges
of Applied Arts and Technology as nursing
education moved into the general education
stream. The education program for R.N.'s was
cut by one third - from three years to two -
and in both 1971 and 1972 there were two
graduating classes of nursing students at
Ontario teaching centers - graduates of the
two-year and of the three-year programs. The
effect was to increase graduations by 52% in
1971 and by 42% in 1972 over the previous
years, (See Figure 4)
Nursing in the Seventies
The present unemployment in nursing is
I the result of many factors. Because of their
lack of experience, nurses have been
relatively powerless to plan their destiny as a
profession. Low pay, shift work and the stigma
I attached to working mothers combined to
keep women out of the workforce for many
years, Although the Nursing Manpower Task
Force lists twenty agencies collecting statistics
on nursing, the few figures available are
neither very clear nor very useful. Response to
the perceived shortage has been to train or
import more nurses rather than to get those
already trained back into the workforce.
Fig.4
Graduations of Nurses in Ontario
1970-1974.
(Source: College of Nurses).
It is fairly obvious that society's priorities
as expressed in government policy have
shifted. Today the emphasis is on investment
in transportation, energy and conservation.
There is a demand for economies in the health
field that, in turn, is causing layoffs among
R.N.'s. However, in facing this crisis the
nursing profession appears to be maturing and
adopting organizational solutions. An
employment agency job information center
has been started by the RNAO and each day
the press carries advertisements for
out-of-province and south-of-the-border
employers who are interviewing and recruiting
in Ontario. Although it may be sad to lose these
nurses one can't but envy them the chance to
practIse in another setting and those who do
return will no doubt bring back fresh ideas.
Need for Planning
Recognizing that the weakest section of
economic planning is that dealing with the
capacities of people, considerable investment
in planning from a firm data base is essential. If
large numbers of nurses emigrate we may find
ourselves short-staffed again when there is
some easing ofthe present restraints: we must
be careful not to repeat the mistakes of the
sixties. Today, the emphasis in the health
delivery system is shifting away from remedial
care, towards health promotion and
prevention. It is clear also that R.N.'s are not
prepared for a lifetime's work by one-time
certification,
At the present time there appears to be a
shortage of highly trained people to manage
1_. Schools
Year Diploma Schools I University
,
1970.. 3220 I 137
I
... . I
:
1971 '* 4907 I j 163
1972 *4576 I 177
- I - -
243
:::11 3957
-
3950 j 268
"* Effect of Double Graduation
41
the increasing com plexlty of some areas of the
health service such as data processing and
planning. At the same time, higher education
for those capable and interested, needs to be
made more accessible through an open door
policy and greater financial support to
students. Possible sources of funds include
"health" lotteries, provincial hospital pension
plans and a co-insurance charge added to
patients' accounts,
Since it will ultimately benefit most from
the better qualified work force, the health
sector should provide the leadership that is
needed now."
References
1 Murray. V.V. Nursing in Ontario. Toronto,
Queen's Printer, 1970. (Ontario, Committee on the
Healing Arts Study), pp. 113-116.
2 Black, Charles. Chairman of OHA Committee
on Hospital Schools of NurSing in Hospital
Administration, December, 1967.
3 Imai. Hisako Rose. Report of a preliminary
survey to explore the nursing employment situation
m Canada in terms of the number of 1971 graduates
of Canadian schools of nursing,
registered Ricensed for the first tIme in 1971, who
were able or unable to obtain permanent
employment in nursing as of September 1971.
Ottawa, Canadian Nurses Association, 1972.
4 Personal communicaton, Dr. S. Halliwell,
College of Nurses of Ontario.
5 Ibid.
6 Hagen, Everett Einar. On the thecry of socIal
change: how economic growth begins A study
from the Center for International Studies,
Massachusetts Institute of Technology. Homewood
II., Dorsey Press, 1962. Ch. 6.
7 Weir, G.M. Survey of nursIng educatIon in
Canada. Toronto, University of Toronto Press,
1932. p. 185.
8 Robson, A.A. N. SociologIcal factors affectmg
recruitment into the nursing profession. Ottawa,
Queen's Printer, 1967-
9 Mussallem, Helen Kathleen. Nursing
education in Canada. Ottawa, Queen's Printer,
1965
10 Murray. pp. 101-102.
11 Murray, p. 104.
12 Murray, p. 110.
13 Mitchell, Samuel. A women's professIon; a
man's research. Edmonton, Alberta Association of
Registered Nurses, 1971.
14 Pepperdene, B.J. Unpublished thesis.
Toronto, 1976. (Thesis (ph,D.) - Toronto).
Gabrielle Monaghan, (R.N., Richmond
School of Nursing, Dublin, Ireland; B.A.,
Laurentian University, Sudbury, Ontario) says
it was the realization that many of the
predictions made by nursing leaders in the
sixties were coming true in the seventies, that
made her start thmking about the "Market for
Nurses. " She points out, however, that the
employment situation for nurses today is
complicated by the "greater personal
freedom and responsibility inherent in higher
salaries. ..
The author is in her second (intern) year
of the Hospital Administration Program
offered by the University of Toronto and
working at Belleville General Hospital in
Belleville, Ontario. Her studies are sponsored
by the Government of Newfoundland.
42
This is another in a contmuing series of clInical
wordsearch puzzles relating to different areas of
nursing. by Mary Elizabeth Bawden (A. N., B. Sc. N.)
who presently works as Team Leader m the
Rheumatic Diseases Unit, University Hospital,
London, Ontario.
The C8nedi8n Nurse Oecember 1976
Clinical Word search no. 3
Solve the clues The bracketed number
indicates the number of letters in the word or
words in the answer. Then find the words In the
accompanymg puzzle. The words are in all
directions - vertically, horizontally, diagonally.
and backwards. Circle the letters of each word
found The letters are often used more than once
so do not obliterate them. Look for the longest
words first. When you find all the words, the
letters remaming unscramble to form a hidden
answer. This month's hidden answer has five
words. (Ans wers page 31}." ...
P L N HUM I
OUTAHCL
S N LEG A Z N E U L F NIP L S R
TG I MUSNEGYXOSAGSAO
U B L 0 0 0 GAS C I 0 E S B U L H
RROPCNOWOTRNU I RLST
AEETRCALABPCRTOO I 0
L A V Y A R 0 R I S U SUI N B S M
o T L S LEI F Y M K E B E C M A U
R H A I E P CDS F T R R H H E T E
A I ASS I A T I A U A 0 COR C N
I NNETTN I RLMNNAGMEP
N G R S A U C 0 U LOP C R ELL L
A lYE SSE A E U R A H T N A E E
G C N F H C R L L 001 U G I R T U
E P M U T UPS PEN N S K C 0 A R
A S T H MAE K 0 M S ALP 0 E N A
C HEY N EST 0 K E S Q 0 BUR L
A chronic disease characterized by dyspnea,
wheezIng and a sense of constriction of the
chest (6)
2 Caused by presence of air in the pleural
cavity: may be surgical, spontaneous, or
follow a chest injury (12)
3 A series of tests, such as vital capacity, which
measures the effectiveness of lungs (9, B)
4 Usually occur 12-20 times per minute (12)
5 pen or pcen (5. 3)
6 That volume of air which passes in and out of
the lungs In each respiration (5)
7 When made of iron, it can really take your
breath away during a power failure (4)
8 Small chamQers where the exchange of en
and cen takes place (7)
9 That portion of the brain where the
respiratory center is located (7)
10 A type of carcinoma that originates in the
bronchi (12)
11 Truom (anagram)
12 # 11 composed of new and actively growing
tissue (8)
o I F
U B B
ERR I A N X
NGSSRAA
13 Enlargement of the finger tips which may
result from congenital heart anomalies (8)
14 Breathing characterized by Increasing and
decreasing rate followed by a period of apnea
(6.6)
15 20% of normal room air (6)
16 Sometimes too loud in hide-and-seek (9)
17 This clot is a real mover (7)
1 B Being poked in them is like having your leg
pulled (4)
19 A hereditary disease characterized by an
over-production of thick tenacious mucus
and an abnormal secretion of sweat (6, 8)
20 Between trachea and bronchloles (8)
21 Inflammation of the trachea (10)
22 Chronic obstructive lung disease (4)
23 Congestive heart failure (3)
24 Noises; not related to trains (5)
25 See #24 (8)
26 Inflammation of the pleura (B)
27 Caused by friction of the two pleural
membranes (7,3)
28 Made Smith Brothers 'drops' famous (5)
29 What chimneys and cigars have," common
(5)
30 Raccen (anagram)
31 Absence of respirallons (5)
32 An exudate produced by a #28 (6)
33 Difficulty breathing (7)
34 Collapse of all or a portion uf a # 7 (11)
35 Asian or Swine (9)
36 Physiotherapy to remove exudate from the
lungs (8, 8)
37 Dampens the air but not your enthusiasm
(10)
38 When # 32 IS bright red (11)
39 Its chief constituent is mucin (5)
40 Spoken (4)
41 Pertaining to Cyrano (5)
42 Nostrils (5)
43 What smokers pollute: where caslles are
built (3)
44 Suffenng's partner (4)
45 As necessary (3)
46 Quantum Sufficit (2)
X-lilIes
;11)(1
Tha Csnad..n Nurs
December 1976
43
Fa.lces
Huguette Labelle, CNA president for
the 1974-76 biennium, has resigned
as Principal Nursing Officer with
Health and Welfare Canada to accept
a new position in the federal
government's Department of Indian
and Northern Affairs.
Her new title is Director General,
Policy, Research and Evaluation
Branch, Indian and Eskimo AHairs
Program. Department of Indian and
Northern Affairs. The appointment
became effective October 12, 1976.
In accepting the post. the former
Principal Nursing Officer said that one
of the reasons for the move was her
behef that nurses have a great deal to
contribute in the way of unique
expertise in many areas - not just in
the health care field.
Florence Gass recently retired as the
Director of Nursing at Victoria General
Hospital, Hafifax, Nova Scotia after 21
years service. After completing
post-graduate work at McGill School
of Nursing, she was assistant director
of nursing at the Victoria General
Hospital. Victoria, B.C., before
working In Halifax.
Father Jean-Marc Daoust S.J. of
Montreal has been appointed
Executive Director of the Canadian
Catholic Health Association. Since
1966, he has been very active in
health care through the promotion of
pastoral care and the development of
hospital chaplincy education
programs in health care institutions.
Helen Sabin, Executive Director of
the Alberta Association of Registered
Nurses from 1960 to the present.
recently announced her retirement.
Her tenure of office has seen the
number of practicing registered
nurses of the A A R N. grow from
4,382 (1960) to 11.804 (1976).
Her administrative approach has
been one of experience fairness,
common sense. flexiblhty and courage
to back up her decisions. She has
been noted for Integrity. demonstrated
adherence to ethical principles and
soundness of moral character She
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has been able to avoid the common
syndrome of "we have always done it
that way" and instead has dealt
effectively with the demands of
changing situations. Her coordinating
activities have included speaking for
nursing, Interpreting Association
policy and seeking solutions to mutual
concerns with members,
governments, associations and
organizations eX1ernal to the A A.R.N,
Jeanette Funke (R.N., Regina Gray
Nuns Hospital school of nursing: Dlpl.
P.H., B.N.. McGill UniVersity,
Montreal, M.Sc.N. UnrverSltyof
Colorado, Denver) assistant
professor Unlver
ty of Alberta school
d :"IurSlng nas recelveo a grant from
the Toronto Sick Children s Hospital
Foundation. covenng a 22-month
period, 10 study "The Reliability and
Validity Testing ot Indicators of
Maternal Adapt Ie Behavior. She is
the project dlreC1t.
-
...,., "
-
Yvonne Chapman has been
appOinted Executive Director of the
Alberta AssociallOn of Registered
Nurses effective November 1, 1976.
Chapman brings to this position a
broad background and a depth of
experience In nursing as well as in the
aHairs of the Alberta Association of
Registered Nurses. She is well known
to members and colleagues In the
health care field through her
employment as Director, Collective
Bargaining Program for the past six
years.
Origirlally from North Sydney,
Nova Scotia, she received her basic
education at the Victoria General
Hospital School of Nursing, Halifax.
Post-basic education includes a
diploma In Nursing Service
Administration from the University of
Saskatchewan and a Baccalaureale
Degree in Nursing from McGill
University.
Prior to accepting employment
with the A.A. R.N. in 1970, Chapman
held a variety of positions in hospitals
and public health agencies from
general staff, to supervisory, to
director of nursing positions and also
as a consultant with the
Saskatchewan Hospital Association.
AnnaClaireMacAdam(R.N.,B.A )IS
serving a two-year tour of duty with
MEDICO. a service of CARE, In
Afghanistan. She will be working in a
supervisory capacity furthering the
education of local nurses, in a new
hospital in the Afghan capital of Kabul.
Prior to Joining MEDICO,
MacAdam worked at the Camp Hill
Hospital in Halifax and nursed in Peru
with CUSO.
New Appointments
The Faculty of Nursing, Umversity
of Alberta, Edmonton, has recently
appoinled to ItS staff:
Amy M, Zelmer (R.N.; B.Sc.N.:
M.P.H., Ph.D., Michigan State
University) as Dean of the
Faculty of Nursrng.
Marilyn Jean Campagna (R.N;
B.Sc.N., University of Windsor) as
lecturer:
Maria-Rubilie Glenn (R.N.; B.Sc.N.,
University of Alberta) as lecturer in
medical-surgical nursing.
Carol May Mitchell (B.N., University
of Manitoba) has been appointed
lecturer in the Faculty of Nursing,
Umversity of British Columbia.
Elaine Marie Mullen (R.N.: B.Sc.N.:
M.S., Duke University, North Carolina)
has been appointed lecturer in the
School of Nursing, Lakehead
University, Thunder Bay, Ontario.
Lakehead University, Sudbury,
Ontario announced the appolntmenls
of Alice Jope (B.Sc.N.) and Carol
Woods(B.Sc.N.) as lecturers In the
School of Nursing.
Robert Donahue has been appointed
Acting Director of the Collective
Bargaining Program of the Alberta
Association of Registered Nurses
effective November 1, 1976_ He brings
to his new position a background in
journalism, public relations and his
experience as Employment Relations
Officer for the A.A. R.N.
Jane Bennett (B.Sc.N.) has been
appointed Employment Relations
Officer with the Collective Bargaining
Program of the Alberta Association of
Registered Nurses Her background
includes general duty, inservice
education and emergency room
nursing.
.
44
The Canadian Nurse December 1976
("t11ell(ltll e
January
Counselling the
emotionally/mentally disturbed
patient - conducted at the Clarke
Institute of Psychiatry, Toronto,
Ontario from Jan. 25 to April 12, 1977.
Fee: $75 For information contact:
Mrs. Dorothy Brooks, Chairman,
Continuing Education Programme,
Faculty of Nursing, 50 St. George St.,
Toronto, Ontario, M5S lAl.
The Grieving Process and the
Dying Process - an evening course
given at the University of Toronto on
January 26 - March 16, 1977. For
information contact: Mrs. Dorothy
Brooks, Chairman, Continuing
Education Programme, Faculty of
Nursing, 50 St. George St., Toronto,
Ontario, M5S 1/ '.
February
Nursing in Inflammatory and
Ulcerative Disease of the
Gastro-intestinal Tract. To be held on
Feb. 14-15, 1977 at the University of
Toronto. Fee: $50.00 For information
contact: Mrs. Dorothy Brooks,
ContinUIng ::ducation Programme,
Faculty of Nursing, University of
Toronto, 50 St. George St., Toronto,
Ont., M5S lA 1
The Eleventh Health Care
Evaluation Seminar is being hosted
by the Division of Community Health
Science, University of Calgary on Feb.
6-11, 1977. It will focus primarily on
Maternal and Child Health.
Applications from health
professionals, administrators and
others concerned are invited. For
information write: Christina Berglund,
Seminar Coordinator, Division of
Community Health, University of
Calgary, 2920 - 24 Ave N. w.,
Calgary, Alberta, T2N 1 N4.
Supervision in Community Nursing
to be held on Feb. 14-18, 1977 at the
University of Toronto. Fee:$200.00
For information contact: Mrs. Dorothy
Brooks, Continuing Education
Programme, Faculty of Nursing,
University of Toronto, 50 St. George
St., Toronto, Ont., M5S IAI.
Cardiac Pacing Symposium -
February 23, 1977 . To be held at
University Hospital. London, Ontario
Cosponsored by the Canadian
Council of Cardiovascular Nurses,
Medtronic of Canada Ltd., and
Continuing Education, Faculty of
Medicine, University of Western
Ontario. Fee: $10. For further
information, contact: Leslie Key,
Chairman of Planning Committee,
196 Cromwell Street, London,
Ontario. N6A 1 Z5.
March
Symposium on Infant Nutrition,a
closed circuit telecast sponsored by
Health Projects International, will be
shown simultaneously in Toronto
(Hyatt Regency Hotel), Montreal
(Bonaventure Hotel) and Vancouver
(Four Seasons Hotel) on March 23,
1977. Nurses are invited and there is
no fee. For information contact: HPI,
200 Madison Ave., New York, N. Y.
10016, (212) 6B3-7620.
Adapted Physical Activity to the
Rehabilitation Process - 1 st
International Symposium to be held at
the Chateau Frontenac, Québec on
March 17 - 19, 1977. Papers will be
presented on such topics as: aging,
the mentally retarded and the
perceptually handicapped. For further
information, contact: S.I.AP.A,
Centre de Réadaptation du OUébec,
525 boulevard Hamel, Ouébec,
Canada, GIM 2SB.
Mental Retardation - a one-day
conference for nurses held on March 9
and 16, 1977 at The Hospital for Sick
Children, Toronto. Tuition:$ 20. For
information, contact: The Co-ordinator
of Nursing Education, The Hospital for
Sick Children, 555 University Avenue,
Toronto, Ontario. M5G IXB.
April
Tenth Conference of Operating
Room Nurses of Greater Toronto to
be held April 25-27, 1977 at the
Skyline Hotel, Toronto, Ontario. For
information contact: Mrs. Eleanor
Conlin, Convener, PublicIty
Committee, 25 Fidelia Cres.,
Bramalea, Ontario, L6L 3P7.
Nursing the Paediatric Emergency
- a two-day conference conducted by
the nurses of the Emergency
Department at The Hospital for Sick
Children, Toronto on April 28-29,
1977. Commonly encountered
medical-surgical problems with
guidelines to assessment, priorities
and nursing action, as well as health
teaching are included. Tuition:$35.
For information, contact: The
Co-ordinator of Nursing Education.
The Hospital for Sick Children, 555
University Avenue, Toronto, Ontario
M5G lX8.
Symposium on Coping with Cancer
to be held at the Royal York Hotel,
Toronto, Ontario on April 24-26, 1977.
Topics to be discussed include:
cancer prevention, screening for
cancer, helping the newly diagnosed
patient, palliative care and other
related topics. Contact your provincial
nurses' association for details and
registration forms.
May
International Council of Nurses
16th Quadrennial Congress to be
held in Tokyo, Japan from May 30 -
June 3, 1977. Theme: New Horizons
for Nursing. For information write:
Canadian Nurses Association, 50 The
Driveway, Ottawa, Ontario, K2P 1 E2.
The Third National Conference for
Autistic Children to be held in
Regina, Saskatchewan on May 12-14,
1977. For information contact: The
Conference Chairman, 95 Hudson
Drive, Regina, Saskatchewan,
S4S 2Wl.
Victorian Order of Nurses' Annual
Meeting to be held on May 5-6, 1977
at the Chateaú Lauri
r Hotel, Ottawa.
For information contact:Victorian
Order of Nurses for Canada, National
Office, 5 Blackburn Ave., Ottawa,
Ont., KIN 8A2.
Canadian Hospital Association
National Convention to be held on
May 10-12, 1977 at Quebec City. For
information contact: The Canadian
Hospital Association, 25 Imperial St.,
Toronto,Ont. M5P lCl.
Annual Meeting of the American
Thoracic Society to be held in San
Francisco, California on May 15-18,
1977. For information contact:
American Thoracic Society, 1740
Broadway, New York N. Y. 10019.
June
Nursing Care of the Sick Newborn
to be held at The Hospital for Sick
Children, Toronto on June 13-17,
1977. A five day conference for nurses
to increase their knowledge of the
premature and newborn infant.
Clinical practice not provided. Tuition:
$80.00. For further information,
contact: Hilda ROlstin, Co-ordinator,
Nursing Education, The Hospital for
Sick Children, 555 University Avenue,
Toronto, Ontario, M5G lXB.
Canadian Tuberculosis and
Respiratory Disease Assoc. Annual
Meeting to be held on June 13-15,
1977 in Moncton, New Brunswick. For
information contact: The Canadian
TuberculosIs and Respiratory
Disease Association, 345 O'Connor
Street, Ottawa, Ontario, K2P IVP.
Canadian Medical Association
Ann ual Meeting to be held in Quebec
City on June 20-25, 1977. For
information contact: The Canadian
Medical Association, 1867 Alta Vista
Drive, Ottawa, Ontario,KlG 3Y6.
August
World Federation for Mental
Health - 1977 Congress, "Today's
Priorities in Mental Health," to be
held in Vancouver, B.C. from August
21 - 26, 1977. The focus of the
meeting will be on finding ways to
make health systems work for all the
people, including the mentally ill.
Techniques of Health By The People
will be emphasized. For further
information contact: Secretariat,
World Federation for Mental Health,
Health Sciences Centre Hospital,
2075 Wesbrook Place, The University
of British Columbia, Vancouver, B. C.
V6T lW5.
The Canadian Nurse December 1976
45
Resumes are based on studies placed
by the authors in the CNA Library
Repository Collection of Nursing
Studies.
II
Ilesel11.cll
.'
JiI
e Consumer Opinions.
A comparison of consumers'
and providers' opinions of
community and health
services in a northern Alberta
town. Seattle, Wash., 1975.
Thesis (M.A.) U of Washington
by Margaret A. Seymour.
In 1972, a pilot project in
community health services was begun
in a northern Alberta area. It was to
serve people of diverse cultural
backgrounds. The literature indicated
that there is often a wide discrepancy
between the opinions of the health
team and the consumers on priorities
in health care. When consumer
opinions are ignored, health programs
can, and do fail.
This study. by means of a
questionnaire, was to: I. determine
consumers' opinions regarding
community and health services in an
isolated area in northern Alberta; 2.
determine the opinions of the health
team in the same area with regard to
the same services; 3. compare and
contrast the two. Findings indicated a
high degree of interest in health care
planning, a desire by both consumers
and the health team for more feedback
from the health services board with
regard to planning and a fairly high
degree of agreement between the
opinions of the consumers and the
health team regarding problems in the
area surveyed.
. Senior Citizens
A Study of Health and Related
Needs of Senior Citizens in
Two Housing Complexes.
Independent study by Myrtle L.
Kirstine (M.Sc.N.)
In this descriptive study,
community health nursing
personnel interviewed 122 senior
citizens - 68 residents of one newer
senior citizen low rental apartment
building, designated building A; and
54 residents in an older similar
building, designaled building B.
Comparisons were made between the
health needs of residents in each
building, their concerns and opinions
regarding the housing, their health
and the future. Nurses were asked to
rate residents' coping abilities in the
present situation and to determine the
residents' need for nursing and other
care.
The primary purposes were to
gather data for planning community
health nursing services for elderly
persons. to examine the feasibility of
an extended nursing role in caring for
the elderly, to gather data on the
adequacy of this type of Ontario
Housing as perceived by the
residents, and to collect data that
could assist in maintaining the elderly
in independent living arrangements. A
secondary purpose was to identify
learning needs of nurses for assuming
an extended role in the care of elderly
persons.
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Building A had been occupied for
less than one year and building B had
been occupied for seven years.
Findings were that residents in
building 8 were generally older, more
likely to be living alone as widows or
widowers, were less likely to have
accurate knowledge of services such
as ambulance, fire and police
departments. The older group in
building B engaged in more social
activities within the building whereas
the younger group in building A
engaged in social acitivities mainly
outside the building.
Residents of both buildings had
similarities: almost all came from the
local area and had family or friends
nearby; the majority attended a local
physician whom they had seen in
recent months. Most residents
reported medical conditions related to
heart and circulatory disorders: the
older group reported more arthritic
and rheumatic complaints. Both
groups were prone to neglect dental
care. On the average, the older group
I
in building B took more prescribed
medications and had less knowledge
regarding these than the younger
group in building A. Both groups were
considered to have poor knowledge of
contraindications and side effects.
Most residents adopted a
philosophical and stoic outlook toward
their health and the future.
Most senior citizens, residents of
both buildings, were very happy with
their living accommodation. This was
reflected in their positive remarks.
Some members of the older group in
building B did express the need for
dining facilities in the building and lor
some type of convenience food shop
where they could buy staples.
Interviewers rated the coping
abilities of the older group in building
B, lower than the younger group in
building A, particularly in access to or
ability to use public or private
transport, in their understanding of
medications and in deterioration of
mental faculties.
Regular nursing visits and visits if
ill were the most frequent suggestions
given by residents and nursing
personnel as being the means
whereby nurses could be helpful In
caring for these senior citizens and lor
in preventing crises.
There was some hesitation on the
part of nurses to suggest nursing visits
when residents were under medical
care, although it was believed that
nursing visits would be helpful
Conclusions were drawn relating
to housing for senior citizens, general
health care and an extended role for
community health nurses.
. Education
Exploration of the Opinions of
Nursing Faculty Regarding
Change. Toronto, Ont., 1975.
Thesis (M.Sc.N.), University of
Toronto by Dorothy L Eden.
This project was undertaken to
explore the opinions of nursing
faculty to change. Government
legislation forcing diploma schools of
nursing into general education was
the impetus behind this study. Three
former hospital schools of nursing thaI
were moving into the same
educational institution were selected.
This educational institulion had had its
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own nursing program for some years.
A descriptive study was designed, so
the expressed opinions of the nursing
faculty already in general education
could be compared with the opinions
of the nursing faculties moving into
general education.
Two questionnaires were given to
a sample comprised of full-time
nursing teachers who did not have
administrative functions. The first
questionnaire was given after
representatives of all faculties had
been working on a common
curriculum; the second one was
administered five months after the
common curriculum had been
instituted. Where appropriate, the
responses were computer analyzed
for means, medians, modes and
frequency distributions. Content
analysis was done on responses to
open-ended questions,
The findings indicated that in
most areas the former hospital
respondents had more concerns than
the members of the nursing faculty in
general education. The hospital
respondents indicated that their role
as a teacher had changed and they
were more dissatisfied with their jobs.
Both groups were satisfied with being
part of a large multi-discipline school,
with qualified staff to teach
non-nursing subjects and with their
relationships with students. Concerns
for both groups of respondents were in
the areas of curriculum and teaching
responsibilities. The two samples
perceived that the students had
adjusted easily and well, and identified
some factors contributing to this
adjustment. Statisltcal analysis of the
individual variables indicated a trend
toward general homogeneity within
the total current faculty group.
46
The Canadian Nur.e December 1976
l
oolt8
Nursing in Canada: Canadian Nursing
Statistics 1975 Catalogue 83-226 Annua
(Bilingual) (Soins infirmiers au Canada:
Statistique des soins infirmiers) is now
available. Price $2.10, Orders should be i
sent to: Publications Distribution,
Statistics Canada, Ottawa, K1 A OT6.
Law Every Nurse Should Know
by Helen Creighton. 327 pages.
Philadelphia, W.B. Saunders
Compan
, 1975.
Reviewed by Mary Tkach, Core
Year Nursing Instructor,
Wascana Institute of Applied Arts
and Science, Regina,
Saskatchewan.
As members of the health care
profession, nurses are becoming
increasingly aware of the rights of
the patient who is receiving care as
well as the professional rights of
nurses. Legal aspects of health care
are an important concern.
Though much of this book is
devoted to a definition of terms in
reference to American statutes and
laws, it provides the nurse with many
definitions of legal terminology and
case studies 10 improve her
understanding of legal jargon. Just as
medical terminology is difficult for lay
persons to understand so legal
terminology becomes a puzzle to
health care personnel unfamiliar with
its use and expression. Here. legal
terminology in relation to health care
workers is made more clear and
concise. The book also promotes
understanding ofthe legal aspects the
nursing profession must consider.
One chapter of the book is
devoted to Canadian Law and Legal
Practice. Differences between
American and Canadian laws and
statutes are outlined. Recent
information on the expanding role of
the nurse practitioner, the nurse's role
and responsibility as a member of a
professional body provincially and
nationally, and her role as an
employee of health care institutions is
included. The major difference and
one of significant importance to
Canadian nurses is the infrequency
with which the nurse alone will be
charged with negligence in Canada.
Such forms of legal action are brought
against health care institutions
rendering them liable for all those
activities performed by its employees.
The scope of this book includes
information directly pertaining to the
nurse and her role and responsibility in
carrying out her daily activities as an
employee of a variety of agencies.
Unfortunately, the greatest part of
this book is devoted directly to the
American governmental statutes and
is not directly applicable to the
Canadian situation. However, it is
useful in illuminating the legal
implications of nursing practice. This
book would be a most informative
reference for students of nursing who
are presently recell ''lg only minimal
instruction regarding the legal aspects
of the profession.
Since an awareness of legal
rights of the individual has shown a
sharp increase in recent times, It IS
hoped that in the future more
informallon can be included about
Canadian law specifically. It is also
hoped that each nurse, functioning in
one of the many and varied roles of her
profession will take responsibility for
understanding the legal aspects of her
role and the responsibilities she
carries with that role as an employee
within the health care field.
Care of the Cardiac Surgical
Patient by Ouida M. King, St.
Louis, TheC.V.MosbyCompany,
1975.
Approximate price $13.60.
Reviewed by Baine Parfitt,
Lecturer, University of Alberta,
School of Nursing, Edmonton,
Alberta.
An important overall feature of
King's book is that a basic level
nurse would require some
background knowledge and
assistance in order to best appreciate
some of its content.
King's discussion of embryology
makes it easier to understand the
congenital cardiac defects. A good
brief review of anatomy, physiology
and embryology is Included in the test.
There is also a good review of
diagnostic procedures used in cardiac
surgery. These would be more
pertinent to nurses who have studied
at the post basic level.
King's descriptions of diseases
requiring surgery are concise in
providing background. I found the
diagrams and illustrations excellent
Her description of the surgical
procedures gives plentiful aid to the
cardiac surgical nurse.
I would like to have seen this book
provide more in-depth consideration
of patient care in cardiac surgery. The
psychosocial needs of these patients
was given minimal consideration.
It is unusual to see a chapter on
electricity or electronic equipment
given in a nursing textbook. We could
have more ofthis since we are making
increasing use of such equipment in
nursing generally.
Exercise physiology is a very
large area and the chapter on it is a
substantial summary. While lacking
depth, a good attempt has been made
here to be thorough.
The teaching plan for cardiac
surgical patients is brief but complete,
However, an emphasis should have
been placed on the individu alizatlOn of
patient teaching with reference to
conditions for effective learning.
In general, I found King's book
excellent on the technology of cardiac
surgery. Such a competent work has
its place as a major reference In
cardiac surgical Units It was both an
honor and a challenge to review.
Young Inner City Families:
Development of Ego Strength
under Stress by Margaret M.
Lawrence, 139 pages, New York,
Behavioral Publications, 1975.
Reviewed by Mrs. A. N. Kelly,
Halifax Infirmary, School of
Nursing, Halifax, Nova Scotia.
This book deals with an
interdisciplinary approach to problems
relating to inner city or ghetto families.
It also attempts to show how ego
strength is developed in individuals
shaped by the stresses of ghetto life.
Lawrence outlines three factors
influencing ego development, calling
them Nature, Nurture and Noxia. She
states that these three factors play
outstanding roles in the lives of
developing infants and children in the
Harlem Hospital community.
The author defines Nature in
reference to man as the 'constitutiona
basis with which to work ... the grounl
through which all development is
woven.' She POints outthat a person's
constitutional makeu p is also affectec
by genetic and congenital factors. ShE
defines Nurture as 'being cared for,
being loved, being seen as a person if'
one s own right, having contact in
one's daily life prove that people car
be trusted and that the world is a
stable and friendly place.' Noxia is
reférred to as trauma or severe injury,
physical or emotional.
Lawrence attempts to show how
the ego is developed (Nature,
Nurture), hOW It is stressed (Noxia)
and how it survives (development of
ego strength), and uses case histories
to exemplify her theory. Two ex1ensive
case studies are presented, those of
Hassan and Pedro.
Hassan's case includes a brief
background on the development of his
problem, and essentially portrays a
multi-agency approach to his problem.
Pedro's case study deals with an
individual child, gives an in-depth
personaf and family history, outlines
the treatment attempted, and
comments on its effectiveness and
follow-up. In both these case studies
the author effectively relates the three
factors - Nature, Nurture and Noxia
to the development of the child. In her
discussion of treatment in these two
case studies and others, the author
describes therapeutic education,
provided through a muilidisciplinary
approach
As a Canadian I found the many
titles of the personnel involved in the
multidisciplinary approach very
confusing, as I was unaware of the
roles inherent in the titles. This
affected my concentration. I would
have preferred an increased
emphasis on the case histories - I
finished the book wanting to know
more background information and
more about Ihe approach.
This book would prove most
useful to those in community nursing
who are interested in the psychosocial
effects on child development. On the
whole, however, I do not feel it is
useful in diploma programs except
perhaps as a senior project on child
development.
The Canadoan Nurse December 1976
47
I...ibl-tll-U lT1)(lt\te
Publications recently received in the
Canadian Nurses' Association Library
are available on loan - with the
exception of Items marked R - to
CNA members, schools of nursing,
and other institutions. Items marked R
include reference and archive material
that does not go out on loan. Theses,
also R, are on Reserve and go out on
Interlibrary Loan only.
Requests for loans, maximum 3
at a time, should be made on a
standard Interlibrary Loan form or by
letter giving author, title and item
number in this list.
It you wish to purchase a book,
contact your local bookstore or the
publisher.
Books and documents
1. Benson, Evelyn Rose. Community
health and nursing practice,
by. . and Joan Quinn McDevitt.
Englewood Cliffs, N.J., Prentice-Hall,
c1976. 368p.
2. Bonine, Gladys N. Travaux
pratlques en pédiatrie, par. . . et L.
Pounds. Montréal, HRW, c1976. 92p.
3. Brennan, William. T. Guide to
problems and practices in first aid
and emergency care, by. . . and
Donald J. Ludwig. 3ed. Dubuque,
Iowa, Wm, C. Brown, c1971, 1976.
176p.
4 Canadian Hospital Association.
Office and association directory.
Toronto, 1976. 87p. R
5. Canadian Medical Association.
Council on Medical Services. Review
of primary care studies, prepared by
MW.L. Davis. Ottawa, 1976. 36p.
6. Canadian Medical Directory, 1976.
Don Mills, Seccombe House, 1976.
808p. R
7. Climcal protocols: a gUide for
nurses and physicians, by Carolyn M,
Hudak. . . et al. Philadelphia,
Lippincott, c1976. 461p.
8. Comment répondre aux besoms
samtaires fondamentaux des
populations dans les pays en vOle de
developpe'71ent. étude comm.r-
FISE IOMS présentée par V.
Djukanovic. . . et E.P. Mach.
Genève, Organisation mondiale de la
Santé, 1975. 130p
9. Crosse, Victoria Mary. The preterm
baby and other babies with low birth
weight. 8ed. EO,;ib 11, Churchill
Livingstone, 1975. "';vp.
10. David, Nicole. L'infirmlére et
('enfant; adaptation de textbook of
pediatric nursing 4ed., par Dorothy R.
Marlow. Version française de. . . et
Claire-Andrée Leclerc. 2éd. Montréal,
Les Éditions HRW en collaboration
avec W.B. Saunders, c1976. 718p.
11 De Carlo, Thomas J. The
executive's handbook of balanced
physical fitness; a guide to a
personalized exercise program. New
York, Association Pr., c1975. 95p.
12. Erickson, Marcene L.Assessment
and management of developmental
changes in children. St. Louis, Mosby,
1976. 268p.
13. Evans, David MacLean
Demetrius. Introduction to medical
chemistry, by, . and John Bowen
Jones. New York, Harper & Row,
c1976. 276p.
14. Frisch, Fred. Béments de
médecine psychosomatique pour
infirmiéres. Paris, Centurion, c1976.
137p.
15. Fuller, John Grant. Fever; the hunt
for a new killer virus. New York,
Ballantine, c1974. 280p.
16. Gillies, Dee Ann. Patient
assessment and management by the
nurse practitioner, by . . . and Irene B.
Alyn. Philadelphia, Saunders, 1976.
236p.
17. Hamish, Yvonne. Patient care
guides: practical information for
public health nurses. New York,
National League for Nursing, 1976.
354p. (NLN Pub. no. 21-1610)
18. Hicks, Dorothy J. Patient care
techniques. Indianapolis,
Bobbs-Merrill, c1975. 97p. (Allied
health series)
19 Howe, Phyllis Sullivan. BasIc
nutntlOn in health and dIsease
includtng selection and", :; - -d.
600. Philadelphia, SL J '76
454p.
20. Inter-A- '-an C
Conse and Utl _
Am(' '')nhuman P
Bicmoo.
- - ch
Peru, 2-4 w_...! 19ï5.
Washington. Pan Arr- .. nt.':ltn
Organization, 1976. 25
ù
21. International Sympv urn on New
Approaches in Trypar ;omiasis
Research, Belo Horizonte, Brazil,
1975. New approaches in American
trypor:osomiasis research;
procf'edtngs of an Inte'national
S
'Slum. Bf-'o HOI,J te, Mtnas.
Gc BrazIl, 10-27 March 1975.
Washington, Pan American Health
Organization, c1976 410p. (Pan
American Sanitary Bureau Scientific
pub. no. 318)
22. John E. Fogarty International
Centre for Advanced Study in the
Health Sciences. Diabetes mellitus,
edited by Stefan S. Fajans. Bethesda,
Md., U.S. Dept. of Health, Education,
and Welfare, National Institutes of
Health, 1976. 361p. (U.S. DHEWPub
no. (NIH) 76-854)
23. Johnson, Roderique. The ethical
aspects of government intervention
into individual behavIour, Ottawa,
Long Range Health Planning Branch,
Health and Welfare Canada, 1976.
53p. (Canada, Health and Welfare
Canada. Staff papers. Long Range
Health Planning 76-2)
24. Kalmus, Hans. Genetics.
Harmondsworth, Penguin, 1948.
171p.
25. Korones, Sheldon B. High-risk
newborn infants; the basis for
intensIve nursing care. 2ed. SI. Lou is,
Mosby, 1976. 270p.
The 1976 Index for The
Canadian Nurse, vol. 72,
is available on request.
Write to The Canadian
Nurse, 50 The Driveway,
Ottawa, Ontario,
K2P 1 E2.
26. Langevin, Jean-Louis. La
directIon particIpatIVe par objectifs,
par. . Raymond Tremblay et
Laurent Bélanger. Québec, Centre de
Formation et de Consultation, Les
Presses de I'UniverSlté Laval, 1976
235p.
27. Leininger, Madeleine M.
Transcultural health care issues and
conditions. Philadelphia, Pa., Davis.
c1976. 206p. (Health care dimenSions)
28. Locke, Edwin A. A gUide to
effective study. New York, Springer,
c1975. 201 p.
29. Lussier, Rita J. Perfectlonnement
1976-1977. Québec, Ordre des
inflrmières et infJrmiers du Québec,
1976. 48p.
30. -. ProfessIOnal development
1976-1977. Quebec, Order of Nurses
of Quebec, 1976. 48p.
31. Maegraith, Brian Gilmore,Adams
and Maegralth: tropICal medicme for
nurses, by. . and H.M. Gilles. 4ed.
Oxford, Blackwell Scientific
Publications, c1975. 333p.
Request Form for "Accession List"
Canadian Nurses' Association Library
Send thIs coupon or facsimile to
Librarian, Canadian Nurses' Association
50 The Driveway, Ottawa K2P 1E2. Ontario.
Please lend me the following publications, listed III the
. . . . . .. .................. .Issue of The Canadian Nurse,
or add my name to the waiting list to receive them when available
Item
N
Author
Short title (for identification)
Request for loans will be filled in order of receipt
Reference and restncted matenal must be used in the CNA library
Borrower.
Registration No
Position.
Address
Date of request
48
The Canadian Nurse December 1976
I.JI)'-il'-!J lT1)(lilt...
32. Maxmen, Jerrold S. The
post-physician era; medicine in the
twenty-first century. New York, Wiley,
c1976. 300p.
33. Meldman, Monte J. The
problem-oriented psychiatric index
and treatment plans POPI.
by. . Gertrude McFarland and Edith
Johnson. SI. Louis, Mosby, 1976.
202p.
34. Montag, Mildred Louise.
Handbook of fundamental nursing
techniques, by. . . and Alice R.
Rines. New York, Wiley. c1976. 111 p.
35. 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. New York, 1976. 87p.
36. Notter, Lucille E. Professional
nursing. Foundations, perspectives,
and relationships, by . . , and Eugenia
Kennedy Spalding. ged. PhiladelphIa,
Lippincott, c1976. 475p.
37. Nursing care of the patient with
medical-surgical disorders, edited by
Harriet Coston Moidel . . . at at 2ed.
New York, McGraw-Hili, c1971, 1976
1193p.
38. Order ofthe Hospital of SI. John of
Jerusalem. Priority of Canada. Annual
repon. 1975. Ottawa, 1975. 63p.
39. Passman, Jerome. The EKG -
basic techniques for interpretation; a
practical guide for interpreting and
analyzing the electrocardiogram,
by . . . and Constance D. Drummond.
New York, McGraw-Hili, c1976. 316p.
40. Principes élementaires
concernant Ie som des mala des.
Cours de technique par une
religieuse de I'Hðtel-Dieu de
Montreal. Montréal, I'HOtel-Dleu,
1931. 289p.
41. Research utilization inventory; a
survey and analysis of current
research in social and health
organizations in New York City, 1974,
prepared by Grant Loavenbruck
assisted by David Bowman and
Thelma Nelson. New York,
Community Council of Greater New
York, 1976. 297p.
42. Roemer, Ruth, Plannmg urban
health services from jungle to system,
by . . . et al with a concluding chapter
by Milton I. Roemer. New York,
Springer, c1975. 351p.
43. Rothman, William A. A
bibliography of collective bargaining
in hospitals and related facilities,
1972-1974. Ithaca, N.Y., New York
State School of Industrial and Labor
Relations, Cornell University, 1976
139p. (Cornell Industrial and labor
relations bibliography s
ries no. 14)
44. Sheffield, Edward F. Teaching in
the universities; no one way. Montreal
and London, McGill-Queen's
University Press, 1974. 252p.
45. Teaching in the health
professions, edited by . . . Charles W.
Ford and Margaret K. Morgan. SI.
Louis, Mosby, 1976. 289p.
46. Tremblay, Raymond.
L 'appreciation du personnel par
simulation dans la selection des
cadres. par . et al. Québec, Centre
de Formation et de Consultation, Les
Presses de I'Université Laval, 1976.
80p. (Dossiers Management 1)
47. Wilson, Kathleen J.w. A study of
the biological sciences in relation to
nursmg. Edinburgh, Churchill
Livingstone, 1975. 1 72p.
Pamphlets
48. American Nurses Association A
case for registered nurses. Kansas
City, Mo., 1975. 28p.
49. -. Continuing education in
nursing; guidelines for staff
development. Kansas City, Mo.,
c1976. 11p.
50. -. Continuing education in
nursing; an overview. Kansas City,
Mo., c1976. 9p.
51. Black, Stella. Breast
self-examination; guidelines for a
protective plan of care. Vancouver,
Registered Nurses' Association of
British Columbia, 1975. 20p.
52. Dartnell Corp. What a supervisor
should know about how to plan
successfully. Chicago, c1975. 24p.
53. -. What a supervisor should
know about increasing his word
power. Chicago, c1975. 24p.
54. Fédération canadienne des
enseignants, L 'enseignement au
Canada. Ottawa, 1975. 35p.
55. ealth League of Canada. Report
of a survey of venereal disease
incidence in Ontario. Toronto, 1974.
4p.
56. Lazure, Hélène. L 'attentIon
focale, /'art de gagner du temps?
Montréal, 1976. 15p.
57. National League for Nursing.
Depl. of Baccalaureate and Higher
Degree Programs. Doctoral programs
in nursing, 1976. New York, 1976. 5p.
(NLN Pub. no. 15-1448) R
58. Registered Nurses' Association of
British Columbia. Project to identify
the expected competencies of a
refresher course graduate.
Vancouver, 1976. 24p.
59. Saskatchewan Registered
Nurses' Associati9fl. Statement of
orientation programs for registered
nurses. Regina, 1976. 16p.
Government Documents
Canada
60. Bibliothèque natronale du
Canada. Groupe de Travail sur Ie
Service de Bibliothèque aux
Handicapés. Rapport. Ottawa,
Information Canada, 1976. 225p.
61. Conseil Canadien pour la
Coopération Internationale. Profil des
pro jets de développement
international appuyes par les
organismes non-gouvernementaux
canadiens 1974-75. Ottawa, 1976.
153p.
62. Conseil de Recherches
médicales. Guide de subventions et
bourses (programme eX1ra-mural).
Ottawa, 1976. 90p.
63. Health and Welfare Canada.
Non-Medical Use of Drugs
Directorate, Health Protection Branch
The hole in the fence. Ottawa,
Information Canada, 1975. 132p.
64. Medical Research Council. Grants
and awards guide (extramural
program) Ottawa, 1976. 90p.
65 National Library of Canada. Task
Group on Library Service to the
Handicapped. Report. Ottawa,
Informatiol) Canada, 1976. 206p.
66. Santé et Bien. .
tre social Canada.
Direction de I'usage non médical des
drogues. Mes amis, mon jardin.
Ottawa, Information Canada, 1975.
132p.
67. Statistics Canada. Health
manpower; regIstered nurses, 1974
Ottawa, Information Canada, 1976.
116p.
68.-.0pponunity for choice; a goal
for women in Canada. Edited by Gail
C.A. Cook. Ottawa, Information
Canada, 1976. 217p.
69. -. Public general and allIed
special hospitals in Canada; historica
summary of inputs and utilization of
facilities 1953-1973. Research pape.
prepared by Louis A. Lefebvre.
Ottawa, 1976. 62p.
70. Statistique Canada. Les Mpltaux
publics généraux et spéciaux divers
au Canada; sommaire chronologique
des intrants et utilisation des
installations 1953 à 1973. Document
de recherche préparé à Louis A.
Lefebvre. Ottawa, 1976. 37p.
71. -. Main-d'oeuvre sanitaire;
infirmiéres autorisees, 1974. Ottawa,
Information Canada, 1976. 116p.
72. -. L 'objectif pour les
Canadiennes; pouvOir choisir Édité
par Gail CA Cook. Ottawa,
Information Canada, 1976. 240p.
Great Britain
73. Central Office of Information.
Reference Division. Children in
Britain. Prepared for British
Information Services. Rev. ed.
London, 1976. 46p.
74. Central Office of Information.
Reference Division. Social services in
Britain. Prepared for British
Information Services. London, 1976.
81p.
Northern Ireland
75. Dept. of Health and Social
Service. Guide to the structure for
health and personal social servIces.
Belfast, 1974. 21p.
Ontario
76. Ministry of labour. Research
Branch. A comparative review of
innovative working time
arrangements in Ontario, by G.
Robertson and P. Ferlejowski.
Toronto, 1975. 24p. (Employment
information series, no. 15)
77. -. HIstorical trends in job
vacancies by major occupation
groups: Ontario and ten Canada
manpower centre (C.M.G.)
management regions 1970-1975.
Toronto, 1976. 26p. (Employment
information series, no. 16)
7B. -. The impact of the required
The Canadian Nurse December 1976
49
1 level of employee support on
securing union certihcation, by V.
Pili otis. Toronto, 1975. 26p. (Labour
relations series, no. 1)
Studies deposited in CNA
Repository Collection
79. Casswell, Beverley. Methodology
for determining professional
development needs of teachers for
curriculum planning in diploma
nursing education. Toronto, c1974.
133p. (Thesis (M.A.) - Toronto) R
80. The expanded role of the nurse
programme: final report. Vancouver,
University of British Columbia, School
of Nursing, 1976. 53p. R
81. Gibbon, Mary E. A study of
nurse-patient assessment of certain
aspects and needs of elderly patients
with chronic disease. Buffalo, 1973.
72p. (Thesis (M.Sc.) - New York) R
82. Haliburton, John C. Internal
evaluation of an experimental dacum
curriculum in a diploma school of
nursing Boston, 1976. 103p. (ThesIs
- Boston) R
83. Macdonald, Myrtle I. A three year
study of role definition and function:
home visiting of mental patients by a
public health nurse, 1970-1974.
Montreal, 1976. 25p.
84. Mahley, Dorothy (Eden)
Exploration of the opimons of nursmg
faculty regarding change. Toronto,
1975. 114p. R
85. Parker, Nora I. Survey of
graduates of the University of Toronto
baccalaureate course in nursing no.
5, 1973. Effectiveness of the
curriculum as seen by the 1973
graduates, by _ . _ and Judith A.
Humphreys. Toronto, University of
Toronto, Faculty of Nursing. 1976. 1v.
(various pagings) R
86, Pickering, Edward A. A case f(X
the VON m home care. A report
prepared for the Victorian Order of
Nurses f(X Canada Ottawa, Victorian
Order of Nurses for Canada, 1976.
41p. R
87. Schnell, Bruce R. A study of
unit-dose drug distribution in four
Canadian hospitals, by . Bruce A.
Anderson and D.E. Walter.
Saskatoon, Sask., College of
Pharmacy, 1976. 465p. R
88. -. A study of unit-dose drug
distribution in four Canadian
hospitals; summary report,
by. . . H.A. Anderson and DE
Walter. Saskatoon, Saskatchewan
College 01 Pharmacy, 1976. 45p. R
89. Westwood, Catherine Ann. A
comparative study of the
self-acceptance of suicidal and
non-suicidal youths. Vancouver,
1976. 88p. R
Did you know no
Normally, leukemia occurs in about
2 3 persons per 100,000 population.
Recently it was confirmed that six
workers in a U.S. Goodyear p1anthav8
died from leukemia in a 10-year
period. Exposure to benzene, a basic
hydrocarbon used in the production of
plastic products, is thought to be the
probable cause.
The rubber industry pnmarily
uses benzene as a solvent because it
dissolves rubber. One of its most
important toxic side effects is the
production of blood dyscrasias.
It is estimated that in the U.S., two
million workers are potentially
exposed to benzene in printing,
lithography, and dry cleaning and in
the manufacture of coke and gas
adhesIves, coatings and a variety of
chemicals.- The Nation's Health,
July 1976.
A Sabbatical Year
for Professionals
The IDRC offers ten awards for training, research or investigation
10 Canadian professionals/practitioners in 1977-78
The Award
Stipend up to
Travel costs for award holder and family
Travel in the field up to
Research costs up to
andlor actual training fees
$18,500
variable
$ 1 ,000
S 2.000
variable
The Candidate
1. The professional with no specific experience in inler-
national development, who wishes a year for training
or personal study with a view to pursuing a career in
this field.
2, The professional in the development field whO wishes
to improve skills or do personal research.
Applicants must be at least 35, Canadian citizens or
landed immigrants with 3 years residence, and have 10 years profes-
sional experience.
Research and training areas
Any area dealing with international development. such
as agriculture, nutrition, information. communications. population.
-......
INTERN:\ TIONAl
DEVElOPME:\:T
RESEARCH CENTRE
..
IliA. J
..................
health. social sciences. technology transfer. education, engineering.
etc.
Tenure
To begin before January 1978 for one year only,
Application
Applications may be obtained from:
Research Associate Award
International Development Research Centre
P,O, Box 8500
Ottawa. Ontario. Canada
KIG 3H9
Forms must be submitted by Februarv 15th. 1977,
Awards will be announced May 15th. 1977,
The International Development Research Centre is a corporation
established by the Act of the Canadian Parliament. May 13th. 1970.
The Centre also offers Research Associate awards for mid-career
professionals from developing countries and for Ph.D. Thesis
Research in the field of international development.
50
The Canadian Nursa
('lalHHi 11(>>.1
... \.I'-(>>I-t iH(>>III(>>)ltH
Alberta
Head Nursa for 50.bed AuxIliary Hospital connected to a General
Hospital located 126 miles east of Edmonlon. Salary and personnel
pobces In accordance with the AARN Accommodation available In
residence. ADDlv_ Director of Nursing. Walnwnght Hospital Complex,
Box 820 WaInwright Alberta
British Columbia
Doractor 01 Nursing required lor new acute care, 25.bed hospital,
duties to commence Immediately. Preference given to applicant with
prevIous experience as D.O.N., Head Nurse or Supervisor. Salary in
accordance with RNABC policies. Application to: D.O.N., Princeton
eral ....ospltal, P.O. Box 610, Pnnceton, Bntlsh Columbia, VOX
Head Nurse - Psychiatric Unit - Position requires a R.N
with
psychiatric training and experience In Ward Management. The unit IS
16 beds with 6 day care units It IS a new umt oeanlng In January or
Februaryof 1977. The position becomes avaIlable November 1, 1976
Salary according 10 RNABC contract Apply In writing to. The Doreclor
of NursIng Mills Memonal Hospital, 2711 Tetrau" Street, Terrace,
Bnllsh Columbia, V8G 2W7
Registered Nurses wltn psycnlatnc training or expenence. for new
psychlatnc ur,It opening January or February 1977. Salary accordIng
to RNABC contract Please apply In wntlng to The Drrector of NurSing,
Mitis Memonal Hospital 2711 Tetra
1t Street, Terrace Bntlsh Colum-
bia. V8G 2W7
General Duty Nuraa5 lor modern 41.bed hospital located on the
Alaska Highway Salary and personnel polIcies In accordance with
RNASC Accom'11odallon available In residence. Appl
Dlretlo' (\1
NurSing, Fort Nelson General HOSpital, P.O. Box 60, Fort Nelson,
Blltlsh Columbia, VOC 1 RO.
Ontario
Reglatered nurse, with 8J1Cpenence. requlrea for our accreditee
thirty-two bed hosp
al, IOcaled In a community of 1800 In Northern
Ontario. Exce,lent salary and I"nge beneflls. Apply to Duector 01
Nursing, Hornepayne CommUnity Hospital, Hornepayne, Ontario,
POM IZ0.
Quebec
Reglatered Nurse reqUired for co-ad children 5 summer camp In the
laurentlans (seventy miles north of Montreal) from late June untlllBte
Augusl 1977 Call (514) 487,5177 or wr
e: Camp MaroMae, 5901
Fleet Road, Hampstead, Montreal, Quebec, H3X 1 G9
Head Nurse
required to participate in the
organization, initiation and
management of a new 14-bed
Forensic and General Psychiatric
In-Patient Unit within a specialized
131-bed hospital.
Requirements
Minimum 3 years experience in
psychiatry within a general hospital
setting.
Post graduate studies in psychiatry
preferred.
Previous experience in
administration an asset.
Must be bilinÇjual.
Salary
According to Government scales.
Inquiries should be addressed to:
Director of Nursing
Sherbrooke Hospital
375 Argyle Street
Sherorooke, Quebec J1J 3H5
United States
Registered Nurses - Hospital openmgs available for new graduates
and expeflenred nurses (R.N. 5). Willing to re-Iocateto UMed States
No charge to Ihe applicants. We arrange everything lor you I I Please
coni act: MIsS Shore (416) 449-5883.
Registered Nurses - Hu
ey Medical Center IS a well equipped,
modern, 600-bed teaching hospllal offellng complete and specialized
services for the restoration and preservation of the communlty's
health. II also oHers orientation, in-serVice and contlnumg education
for employees 1\ IS Involved In a bUilding program to provide better
surroundings lor patients and employees. We have Immediate ope-
nings for registered nurses In such speaalty Units as Cardlo-Vascular,
Operating Rooms. Nursenes. and General Medical-Surgical areas
Hurley Medical Center has excellent salary and Innge benefits Be.
come a part of our progressive and well qualified work force Today.
Apply Nursing Depa
ment, Mr. Garry VIele, Associate Drrector of
ri)''?66
l Medical Center, Flint, Michigan 48502 Telephone
CUBa
r
Assignment
Overseas
Challenging positions for nurses
interested in community health.
Colombia: To develop rural public
health programmes and a
training programme for
paramedical personnel.
Ghana: To instruct in Schools of
Nursing (Psychiatric Nurse
Tutor).
For more Information please contact:
CUSO - Health - 11
151 Slater Street
Ottawa, Ontario, K1 P 5H5
CUSO
University Nursing
Faculty Positions
Community Health
Medical-Surgical
Master's degree and teaching
experience required. Excellent
personnel policies and fringe
benefits. Rank and salary
commensurate with education and
experience. Positions available:
Fall, 1977.
Write to:
Miss Kathleen King, Dean
Faculty of Nursing
University of Toronto
Toronto, Canada
M5S 1 A 1
December 1976
Intensive Car. Nurses - Because of a major expansion program II
our IntenSive care facIlities, several posItions m vanous mtenSI\/e carE
settings are available We are looking for experienced nurses fa/
medical, surgical, cardIOvascular, coronary. respiratory, and neuro
surgical Intensive care areas We are a 450-bed teaching hosplta
located In a university setting. Recreational, cultural. and educatlona
opportunities are available wlthm the Immediate VICInity. Said[)
commensurate with experience and education; Trlnge benefits supe
rlor Wnte to: Mrs Dorothea Kneger AsSIstant to the Director for
Staffing, UniversIty of Kentucky, UniversIty Hospital, lexington, Ken
lucky, 40506
Practice Total Nursing In a vanety of supportive environments
Opportunities Include: expanded use of Pnmary NurSIng; ICU/CCU
all other subspecialities. You can realize your nursing potential In one
01 our 17 hospllals (ranging !rom 15 to 570 beds). ContinUIng educa.
tlon programs keep your skills up-to-date and can prepare you for é
management role. Work where you're appreciated and make the most
of your free time at famous U.S. National Parks and at well known ski
resorts. Contact: Gall Clark, Nursing RecrUiter, Intermountain Health
Care, Inc., 36 South State, SUIte 2200.C, Salt lake CIty, Utah,84111,
(801) 533-8282
Head Nurse
with preparation and/or
demonstrative competence in
Psychiatric Nursing and
Management functions, required for
Head Nurse appointment. To be
responsible for partici pation in the
organization, initiation, and the
management of a New Psychiatric
In-patient Unit.
Please apply, forwarding
complete resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6.
Required immediately a Public Health
Nurse for International Grenfell Association
Nursing Station at Hopedale, Labrador.
Post involves the provision of generalized
public health nursing programs within a
multi-culture setting in the Labrador
communities of Davis Inlet, Hopedale,
Makkovik, and Postville.
Qualifications: Public Health Nursing or a
Baccalaureate Degree eligible for
registration with the Association of
Registered Nurses of Newfoundland.
Salary: $11,781. to $14,401. per annum plus
Labrador Allowance.
Accommodations provided at subsidized
rates. Working conditions in accordance with
Nurses collection agreement. Travel paid for
minimum of one year service.
Apply: Mr. Lloyd Handrlgan
Personnel Director
International Grenfell Association
SI. Anthony. Newfoundland, AOK 4S0
The Canadian Nurse December 1976
51
Advertising Rates
!
CED\
E
1EAOi'
For All Classified Advertising
$15.00 for 6 lines or less
$2.50 for each additional line
THE MONTREAL GENERAL
HOSPITAL
Rates for display advertisements on request.
Closing date for copy and cancellation is 6 weeks prior
to 1 st day of publication month.
A McGill University Teaching Hospital
Requires
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.
NURSING DIRECTOR
SPECIAL SERVICES
Address correspondence to:
(Obs-Gyn, Psychiatry, Neurosurgery, Burns& Isolation)
Requirements:
Baccalaureate in Nursing
Eligible for Licensing in Quebec
Previous Administrative Experience Essential
The Canadian Nurse
Send Resumé To
50 The Driveway
Ottawa, Ontario
K2P 1 E2
.
The Director of Nursing
THE MONTREAL GENERAL HOSPITAL
1650 Cedar Avenue
Montreal H3G 1 A4 Quebec
II
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OPPORTUNITIES
FOR REGISTERED NURSES
The Montreal
Children's Hospital
J
with Post graduate Diplomas
Outpost Nursing/Midwifery/
Advanced Practical Obstetrics
Registered Nurses
Nursing Assistants
.
An opportunity to join the N.W.T. Medical Servi.
!;es involved in meeting the health needs of the re-
sidents of the Northwest Territories. Nursing sta-
tion positions offer work which IS demanding, re-
warding, often frustrating, but always interesting.
A spirit of self-reliance, sound judgement and a
sense of responsibility is essential. You will be in-
volved in providing emergency treatment, short
term in-patient nursing and community health ser-
vices to the residents of settlements in the North-
west Territories.
Candidates must be registered or eligible for regis-
tration as a nurse in a province of Canada with a
post graduate diploma in Outpost Nursing. Mid-
wifery or Adv Pr" Olistetrics. Previous
0::)1')1 lion Canadians must have
ra- StdtuS in Canada. Proficiency
, F ng nguage IS essential.
For applications and information, please write Per.
sonnel Administrator, Medical Services, Northwest
Territories Region, Health and Welfare Canada,
14F Baker Centre, 10025. 106 Street, Edmonton,
or call collect area code 403-425-6787.
Our patient popuialiOn consists of the
baby of less than an hour old to the
adolescent who has just turned
seventeen. We SE'e 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.
'. ..
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If you do not like working with children and
with their families, you would not like it
here.
.;,;:
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If you do like children and their families,
we would like you on our staff.
Interested qualified applicants should
apply to the:
. . Health and Welfare
Canada
Sante el Bien-ëlre social
Canada
Director of Nursing
Montreal Children's Hospital
2300 Tupper Street
Montreal, Quebec, H3H 1P3.
..
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The Canadian Nurse December 1976
..
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Hotel DieD . . . An Urban Hospital
In the center of things
Located in New Orleans, the center of commerce and
recreation for a major portion of the South, Hotel Dieu
offers you, the Canadian nurse, something special in
professional development. If you are looking for a place
to grow, we invite you to join other Canadian nurses now
on our staff.
Hotel Dieu is a modern, private, non-profit 461-bed
teaching hospital with a complete range of services,
except for psychiatry. We are affiliated with major uni-
versities in our area and offer continuing education
programs to assist our personnel in expanding their
professional skills. If you are a recent nursing graduate,
H
o
s p
our nurse internship program will help you make the
transition from student to staff nurse while earning a full
staff nurse salary. We are the only hospital in New
Orleans with a complete unit management program
which frees you from time consuming non-nursing
duties to allow you more time for total patient care.
Relocation reimbursement, housing assistance, all visa
arrangements, and liberal fringe benefits are all good
reasons to find out more about us. Write Ross McStay
today or call him collect for information, area code 504.
588-3196.
Dieu
TAL
P,O. Box 61262 . New Orleans, La, 70161
An Equal Opportunity Employer
r
The Canadian Nurse December 1976
Assistant Director of Nursing Services
for the
Capital Regional District Community Health Service
Victoria, B.C.
Salary: $2100 per month (single rate)
In cooperation with the Director of Nursing Services to plan, organize, and
control a diversified program of public health and home care nursing
services provided to the residents of the Capital Region. As a member of a
management team the Assistant Director of Nursing Services will playa key
role in planning and developing special nursing programs, assisting
supervisory nursing personnel with the implementation of such programs
and providing information regarding the nature of nursing services to
various community groups and other health and welfare agencies within the
community. The successful applicant will also be required to assist with the
day-to-day administration of a collective agreement covering approximately
one-hundred (100) public health and registered nurses. participate in
contract negotiations on a regular basis, assist with personnel selection,
develop and foster in-service and continuing education programs for
nursing staff.
The successful applicant will be required to work with a good deal of
independence, be innovative and capable of making decisions with a high
degree of objectivity while developing and maintaining good working
relationships with all health department personnel and representatives of
various community agencies.
Applicants should possess a Master's degree in Nursing with a major
emphasis on community health nursing and administration. Preference will
be given to those applicants with a minimum of six (6) years public health
nursing experience in more than one area, and of which, at least four (4)
years have been at a responsible supervisory level. Applicants with a
Bachelor's degree in Nursing combined with considerable previous
supervisory experience will also be considered for appointment to this
position.
Candidates should be registered or eligible for registration in B.C. and
possess or be capable of acquiring a B. C, Driver's Licence.
The Capital Regional District encompasses an area of 950 square miles
and consists of seven municipalities and seven electoral areas located on
the southern tip of Vancouver Island in a unique geographical location. The
urban hub of the region is the metropolitan Victoria area which has a current
population of 220,000.
Written applications giving details of education, training and work
experience together with appropriate character references will be
received by the Personnel Administrative Assistant, Capital Regional
District, P. O. Drawer 1000, Victoria, B.C. V8W 256 at the earliest
possible date.
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grow
with us
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University of Kentucky
Medical Center -
a progressive tertiary care center
oriented toward service, teaching
and research.
We offer-travel and moving
allowance-salary commensurate
with experience and
education-three weeks paid
orientation-three weeks
vacation-10 holidays-sick leave
benefits-paid tuition
benefits-inservice and continuing
education-professional freedom
and growth.
r----------------l
Wrilelo:
Mrs. Dorothea Krieger
Assistant to the Director for Staffing
Department of Nursing
UNIVERSITY HOSPITAL
University of Kentucky
Lexington, Kentucky 40506
Name
Address
City
State
Degree _
Date of Graduation
Zip
An EqualOpPOftumty EmplOyer
54
DIRECTOR OF NURSING
Vancouver, B. C.
Applications are invited for this senior management
position, which requires a positive and innovative
approach to nursing care planning and management.
Applicants must have management experience in
nursing. A Baccalaureate degree in nursing, couples
with management training, is preferred. This position
becomes vacant in April. 1977, because of the
retirement of the Director of Nursing.
The G.F. Strong Rehabilitation Centre is a 100 bed
specialized rehabilitation facility, which will shortly be
Increased to 150 beds. The Centre provides services to
physically handicapped adults and children on both an
inpatient and outpatient basis.
The Director of Nursing will have the responsibility for
operating and expanding a specialized nursing service,
which includes educational activities.
Reply in confidence, giving full personal and
professional particulars and salary expected to Mr.
E.J. Desjardins, Manager, G.F. STRONG
REHABILIT ATION CENTRE, 4255 LAUREL STREET,
VANCOUVER, B.C. V5Z 2G9
Assistant Director of Nursing
Inservice Education
. OPPORTUNITY and . CHALLENGE is yours in
. Designing, co-ordinating, implementing, and evaluating
the Inservice Program for the Nursing Department.
. Directing your nine staff members in accomplishing
Inservice Program goals.
. Participating as a member of the Nursing Management
Team.
. Promoting the quality of nursing care.
. Working in an 825-bed hospital affiliated with the University
of Manitoba.
. Receiving salary commensurate with education and
experience,
Applications are welcome from nurses:
. Currently registered or eligible for registration with the
Manitoba Association of Registered Nurses.
. With Master's in Nursing or related area.
. With five years experience in Inservice Education.
. That possess initiative, creativity, and drive.
Apply In writing to:
Mrs. P. McGrath
Director of Nursing Services
St. Boniface General Hospital
409 Tache Avenue
WINNIPEG, Manitoba
R2H 2A6
The Cenadlen Nurse December 1976
Director of Nursing
Chilliwack General Hospital
Chilliwack, B.C.
Applications are invited for the position of Director of
Nursing.
Applicants should have successful supervisory or
nursing administration experience - Bachelor or
Master's Degree desirable.
The Chilliwack General Hospital is a 289 bed accredited
regional hospital (including 96 extended care beds) and
is situated 65 miles south-east of Vancouver.
Please reply in confidence to:
The Administrator
Chilliwack General Hospital
45550 Hodgins Avenue
Chilliwack, B.C.
V2P 1P7
Senior Consultant
the Department of Continuing Education and
Manpower, Instructional Planning & Evaluation,
requires a person to co-ordinate new programe
development in Health Manpower Education and
improvement of present Health Sciences programming.
Determining suitable educational methods; managing
pilot projects and conducting program evaluation in
conjunction with College staff,
Applicants should have experience in teaching and
administration in nursing education; graduate work Or
equivalent in education and experience; planning
ability.
Salary: $18,702 - $24,067 per annum
Apply in writing referring to # VWL 272 on or before
December 27, 1976
Personnel Department
Community Colleges Division
Room C-410 - 2055 Notre Dame Avenue
Winnipeg, Manitoba
R3H OJ9
The Royal Melbourne Hospital
Victoria, Australia
Qualified Nurse Teachers
This major acute general hospital of 702 beds, situated 1 mile from the
city centre of Melbourne provides Nursing Education for
approximately 500 student nurses. A variety of Post Basic Courses
are conducted.
The School of Nursing IS located in a recently completed complex
adjacent to the Hospital
Positions are available for those who wish to participate in developing
an expanding curriculum for general student nurses.
For those Interested in CLINICAL TEACHING, The Royal Melbourne
Hospital offers excellent opportunities In medical, surgical and
specialist units.
Salary and allowance for Nurse Teacher (Diploma or Certificate)
according to experience will be based on the Determination of the
Registered Nurses' Board in Victoria and will be in the range of A$187
-AS230 per week (UK E134-UK E165, N.Z. $234-N.Z. $518,
C. $225 - C. $276.).
A single economy class air fare will be refunded when the successful
applicant commences employment.
For further details, please write including information about
training and experience to:
The Deputy Director of Nursing (Administration)
C/- Post Office
THE ROYAL MELBOURNE HOSPITAL
VICTORIA, AUSTRALIA
Associate
Director
of Nursing
Applications are invited for the position of Associate Director
of Nursing in a 500 bed accredited general hospital.
The Position:
As a memberof the Nursing Administration team, this position
requires a nurse with innovative qualities and ability to
organize, delegate. and direct the work of others.
The applicant must have an enthusiasm for initiating and
following up new ideas. projects and programmes,
Minimum Qualifications:
Must be currently registered in the Prc lce of Ontario.
Preference will be given to candidates ..,th a B.Sc.N, and
experience in Hospital Administration.
Apply in writing to:
Director of Personnel
Belleville General Hospital
Belleville, Ontario
KBN 5A9
TM Canadian Nurse December 1976
55
CD
'.
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Open to both
men and women
Health and Welfare Canada
Medical Services - Nortwest Territories Region
Frobisher Bay, N W.T.
COMMUNITY HEALTH NURSE
Salary: $13,298 per annum plus Isolated Post Allowance
Ref, No: 76-E-1765 ICNI
Duties
The mental healthlpublic health nurse is responsible for
identifying mental health problems in the community, plan-
ning for and providing support and gUidance for persons
with mental hea:th problems, referral for care and treat-
ment, and Implementing generalized public health nursIng
programs in the community.
Qual ifications
The candidate must possess eligibility for, or registratIon '"
a province or territory of Canada. A certifIcate in Public
Health Nursing or in a specialty relevant to the duties of the
position or Baccalaureate Degree with specialty courses
relevant to the duties of the position is required. Nursing
experience and demonstrated competence in psychIatric
nursing is desirable, Proficiency in the English language is
essen ti al.
For information, onterested applicants are encouraged
to call (4031425-6787.
How to Apply
Forward completed "Application for Employment" (Form
PSC 367-4110) available at Post Offices. Canada Manpower
Centres or offices of the PulJlic Service Commission of
Cani/da, to:
Public Service Commission of Canada
300 Confederation Building
10355 Jasper Avenue
Edmonton, Alberta T5J 1Y6
Closing Date: December 31,1976
Please quote the applicable reference number at all times.
511
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...in Canada's
Health Service
Medical Services Branch
of the Department of
National Health and Welfare employs some 900
nurses and the demand grows every day.
Take the North for example. Community Health
Nursing is the major role of the nurse in bringing health
services to Canada's Indian and Eskimo peoples. If you
have the qualification'i and can carry more than the
nonnalload of re
ponsibilit) . .. why not find out more?
Hospital Nurses are needed too in some areas and
again the North has a continuing demand.
Then there is Occupational Health Nursing which in-
cludes counselling and some treatment to fedeml public
servants.
You could work in one or all of these areas in the
course of your career. and it is possible to advance to
senior positions. In addition. there are educational
opportunities such as in-service tmining and some
financial support for educational leave.
For further infonnation on any, or all. of these career
opportunities, please contact the Medical Services
office nearest you or write to:
........,
I Medical Services Branch I
Department of National Health and Welfare
Ottawa, Ontario K1A OL3
I Name I
I Address I
I City Prov I
I I .. Health and Well are Sante e\ Bien-é\re social I
Canada Canada
..........,
The CanadIan Nurse Oecember 1976
Index to
Advertisers
December 1976
The Canadian Nurse's Cap Reg'd
37
The Clinic Shoemakers Cover 2
Equity Medical Supply Company 21
International Development Research Centre 49
J.B. Lippincott Company of Canada Limited
28. 29
Procter & Gamble
Cover 3
Reeves Company
5
W,B. Saunders Company Canada Limited
3
The Uniform Shop of Peterborough Limited
31
Uniforms Registered
Cover 4
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.
BæEI
1976 INDEX
JANUARY-DECEMBER 1976
VOLUME SEVENTY-TWO
VOLUME 72
THE
CANADIAN
NURSE
ð
Official Journal
of the Canadian Nurses' Association
LHa:'D
A AÞ'tract E EduOI'"idl
Ja boo..-)' JI Jul)
F - FcbruaC) Au August
Mr M..ch S September
Ap Apnl ()ç October
1\.1) M.) N - Nmembcr
Je - June D December
-A-
.\BIJOT1. Juan \.
Olnlca1 nurse speclah
l. Lak.cshorc Psych.atnc "O!'op.tal. S8Au
.\BORTJO'
\\har are the: bonds be[Vr"een the: 'cru.!t and the uteru.!t:) tAdamkle-
WICl) 26F
t
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Bk rev 5
M)
4.CCREDITA TJO'
CAL Sro. Commillee on Accrednd.hOn awarded financial suppon b}
CNF. I!S
Canadloln Nur.-.es A
lallon statement on iiIILcredlL1lion. -1213
In.lallon hits Accrcdlldllon Council. I-Ile
N." CCHA @u.de. 16Ap
ACHllH.\U.'TS
A clinical C'"aluatlon 1001 lor srudcm nur"'loC!!o. I Monon _ .ct 011) 371e
.\Cll'l ,cn RF
The eflects of dlfterent technique... of acUPUOCruTC on knee pam.
t RdITl,ey) bOAu
.\DA \I/oJE\\lC.f. \ inc.nt \\.
What él'"C the bonds between the fctu!lo and the uterus')
6F-
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Home care after surgery lor scohosls. (RcldJ .13'\1
NWSlni! and related needs of )ouni! adults '-"Ith posltraumati('.
spUlal cord lesions In the home. (Tubman) A. -ISla
ADOLPH l S. Patricia
Slro};t'. {t'l al. .-IF
Sunn)brook
Iroke le.tm - an mno".tllve expenence. 16F
.\FFLEC..., Joan
Facull) L'nl"crslty of Alberla. -I1F
U'GH.\"
TA'
Anna Claire M.cAdam ,,"Ih CARE/MEDICO,
JD
.\I BERT.\ .\SSOCl.\TlO' OF RlGISTERED" RSf.';
Celebr.ues. diamond Jlbllee. 1-I1\1r
Helen Sabon. EDXECUllVE Dircclor,
JD
Jane Bennen Bogart. Employment Relations Ot licer. -I1D
Mar@:.el M'lchelJ. .. 'lwSot' of the Year" award. J.JS
Mar@:aret M. Sb'eet. ""Honor.v Membership". (port) I-IS
Robert [)c)nahue. AClm,g Dlfector of the Collatlve Bar
.tmm@:
P'O@I'olIJI.
JD
Suppons um,"er
lt)' education for all AIt)Crla nurse
by 1990. II S
'"onne Chapman. Executl"e Director. Cport) -I3Ð
ALBERT.\ \lE,nL HE4.LTII AD\lSOR\ CO! 'CIL
Re...earch 1010 'health poI.enlJals . 7Ð
ULA '. John \.B,
The Idcntdicauon and b'eatment 01 dlflicult bablCs II Ð
.\ \fBl LA 'CES
Tr.Iß:o.por1 01 neonotlc!lo .. motller 01 pre"enllon. IJohn,on. G.c.hl
19M)
..\\lERlC\.' Ll'G ASSOClUIO'
Nwsmi! fellowship. I-iAu
.\\lERICA' 'l RSES .\SSOCl.\TlO'
NU'II and ANA app-ove plotn:!> lor U
",-reemng aeencv. 9J1
A'DER.'iO'. Jean
Flddlehead SUIV1:!>e. (panl IOJ3
.\'DERSU'. Joan
B.... rt".. 5.Ue
.\ "It RSO'. Joan \Lodge
The concernsilndcopmi! beha" lor
ofthe 5ln@:le moI.her v..uha(.hlld
Bled !IoIJl. months to eight years. A. -IMM)
"TI-"tL\1I0' BO.\RD
Is.sues bulletll)5 on compcn
tlon gUJ(lch
. 10JI
Rl' .\ 'D. LlSett.
Member-at-large. nun.Iß@: educallon candldale (,"lA. (port) 27Ap
.\R\I
TRO'(;. Jean
Retired re@:looal nursm@: SUpcrVlo;.or. I !II
AR \lSTRO'(;. \I
rgaret
Bk re," . SOJd
\SSOCI.\TIO' tOR TIlE C.\R"- Ot CHII DRF' " HOWl.
TALS
Edmonlon group recenoes. charter. 12My
..\SSOCI..\TIO'I. O
RE(;I
TERED 'lR'f.'; tit
'E\\FOl'DLA.'D
Twenty-second annual meellng. ION
ATTITlDE
PreJldlce 10 nursing. (Brlann :!6Je
RN/.BC members to explore profCS30lonal atll[ude
. 11M)
AlDIO\lSlAL
48F.
8Mr. S2Je. 6!Au, SON
Al DIO \ ISl.\L AIDS
About concepllon and conb'aceptlon ..J8F
After maslectcm). 51Je
An alfalr of ,he hear! SON
A
lgnment. 52Je
A ba'ic dJ'p-O.lçh to the elecb'"ocardlogram. SO,
Becoming.
8F
Breasl self.eumlnallon and time and two women. 521e
Britt. Mar@:aret. Films on the health sctCnce
. ..JSF
Brochures. 62Au
/. cancer source book for nurs.cs. S2Je
Chronic bronchitis and pulmonar) emph)sema. 62Au
Circulatory connol.
Or..
Common heart dl
ordcr:<t. and their cau
. .5ON
DNA. 62Au
Diet sheets. 6:!Au
Earl) dlagno:<t.l
and mana,gemenr of brC'd't cancer. 5:!.1c
Ea..y eallni! "'Ith Canada's food gUide. p.u11. -IMF
The elusive enemy. 52Je
Feelin' great.
Ol"ll
A fight tor breath - emph)"'IoCma. ..JMMr
Film Index. 62Au
Food and tltllCss. 61Au
For thos.c who dnnk.. -ISMr
A @Iobal app-oach. 6
Au
Health and Welfare Cdn.lda pdmphlets. 62Au
HelJo worM. .JSF
Help" .
8F
Idiopathic
oho
I
. 50
Introduction to congenItal heart dl!OCase. 50
Kmi! SIZC. ..JSMr
Managemenl of chromc re!tpuodor) lru.ulhctCnc). 6:!Au
A matter of fat. 62Au
Ne", pcruxhcal - "C.dlopulmonar) commcntar) ". .sof\.
Nutrition. 6:!Au
One Tue".)a). SON
Our hc.trI and (,lfculallon.
ON
Prt"entmi! pre!osure ...ore
. 61Au
Ps}'cho
y 111m catalog. 62Au
Pulse of life. SUN
Purposes of family plannmi!. -I8F
Recovery ahcr maslcctomy. 5:!.1e
Robin. Peter and Darryl Itree to 'he hasp"al. SO!\.
Story boarding - a tellChmi! tool. 4 DubIO... et all 4:!.Jc
The SUaJ@hl ChIld, SO!\.
TCdchmg the TV @:enerauon "multi media 10 fo..u:!>"" 15Je
To (ake a hand. 5
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VD - fael or fanlas
.
8F
We can help. S2Je
Your heart is
OUt heal.h. SON
A\\ARDS
Alumnae ASSOCiation 01 Monb'eal General Ho
pllal awards. 3MF
Arnencan Luni! A
nurslßi! fellowship. I-iAu
Ann Shepherd Fen"'lck CNF scholarship and Helen McArthur
Cotndd,an Red CrG . Fello","shlp. )JOe
Cl"IIF contrlbullon. 16Ap
C'l/F schol..-s. I JO<-
CTRDA nursIß8 fcllo",",hlp. I5Je
Canadian DiabetiC Assocwtlon !Iopon!j,.Q(s bW
Jle
. 10Ja
Carol)n MarlC Pð"c"ma. Kdthlecn Elhs Pnzc. 'porn 5
-\u
III
Catherine M...QUIM aw..dcd cerll......le from Hblth and Welf.-e
Canada.
IM)
Constance Ian Becker. CNF .....hol.sh.p I J()(
Cora M..-oc Pnce Agnes Camp""l1 Memoraal A..",d and CN
schol..-shlP, I JOe
Donna ledn Rue. CNf S( lar..h.p. 110c
Donna Lynn Smith re\.elved @:rant Ii m Alberl.il Menial Health
Ad"I\OI)' Council. 7D
Fronller opportunity 16Ap
GenC:va le"'l
Onho award. Hf\.
Helen Bermce Giifl)'. CNF schobrsh.p. 1\0..
Hmpital for Sick Children Foundallon
;rïint to June Kikuchi. -I-IMr
Jane Buchan. CNF schol
hlp. 130e
Janruce E Moore awarded 1975 Canadldn LlCpnd Au Lid a",.d.
(porn -I4Mr
Jeanette FunLe rece."ed@:ranl (rom T orOl1(O SI(.k Children s Hosp'-
tal Foundation. -130
Jud
HIli Mcmor...1 Schol..-sh,p. I
S
'1d1)' Dohey aVo'.udcd lhe Cros
of \ alor 1SF
\b
LouIse McSheflre). C!\.F schol,...h.p. 130c
\I..
Louise McShefl...
. While Sisler Incorpor.cd Schol..-slup.
13()ç
\tdl}' Pack tlrsl woman to recel\o'e Royal Bank Award. (por1) I:!.II
1975 Warner-Lambert Canada Limited Nur
lni! Fellowship aw.d.
I
S
'.Nurse of the Year"" aw.d. I-IS
Peg@:)' Û\o'enon. Cal'Yda Council Gf3.nt. ðN
Rodney Schneck. C.in.lda Council Grant. K'
Specialty
holél'""hlp available. 9D
Support grow
tor
holar!o,hlp .,el'k.}'. 12Au
Ten awards tor "mld c.ccr prole",...lonab"". 7D
U 01 A @:raduale schol.u,hlp 10JI
Wer.d
L
nn Mc"'mp.l. C'l/F scholar>lup. 110e
-B-
BAl'''. Jean
Chief !tUpcrmtendcnt St Jd1n Ambulance Bn@:ade In Canada.
-I4Mr
B-\<"O'. \Ionica
\iolffimdtherm. a "'cdpOn In the h,ghl dJ!!otm!lo1 brtd!lol (.otI"M..er. :! 1Je
B .\ILE\.
. JO)c.
A
IManl ddml'u
lralor poltlent
Cf'\o'I(.e
. Welle,"Ie) H
p"al. To-
ronlO. I..JS
HAl', H. \\,
An educational pr
ramme tor nurY: pr-dCtlUoncr (el all A. "'Xla
B.\J'O.... Innajean
A comparison of the qualit)' 0'- c.ue pro" Ided b) re81
ered nußC,"
workani! the tweh'e hour !JUtl and tl'1<bc ",ur"'m
the eight hour
!IoI'nft m a lar@:C generotl ho
pllotL A. -IMJa
B-\L-\. Sharon
Operation commumcallon. n,
8..\RR, Laura
Lea'es R'l/AO ne.. moo/h. (porIl 130e
B.\l \/IARY. .\lIce Jean
Pr.",de...elccl CN/.. Ipum HAp
B.\l \I(;.\RT'ER. "urt
Anu-
mok.ini! group appoanb encutl,"e dlro..tor 9F
BA\\DE'. \lar) EIi.rabcth
Chrucal ",ord:!>earch. 11JI. 39S ..J
D
BE.\fLE\. Carol
Nw:o.mi! and p1annmi! officer. 'ou SUMlii Emergenc) Health
SCI""ICC I:!.II
BECI\.ER. Con!lolanc
Jan
CNF scholar, hip. 130e
IJElIHIOR
The concerns and coplni! beha"l<<n of the single mother tAndcr-
sonl A.
8\1
BEL TO'. Sbctla
President. SRf\. -\.. 12Au
Bt'TLE\. Elinor \largarct
M
mbcr-.lt-loIf
c. ,"-"-1.11 and .: "11\ mlc \\dl.uc ....mdldale C,-\..
IporI' 1O.-\r
BER(;LLND, Mary
M.y Ber@:lund: backwoods nurse, (Bergstrom) 445
BERGSTROM. In
nd
Mary Berglund backwoods nurse. 445
BERTHFI OT. Hel"...
Director of nUf'\mg. Dou@:las Hmpital. S8Au
BERTR-\'D. M.ri...And....
Whar does "the quality oflifc" mean 10 you'? 26M}
BE.."EL. Lorine
Canadian nur
s to participate in InternatIOnal seminar. liMy
Member-at-large. nur'\mg p-8cbce candidate CNA. (port) 2RAp
The ups and down.. of commuruCalion. I 'F
BIC"NELL. M. Marguerite
Member-at-large. nursmg adminl",tralion candidate CNA. (port)
26Ap
BIFTSCH. Elizabeth
Director of Nursmi! of the Medicine Hal General Hospital. 4Blc
BLAC" \\ EI L, Grace
Ollic..- OOHNA. 41My
BLAIS, Nicole
Cross-Canada rc@:...rrauon. 22Ja
BII:\ D:'IiE:SS
Bhndness can be p-cvenled. (Doner) 271a
BOGART, J.ne Bennell
Employment relatIOn, officer. AARN. 43D
BOIS \ ERT. Cecile
Convalescence following coronary surgery: a group experience
26N
BOO" RE:\lH\S
Andreoli. Kathleen G.. ct al. Comprehensive cardiac care. s.J.N
Arndt. Oara. Nursing admirustraL"-,1); theory for practice with a
systems 3J>p-oach. (Huckaby) 6JAu
Azarnotl. Pat. A pediatric play program. (Flegal) 55Je
Baltimore. Hugh Smith. Public health and communit} medicine.
(Bunon) S2My
Becknell. Eileen. System of nursing practice. a climcal nur
ing
a"e'..ment tool. (Smith) SOJa
Beland. Irene. Chmcal nur"iing. (Pa..."iO'ì) 46F
Block. Bartle) C.. M.m. microbe.. and malter. 51M)
Bro
n. Marie ScOIt. Ambulatory pediatric.. for nuro;;cs. (Murphy)
64Au
Burkhalter. Pamela K.. NW"ilng care of the alcoholic and drug
abuser. .54Je
Burton. Lloyd. Pubhc health and commumt} medicine. (Balti-
more) S2My
Chinn. Pegg)' L.. Maternal and child nursing. (Goer-zen) 50Ja
Creighton, Helen. Law every nur
should know. 46D
Epstem. Charlolte. Nur..mg the dYIIlg. patient. 46F
Fielo. Sandra B.. A ...ummary of inteE!rated nursing theory. 54Je
French. Ruth. Guide to dla,gnO'otIc procedure... 48Mr
Goerzen. Jamce L. Molternal and child nursmg. (Cbmn) SOJa
Golanty. Eric. Human reproduction. S4N
Grubb. Reba D.. Desi,gning hO!'opital training programs. (Mueller)
46F
Hamilton. William P.. Decl
ion making in the coronary care unit.
(Lavin) S6S
Hardyck. Curtis. Under"landin,g research in the social science...
(Petrinovich) 64Au
Health and Welfare Canada. Special care unit... in ho...pnals. 64Au
Hubner. P.J.B.. Nur
.. guide to cardiac momtormg. 480c
Hughes. Jame, G.. et al. Synop...is of pediatric", 55N
Jones. Peler. Llvmg with haemophilia. ..JROc
Katchadounan. Heranl. Biological aspect.. of human ..exualuy.
(Lunde) S
Je
King. Ouida M.. Care of the c..-diac surgical patient. 46D
Kubler-Ros
, Elisabeth. Death the final slage of growth. 511a
Lawrence. Margarel M.. Young inner city families: developmenl
of ego strength under stress. 46D
Mooney. Thoma.. 0.. Sexual options for paraplegics and quadri.
pleg.ics. (.. .el al) 63Au
Mueller. Carolyn J.. De..ignin
hospital training program
,
(Grubb) 46F
Oak\.. Wilbur W.. Cntical CMe medic me. 4SMr
Passo.... Jo}ce Y.. Chmcod nur"ng. (Beland) 46F
Phibb.... Brendan. The human heart: a guide to heart di
a
. 47 Ap
Prudden. Bonnie. How to keep your family fir and heollthy. 50My
Robertson. Elizabeth Chant. The right combination' a@:uidetofood
and nutrition.
OJa
Ross. John. Under"itanding the heart and its dl
a...e"i. (O'Rourke)
S6S
Russel. Ruth 0.. Freedom 10 die; moral and legal aspects of
euthana..la. 55N
Saxton. Delore"i E. Care 01 the patient.. with emohonal problem...
(Haring) 54Je
Schurr. M.. Nurses and mana@:ement. 52My
Shafer. Kathleen. Medical surgical nursing. (el al) 51 My
Skillman. John Joalum. Intensive care. 480c
Smith. Dorothy M.. System of nursing p-actice. a clinical nUTSlng
8sse"sment root (Becknell) SOJa
Spradley. Barbara Wallon. ed.. Contemporary community nur-
sing. SOMy
Towell. David. Underslanding psychiatnc nur...mg. 41Ap.
Van Meter. M..-garel. How to read an E.K.G. correctly. 54N
Verhomclc.. Phyllis J.. Nur"iing re..earch I. 55N
Was\on. John B. 1ñe common symptom gUide. {.. .et al} 63/.u
Weisenberg. Matiliiyohu. ed . Pain: clinical and experimental per-
spectives. 48 Mr
BOO"S
SOJa.
6F. 4HMr. 41Ap. SOMy. S4Je, 63Au. S6S. 480c. SON, 46D
BRA D\. k.athleen Flononce
Died Nov.mbcr 1975,
HJe
BRA YTON. Ma
aret
Recent gue'I 10 C.N.A.. (port) 9D
BREAST
Breast cancer. (Butler) 17Je
MdlTlmatherm; a weapon in the fight agamst breast cancer (Bacon)
23Je
BRIANT. !'ion J.
Prejudice In nur"iIDg. 26Je
BRO\\ '19 Catherine
Living with cy..tic hygroma. 17M"
BI CHAN, Jane
CNF scholarshIp. 130c
Completed contract with CUSO in Malaysia 130c
BI R"E. Debbie
Heallh help..-s. (. .et an 11D
BI RRO\\S, Susan
Alumnae Association of Montreal General Hospital award 38F
BI RSARIES
See Awards
BI TLER. Ada
Brea"'l Cdncer. 17 Je
-C-
C:-O \ HOISE
Burnmg of the mortgage. 12Au
CJ.SO
Jdne Buchan compleled contf3.ct In Mala}"'I3. DOc
CAHOON, M.C.
An educational progf3.mme for nurse practitIOners. (et al) A. 4RJa
CALE1'oDAR
I3Ja.
3F. 16Mr. 16M). 56Je. 14JI, 16/,u. I
S. S4OC. 4N. 4-ID
CAI\1P'\G'l/A, \1aril)n Je.n
Lecturer. Umversltv 01 Alberta. 43D
(' -\\IPBELL. Jo)ce M.
Nursing director at Lions Gate Hospital. North Vancomer.
C.
J8F
CANADA COI:'liCIi. (;RANT
Award... SN
C'\:\!\.DlAN "",..on \TION OF 1'1/1\ ERSIT\ SCHOOl S OF
'1/1 RSI:'IiG
Committee on Accreditation awarded financial support by the Ca-
nadian Nurliies' Foundation. 12S
IV
CANADI'\N CATHOLIC HFALTH ASSOCIATlO"l;
Jean-Marc Daou...t. Executive Director. 43D
CANADIAN COINCIL ON HOSPITAl. ACCREDITATlO'l/
Inflation hils Accreditation Council. 14Je
New CCHA guide, 16Ap
CANADlA'" COl '\jCIL 0'1/ SMO"I:IIG A 'l/D HEALTH
AnU-"imokmg group appomts executive dmxtor. 9F
CA'ljADlA"" HOSPITAL ASSOCIATlOr;
9th annual convention. 14Au
Notes on going merric. 1111
CANADIAN INTER:'IiA TlONAL DE:\ FLOPMF:IIT AGENCY
Relea.,e... new health care guide. 120c
CANADIAIIo MFDlCAL ASSOCIATION
Bob Wilson. Secretary Genef3.L. 145
CANADIAN ME:'IiTAL HEALTH ASSOCIATlO:\
Annual meeting. 8Ja
c.-\ 'l/ADIAN I'l RSE
E. (Hanna) JJa
From 19O5 10 1966, IIAu
Margaret Kerr. obil. (port) IOAu
CAN-\DI-\N :\l.RSES' ASSOCIAT10'
Admission of NWTRNA. 13Au
CNA Hou)C. burning of the mongage. 12Au
A conver
ation with the executive direclor. (pon) 44Ap
Executive director's report. 28Au
Financial statement,. 38Ap
Introducmg...your new executive. 26Au
Issues statement on fisæl constraints. 12S
Membership at December J I. 30Au
National "iurvey studies community nurses. 8Mr
Perspective. (Hanna) E. 4Ap
RNAO/CNA launch pliO! health project. 8F
Resolutions chart new course for national association in 1916-78.
32Au
A re1:ro..pective assessment. 27 Au
Statement on accreditation of education programs in the health
discipline,. 42Ja
Statement on nurses and health promotion. 42Ja
Support.. mternallonal convention. SF
To provide con"iultatlon service m labor relation... bD
C.-\"I;ADlA'I/ NLRSES' -\SSOCIATlO1'o. A"IAL MEETlNG
1976
See Canooian Nurses' Association. Convention 1976
CA'I/'\DlA'I/ Nl RS.'S' '\SSOUATlO.... BOARD 0.' DIREC-
TOR.';
Highli,ghts from the meellng of CN" directors in HahfBA June
18-19. 1976. JIAu
Proposed lee raise to be submitted to general assembly. 8Ap
Resolutions of the Board of Directors 10 the 1976 annual meeting
and convention. 41 Ap
C\'-\Dl\' "I;1.R.';ES' ASSOCI \ rlO"", B\L-\\\S
Re'òolutions of the Board of Director;, to the 1976 annual meetmi!
and convention. 41 Ap
CANADIAN 'I RS'-S' ASSOCIA TIO'. CO"l;\ E'TlO," 1976
AdffiJssion of NWTRNA to CNA. 13Au
All packed? 15Je
CNA Hou..e. burning of the mon
a
e. 12Au
Directory 01 member a!O",oclallon,. II N
Enjo} HdhlolX lor what II I" and lor "holt It wa.,. (Millen 3..JF
Official notice. 28F
Plenty of room for you and your famil)! 42Mr
Progr.om highlights. JSAp
Re..olutlons of the Board of Directors. 41 Ap
77776: Annual Meeting and Convention. 20Au
A ta,te of down east hospitality. 25Au
Ticket of nominatlom.. 24Ap
What doe.. "the quality of life" mean to you? (Bertrand) .:!6M}
Your nex.t CNA convenlion. 161a
C."'-\DI-\'I/ '1/1 RSFS' A""OClATlO'l/, LlBR-\R\
Dad you know) 9F
See Library Update
CANADIAN Nl'RSES' ASSOCIATION. TESTING SER\lCE
Blueprint committee studies comprehcn'\lve exam. SF
Financial
tatemems. 39Ap
CANADIAN Nl RSES' FOl'NDATlON
Annual and '\peClaJ general meeting. 42Ap
Annual meeting. J 6Ja
Awards. 130e
CAUSN Comminee on Accreditation awarded financial support by
tho CNF, 118
CNF scholars, J lOc
Contribution. 16Ap
Suppon grows for scholarship agency. 12Au
C.-\'ò.-\DI.-\'ò PIllLlC HE't.LTH ASSOCIATlO'l;
Awards. 8N
Did you know') J3Au
I
C.-\:\'ADlA"I TUBERClILOSIS AND RESPIRATOR\ DlSt.ASE
ASSOCIATION
Nursmg felJow'liihip available in 1977. ISle
CASADlA'I/ P\lI\'ER'iIT\ ?\!PRSISG STPJ)FNTS .-\SSOCI-\.
T10N
Srudenrs explore "images of rhe nurse". II Ap
CASCER
Breast cancer. (Buller) I7Ic
Canadian task force concludes annual pap smears not neces"ìary for
most women. 13Jc
Did you know...pap t.,... 911
Enforcc
proximity to stress in the client em'lronmem. (Vachon}
40S
Manunatherm: a weapon In the fight 3@:ainstbreastcancer.(Bacon)
1-U.
C.-\RDlOLOG\
An affair of the heart. (Duffie) 360c
Anatom,c and phYSIO]O,gIC dynamics. (Jessop) 225
Cardiac '76. 16Ap
Changes.. . 2OS. J8Oc. 15N
Childhood cardiac anomalies: a review. (Hendry. Milton) 28S
Con\lalescence foUowmg coronary surgery: a group experience.
(BoÎwert) 26N
Emergency care of th
acute MI. (Gauthier. Simoneau) J4.N
In-hospital cardiac education progf3.ms: the n@:ht to know.
(Stockwell. Tada) 12N
Over and ovcr. (Jes!'IopJ 200c
Self-concept of the myocardiaJ Infarction patient. (Cook' 130e
The thoughts and feelings of patients in the wailing period prior to
cardiac surgeI)'. (Rakoczyl A. 48My
Waitin,g for cardiac surgery. (Rakoczy) 300c
",'hat patients want to know about 'heir pacemaker.... 270c
CARDlO\'ASCl'LAR DlSE-\SES
Acute nursing care in the stroke umt, (Pallanu 18F
Convale
cence followmg coronar)' suriZery: a group experience.
(BOisvert) 26N
Dr. Mever Friedman'lIiii most recent commenb of nsk. l Hanna) E.
2N
Focu'\ on prevention. (Oka) I7S
Mr. Jones from head to toc. (Ford) 16N
A new look at cardiac catheterization equipmenr. (LeFort) 34S
Over and over. (Je
op) 200c
Perspective. (Hanna) E. 4S
Self-concept of the myocardial infarcllon pallent. (Cook) 130e
Stepping stone'\: a road to coronal} rehabilitation progf3.ms. (Jes-
SOp! IRN
Stroke, (Adolphu.., an 14F
Stroke rehabilitation - a creative process. (Graham) .:!2F
Suddon d..th, (W.hrl.y) 28N
Sunnyhrook stroke team - an innovative experience. (Adolphus)
16F
The transfer proce
s. (Lethbridge. et all 390c
Waltln!! tor cdrd'ac '\ur
er). tRdkoczyJ 100c
CARE/MFDlCO
Canol Ann Hartm two-year tour of duty in Hondurd
. (por1) 44Mr
Con'tance Swinton conlliiiultant In Solo. Indonelliii,a. (POrt) 38F
CARIBBEAN NIRSES' ORGANIZATION
Recent guests to CN.A.. 9D
CFNTRAL \ ENOl S PRE'iSl'RE
Mpnitorjn
centr.d \/enous pre-'io,ure: princlple'\. procedure
and
problem.... (KdY. Kearn'\) I SJI
CHAl;r!lrtiOl'r.. \lonique
Coordinator of protcslliiiional in'\peClion with the Order of Nur<;e... 01
Qu.bec. (port! 481.
CHAN, Healher
Bk. rev , 56S
CHAPMA:\, Jacq...lin. Suo
Principal invesllgator of federal study. 41My
<:HAPMAN, Y"onne
Executive Director. AARN (port) 43D
CHILD DE\ EI OPMEST
The Identification and b"eatment of difficult babies: early signs of
disruption in parent-infant attachment bonds. (Allan) liD
CHITTlC!I.. Ra. Mdnt)ro
Hononny Doctor 01 SCience degree. 14S
Tnbute to Margaret Ken-. II Au
CHOI-LAO, Agnes T ,H,
The sleep assignment. a way 10 learn problem solving. 34Au
CHRISTE:\SEN, L
Plan ot care: the young child on dialysIs (lrwm. et aI). 410e
CHRIST\IAS
Perspecllve. (Hanna) E. !D
CHRONIC DISE.ASE
N.S. hospice umt. 13Je
CLAR"'E. EUzabolh Mari.
Lakehead Umverslty faculty. 44Mr
CLARKE INSTlTI'TE OF PS\ CHlATR\, TOROSTO
Creates widows. self-help agency. 14My
Nursing publication and research award. 12Au
CLINICAL \\ORDSEARCH
(Bawden! 1311. 395.
2D
CODERRE, Louise
Aphasia: a nurse.s
uide to communicatm
with aphasIc", 21F
COLES, Eunie.
Semor Asslstanr Dire-CloT of NlJrsmg. Hospna1 for Sick Children.
Toronto. retired. S8Au
COLLECTI\ E BARG.-\I"I'G
A""ocial1on offers legal aid to B.C nurses. JOJa
CNA to prO\'ide consultation service in labor relations. 6D
Manitoba labor group. SF
N.B. negotiations reach stalemate. 12S
Plumprre visits bargaining officers' conference. 14Je
RNABC admits student members. creatcs labor relations dl\ISIOn
811
Tips on bargalnmg. II Ap
Tough luck! 71a
COLLEGE OF Nl RSES OF ONTARIO
Susan O. Smith. Nursing Practice Coordinator. 130e
COLLINS, Su...n
Alumnae Association of Montreal General Hospital award. JSF
COLOSTOM\
Specialry .schoJ.trshlp 3\o31Iable. 9D
COMMO:\'\\EALTH "II RSES' n'DERATIO"l
Recent guests to C. N A.. 90
CO\I\llNIC-\BLE DISEASES
Commumcable di'iieases and Immumzatlons. (Cranston) ].l1a
Smallpox eradication prognm almost certain to succeed. 14M)
CO\I\1l NIC 4. T10'
Adjustive and affective responselliii of school-aged children to a leg
amputation. (Ritchie) A. bOAu
Aphasia: a nurse's guide to communicating with apha...ic'ii. (Co-
d.rro) 21F
Medical slaft at Moose Factory hlghl) advanced communication
sy'\tem. 6D
Nursing via satellite. (Henderson) 3IJa
Opef3.tion ('ommunicatlOn. (&Ia) 37N
Perspectl\.e. (Hanna) E. 4F
That cup of tea. (Wan-en) ..JbAp
The ups and down<; of ('ommunication. (Be
el) 13F
VIP treatment prove'\ this ho""pllal reallv cares. (GranO :!.tn
Why? 3SMv
v
CO\lMlflolH HEALTH SER\ICES
Community nursmg Course offered by correspondence. 9F
10RC Investlgatcs role of traditional healers. 14My
The Idenllficatlon and treatment of dlftïcult bablcs_ early signs of
disruption In parent-mfant attachment bonds. C Allan) 110
Mary Berglund: backwoods nurse. (Bergstrom) 44S
Nationa1 survey studies communlt)' nur.-.es. 8Mr
New directions plotted for world health. 1111
Protest: photostcry. 19Au
CO:\GRESSES
AARN celebrates diamond Jubilee. I..JMr
Bnght future predicted for nursing re
arC'h. 6Ja
CNA supports 'ntemanonal con\oenllon. 8F
Canadian Menial Health ASSOCiation Annual meeting. 81a
Canadian nurses to participate in intemationa1 semmar. 11M)
Cardiac 76. 16Ap
Cooperation needed between menra1 health groups. (Canadian
Menra1 Health Association. Annual meetmg J 8Ja
Emergency health nurses. 8D
Habitat: quality of life on a global scale. CMart'u
J 28My
.Infanl nutrition: a foundation for Ia.'ioting health. M.uch 21. 1971
21D
NBARN work!ihop on cnsls intervention. 5Mr
Ontano nurse-midwives hold annual work\hop. 12M)'
Plumptre VI'\lt
bargalnmg officeß- conference. 14Je
Profcssions and publk pohcy. Toronto 9D
RNABC members to explore profcsslOnal attitude!i. 12M)
RNANS holds workshop on carin8 for aged. 9f
RNAO delegates examine nursmg power and proce'io'\. 12Je
Semmar m occupational health. 14Au
Seminar on chronic obstructive pulmonary disease. 70
Students explore '.Images of the nurse.'. IIAp
Teaching the TV genef3.tion .'multl-media In focu,,' . ISJe
Tips on bargamm
. II Ap
Workshop on fitness and lifestyle. IbAp
CO
SUMER SATlSFACTlO,,"
Enforced prmumity to '\tress m the chent environment (Vachon)
405
COSEHOGA COLLF<;E. 'l RS"G 01\ ISIO'
H..lth hc:lpors. (Burk. ., aI) 17D
CUD"', Caroillwas;..
SeU-concept of the myocardia) mlarction patient. l10e
COR \IIER. Simon.
NBARN pres.d.nt. 1011
CORONAR\ CARE U:\'IT
See Intensive Care units
CRUG. Ph)llis
Researcher. Edmonton Local Board ot Health. 110e
CRANSTON, Lynda
Communicable dl"loCa.'\es and Immunizations. 34Ja
Dire-Clor of Nursin(?:. Queen
\\ay-Carleton Ho!>pllal. Onav.a. 8N
CR-\\\FORD. M)r1I. Eung.lin.
Member-at-large. nursmg education candidate CNA. (porn .:!7Ap
CROI 1. !l.aron
E"ecullve Secretal). '\ley,. BTlJJ1,\y,.Jck "......OClatlon of Re
l...tered
Nurses. I..JS
CRO/IER. JuU.
Undel'[õlndln
neurolranllimutel' .md relaled dru
" 'Dough.\.
3
/.u
CR\lNG
Cr)rn
. the IYglecred dimension. (McGree\-). Van HeukC'lrmJ
181a
C\SllC H\GRO\I.-\
Llvmg with q..,..cic hygroma. (Br"O\"n) 17.\1\
-D-
DAI HOl'SIE 1'1\ FRSITY
Faculty appomtmenh. .B'"
D \01 ST, J..n, \Iare
E1(ecutl\e DlrCltor. Cmadldn C.Jtholiç He..tllh 4."oclarlon. ..I1D
DARU'l/G, Grace
Chnical nurse speclali
t in menial health and p<iiychiatnc nursln@:.
Lakeshore Psychldtric Ho
pital. S8Au
D-\\\SON. Lorraine
Emplo)ment reldtlon
!!Ilall 01 RNAO. 44Mr
DA\, Rene
Faculty University of Alberla. 43F
DFATH
Sudden death. (WehrlcYI .:!8N
To whom it may concern, ,Wmten 10N
Wanted: a nnng heart and warm hdnd
. 1Ja
Why' 3SMy
DEH.t'f',BACHER, Chariene
Bk rev., S-Ile
DEU\FR\ OF HEAL11I CARE
CIDA reled
S ne", heallh care gUide. 120c
Cimadlan health servicc!rI u!tCd by Korean Immigranb and theu
perceptions of the helpfulne!rls of those services. (Pope) A.
8My
Changes.... I SN
Did you know? 14Au
Nurse-midwivcs in heallh c..-c s)!rItem. HJa
Nursini! via satellite. (Henderson) JlJd
Self-rehance In health care. 9D
Shapini! a new furure. (RabOYJ -WMr
New B.C. minister explore" dlmcn"lon!!. 01 he.lIth care. 9F
DENTAL PROPH\LA"IS
BrushIng brigade. IMoggachl 26Ja
Dt.PT, OF INDIA:\ AND NORTHER'" AFtAIRS
Hu
uene Labelle. Dirator Generdl. Policy. Re!tearch and Evalud-
lion Branch. Indian and E
klmo Aflair'ii. (porn 210
DI::SJEANS, Georget.e
The problem o'leadership in French Canadian Dursin@:. A. 60Au
DIABETES
Canadian Dm.beuc AS!!IoOCldtlon 'pon
ors bur!rklfles. IOJa
DIAGNOSIS
The EM) brdin scanner. (Secram) -ION
DlAL\SIS
Plan 01 Cdre: the young child on dloll)'ls. (Irwin el 011). .J.10c
DISASTERS
Fife costs up in U.S. hospitals. 12Mr
DOHE:\, !\Ia')
Aw.uded the Cro
s of Valor. 38F
DO"'AHl E, Rober.
Acting Director of the Collective Bar,g.uning Program. AARN.
3D
DONER, t"rrn
Blindness can be prevented. 27Ja
DONNER, Gail
Chdlrperson ofthe Nursmg Dcpl.. Ryero..on Polytechmcallno;.ll[UlC.
T ownlo. 48Je
OOUGHn, Barbara
Understandmg nuerotran!!lominer... dI1d rddleddrug;o.. (Cmzlerl 38/.u
DRl'GS
Babies 411 risk? (Rousselen 34Mr
Understanding neurOlran!!lominers and related drugs. (Doughty.
Crozier) 38/.u
Unit-dose drug distribution olfers !)Ignificant advanlagcs. IIJI
What doc!rl ..the quality of lifc" mean to you? (Bertrand) :!.6My
Dl BI"'. GI...ia
Story boardini! - a leaching tool. (.. .el ill) -I2Jc
Dl'FflE, John
An arfalf ot the heart. lbOc
DUNMORE. Alison
Story b()Mdm,g - a tedchmg tool. ( __et al) -I:!Je
-E-
ECONOMICS
AIB Issue.. bulletins on çompen"dllon gUidehnes. IOJI
Belt-tightenmg hlt!rl nur!rles. natIOnal outlook ble
k. 10M)'
CIDA relea
ncw he.llth çarc
ulde. 120e
CNA I!)sue!) ..tdtemcnt on fi!'ical Lonstramts. 12S
Firc co..t.. up in U.S. hospitals. I:!Mr
NB nurses discuss rcsolutlons on soc and ec benelit!) and condi-
tions. IOS
Spccialloan fund for 1976 grads In Ontario. IOS
What does "the quality 01 hfc" mean to you? (Bertrand) 26M)'
EDEN. Dorothy L
Exploration ofthc opinions of nursing facult)' rcgarding change. A.
SD
EDUCATION
Canadian Nurses' Association statemcnt on accredltauon of educa-
tion programs m the health dio,clphnes. 42Ja
A climcal evaluation tool for student nur..es. (Morton ...et al) 37Je
Commi! out a confrontdtlon with reallt)'. (Harper) 30JI
Health helpers. (Burke... et aH I7D
National and/or reglOn.1I çentcr!) for prcpanng nursing eduutor!rl.
(StID!)on) 17Ja
Through the lookmg gl.1Ss. (Gitterman. Goering) 440c
EDUCATION, BACCALAl'REATE
AARN supportllii university eduç.l.IlOn for all Albena nurses by
1990, liS
Community nur!)mg çour!)e onercd by correspondence. 9F
Exploration of the opmions of nursmg faculty regarding change.
(Eden) A. 4SD
New health services program planned. 12Mr
EDl'CA TION. CONTINllNG
Extended care nursmg cerllfiçdte program. 6D
Di.uy of a retread. (Nelson) 47Au
NUA COUrlliie expands to foreign countries. 7Ja
Ontario offers courses in long-term c.e. 9JI
Rcfresher perspectives. (Scheffer) 4.3Au
A survey of resources for continuini! education in nursing in Nor-
theastern Ontario. (Reid) A. 4SMy
University ot Toronto terminates nurse practitioner course. IIN
EDlCATIO'l/, DIPLOMA PROGRAM
Bilingual nursing sçhool in Ncw Brunswick. IIAp
L 'Ecole des Inflfmières de Bathurst school of nUl'"sini!. Bathurst.
N.B.. offers bilingual nursing diploma program. 44Mr
Ontario to study two- year programs. l2Je
EDLTCATIONAL MEASLTREMENT
Blueprint comn1lltee studies comprehensive exam. SF
EMERGENCIES
Chest pam.__ a summary. (Parks) 35N
Emergency c.ue ot the acute MI. (GauUuet. Simoneau) 3.tN
Emergency health nußC!). 8D
Is there a nurse in the neighbourhood? (Steidl) l5JI
Rcglonal trauma centre. SJa
Under!)tandmg the patient in emergency. (McKnight) 2011
E:\tO,",[). Suzanne
Prote!)t. phOlostory. 19Au
. \IPW\ !\lENT CO:\ DITIONS
How do you feel about.. worlong nights. (Questionnaire) 150c
The market for nurses - we'vecome a loni! way. (r..10naghan) JHO
Nwses .at ILO Conference contribute to world code. 110e
. NVIRO,"\IENT
Habitat: quality of life on a global sçale. lMarcus) 2HM)
E11IICS
ICN a..h nurses to desCribe connicls. 12My
What docs "the quality of lile" mean to you? (Bertrand) 16My
EXTFNDED CARE tAUUTIJo:S
Extended çare. (Nendick) 45Je
Gr.mt MacEwan Community College. Edmonton. 6D
Ontario offers courses in Iong.term care. 9JI
EYE
Bhndne!)s çan be prc\emed. (Doner) 27Ja
VI
--------.
-F-
FAMIL\ PLA"'NINC;
Claire Kaneexecutlve director of Planned Parenlhood Onawa. -I3F
Did you know... multiple births. IOJI
Mary Mills executive director of Planned Parenthood Federation of
Canada. 4JF
What .Ire the bonds between the lelu!!. and the uteru!) 1 V.uamkle-
wiez) 26F
t EDUR, Eileen
Senior Nur'>C Consultant. Alberta Dept. of Socldl Service!. and
Community Health Services Branch. Edmonton. Alberta. SN
n:ES
Order 01 Nurses of Quebeç. 00
Propo
d fee railliie to be submitted to general assembly. 9Ap
FEILO ITJo:R, George
Administrator of Cornwall Generdl Hospital. 44Mr
FELLO\\ SHIPS
See Awards
t'EN\\IC". .\onn Shepherd
CNF scholarship. 130e
FINCH. M.hryn
A,slstant Director of Nursing. Memoli Hedlth Centre. PeneLln-
gui!)hene. 8N
FINI::STONE, "aren
Alumae Association of Montreal Genc.-al Hospital aw.d. J8F
flTZGERALD, Joan
Direclor of nurslßg servK:cs. Ndtional Defence He.w.quarlers.
lport) 481e
FOIS \ , Monique
Publk relatlon
officer with ONQ. +tMr
t'ORD. L)nda
Head to loe: a straightforward approach to patient assessment and
chartmg. 26S
Mr. Jones from head to toc. 16N
FORD. Patricia
PO'!)peCllvc. E. -IJc
FRIEDMAN, MHER
Most recent commenl!!. on fisk. (Hanna) E. 2N
H LFORD, Dorothy
Employment relations oftker with ONA. (port) 41 M)
Fl N"E, Jeanet.e
Received grdnt from Toronto Sick Children"s Hos.pitill Foundation.
430
-G-
GAHR\. Ht:len BerruU!
CNF scholarsh,p. 130c
GASH. Janice
Tran!)port of neonates: a mailer of prevention. (Johnwn) 19My
GAUTHIFR, Lise \iau
Emcrgency care of the acute MI. (Simoneau) 34N
GENETICS
Dllcmma. (Rudd. You..on). 51/.u
GEORGE. "aren
Bk. rev.. 61Au
GEORGE BROWN COLLEGE, TORO"'TO
Ontano offers courses m long-tenn care. 9JI
GERIATRICS
B.C. nurses seek better çare lor eldcrly. 10Ja
RNANS holds workshop on caring tor aged, 9F
A study of health dnd related need
of lliienior clti.zens In two housing
complexes. (KlfstmeJ A. .UD
GE\ ER, Barbara
A nursing challenge. replanlaliOn of a severed .mn. 19AJ1
(;[LCIIRIST. Joan M
Pe....pectrve. E. 4Au
PreSldenl CNA. (pom 24Ap
(;11 LIS, Loretta
Sleeplessness - can you help? 32JI
GIRARD, Alice
Tribute to Margaret KelT. II Au
GIROI X. Suzanne
T nbute to Margdret Kerr. IOAu
GITTERM4.N, Gail
Through the lookmg glass. (Goenng) 440c
GLASS, Florence
Retired. Director of Nursmg. Victolla General Hsopital. Halifax.
(pori) 43D
GLAS.
. Helen Preston
Member-at-large. nur...mg education candidate CNA. (pon) 27Ap
GUS"
"'rie-Rubílie
Lecturer. University of Alberta. 43D
GOODlo\;G, Debbie
Public health nurse. (pon) 6D
(;OERJ"G, Paula
Through the looking ,glass. (GlUerman) -I-IOe
GOSSELIN. Linda Roberta
Member-OIl-large. soc1al and economic welfare candidate CNA.
(port! 30Ap
GRAHA \1. lIelen
Assistant nursmg director at Lions Gate Hospital. Nonh Vancou-
>er. B.C.. 38F
GRAIIAM, Linda
Stroke rehahilitallon - a creauve proce
'ii. .:!1F
Stroke. (et.all I-IF
GR4.NBERG, Joyce
Disseminatcd intravascular coagulation: a patient profilc. (...ct aI)
42J1
GRA 'l/T, Dorotby
VIP treatment proves thl
hosplLa1 really care
. 14J1
GRATTON-JACOB. Franane
1975 W.amer-Lamben Canada Limited NurslOg Fellowship award.
(port! 145
GRANT MacEWAN COMMI'NITY COLLE(;E, EDMON-
TON
Extended care nurslIlg ceniflcalc progrdm. 6D
GREEN. "en
Bk. rev.. j...Ue
GREENE, FJizabeth E.
Member-at-Iargc. nursmg pracllce candidate CNA. (pon) 29Ap
GREIG. Gwen (Cocnth,,;aitel
Bk. rev.. S2My
GRIBBEN. Anne S.
Member of Ontano Labour Relation, BNrd. 41M)
GRINNELL, Jane
Bk. rev.. SSk
-11-
HAITI
NUA course cxpands 10 foreign countrie
. 7Ja
IIALIFAX, NOVA SCOTIA
Enjoy Halifax for what it IS and for what II was. (MlllcT) 3-1F
IIAI L, DoIore.
An unusual obstctncal u!<;e In Papua New Gumca. 22D
IIAI I IDA \ , Shirley
Faculty Dalhou!ile UmveT\ny. 43F
IIA;I;'I/.-\, '\1. .\nne
Dr. Meyer Frlcdman's mo
t recenl commenls on n5k. E. 2N
Edlto. JJa
Perspecti,e. E.
F. 5Mr. 4Ap, 4My, 3J1. 45.
Oc. 2N. 2D
Will the real nurse plca.o.c !!Itand uP? E. -I0e
IIA:\SEN, Ane Marie
Towards mdependence for paraplegics. 24D
IIARPER, Jocelyn
Commg OUt: a controntatlon with realll). 30JI
II.\RRISU'i, Fernaode
Albcna research team receives H & W grant. 12Mr
A contcmporary dilemma m nursing admmisuation. 19Mr
IIARRISO", Mary "ay
Nurses will be heard. liS
IIARTI:\. Carrol Ann
Two-year tow of dut) in Honduras with MEDICO. (port) 44Mr
liAR \\ OOD, Judy
Faculty O.tlhousic University. 4JF
IIA \ ES. lIarriet
Bk. re... SSN
11..\\ ES. Marjorie \\.
Bk. Ie'.. SIJ.
IIA \ ES, Pat
Bk. rev.. 64Au
IIA \ iliA". '\Iiriam J.
Thc occupational health nurse in the work environment. 36J1
IIEALTII AND \\ELFARE CANADA
Operation Lltestyle. II N
Pamela E. Poole chief of Information and cvaluallon divIsion
Research Programs Directorate. -lIMy
ilEAL TII CARE
See Delivery of health care; Quality of health care
HEALTII EDI'CATlON
Canadian Nurses' Association sla[cmcnt on nurses and health pro-
mOlion. -I2Ja
lIealth helpers. (Burke.__et aI) 17D
Operation hfeslyle. II N
IIEART
Sce Cardiology
ilEA TII, Miriam
One of Ibo bluebords. (ponl IN
liE/ERE'. Eleanor I,
Setllng standards for patlcnt care. (Jackson) A. 53N
IIENDERSON, Nicole E.
Nursmg via satellite. 3IJa
liEN DRY. Judith
Childhood cardiac anomahes: a review. (Milton) 1SS
HEN"ESSE\, FJlen
Alumnae Association or Montreal General Hospital award. JSF
IIEWITT, Marjorie
Nursing consultanl with SRNA. (port) 43F
IIILL, Susan
12-hour psychotherapy, (lloch) 30My
IIINDLE, Jnditb ""ren
Member-at-large. nursing practice candtdale CNA. (porn 19Ap
IIOCII, Man:ia
12-hour I'sychotherapy, (Hill) 30My
IIOLDER. Elizabeth
NOise in an mtcnsive care unil. ib
OUfces and annoyance to
patienl
. A. 53N
VII
1I0\lE CARF SER\ KFS
Home care aftcr surgcry for scohm . (Reid) 43l\
IIOOPER, \ alerie
Aliì.lliilslanl registrar. RNABC. IJOe
IIOR \ A TII. Janet
llealrh helpers, ( er all 17D
IIOSPICE CARE 1'1T
N S hospice unn. IJJc
IIOSPITAI :\1 RSI..G SER\JCE
A comp.snson of thc quality ot care pro't.dcd by regastered nuf'SCs
workmg Ihe twelve.hour shill and those \\-orklng thc clghl-hour
shift in a large general hoSPital. (Balnok) A, 481.
A contcmporary dilemma In nursmg adnumstrallon. (Hamson)
19Mr
NUA COurse expands to foreign countnes. 7Ja
PerspcclJ\lr. (Hanna) E. 4My
IIOSPITAL OLT-PATIE"T CLlMCS
l2-hour psychotherapy. (11111. IIoch) 30My
HOI SING
Habltal. quality of hfc on a gJobal 'iicale. (Marcus) 28M)
110\\ DEN, Jocelyo
Assistant nursmg direclor at Lions Gate Hospital. Nonh Vancou-
'er, B.C, 38f
IIUGEL, !\In
Dlrec.1or of Nursmg. Brockvdlc Psychiatnc Ho
plLa1. 58Au
11\ PERTE'ISIO"
Over and over. OeM,Op) 200c
Seven stcps to a successful hy
ncnsl"'e screcning program (Sd-
>erberg) 2SOC
-/-
IDE4. EXCIIANGE
lIeallh helpers. tBu",e.__ot all 17D
ILUCII, ban
Self-reliancc in health (;are. 9D
I"'IMIGRATION
Canadian health s.ervices used b) KOJ1:'an .mmigranb and .he....
perceptions of Ihe helpfulness of those services. (Pope) A.
48My
IMMIGRATION
See also Nursing - M.tnpower
IMMINILATlON
Commumcabtc dlsea..o;cs and Immunlzalions. (Cran
ton) 3-1Ja
Did you know) 13/.u. 7D
SWIßC nu ÕI:Itlack. 10JI
INFANT. NE\\BORN
Perspectlvc. (Hanna) E. 5Mr
Ph)sical a
se
ment of thc newborn. (Marcd) 21Mr
Transport of neonates: a matter of prevcntlon. (lohn!'oon. Ga
h)
19My
I"F A VI Nl TRITION
Babies at Ilsk? (Rousse.cn 3-1Mr
"1. toundatlon for lastlOg health?. liD
Freezing breast nulk at home. (Roussclet) 31 Mr
New concepts in infant nutntion. (Rozer) 18D
A practical gUide to successful breast-feedmg. (TaUart)
5Mr
INFA'l/TS
The Identification and trealmenl of difficult babies (Allan) liD
INFLl'E'l/ZA
Bullctin. 33D
The pandemic mnuenz.a of 1918. (Monon) 3
D
Swine nu attack. lOll
INPI rr
41a. 6f, 6Mr. 6Ap. 6My. 61e. 4JI. 6Au. 65. 6Oc. 6N.
D
INTEl'iSf\ E CARE l NITS
DIsscnunaled JnlCnasL'"Ular LO.Jsulauon a pallem profile. (Gran-
berg. het all
2JI
INTENSI\ E CARE l NITS
Head '0 ,0<. (Ford) 265
Mr. Jones from head to toe. (Ford) 16N
NOise In an Intenslvc care umt. Its .,;ource
and a.nnO)dn('c to
patients. (Holder) A. 5JN
Suddeo death, (Wehrley)
8N
The transfcr process. (LerhbndF. el aI) 390c
INTER"IATlO'AL ASSOCI'\TlO' FOR E'TI-.ROSTOMAL
THERAP\
Specialty scholarship available. 9D
INTER...ATIO'AL COl'NCIL OF Nl RSE"
Ash nurses to descnbe connlCIS. 12My
INTER"IATIO'I/'\L DE\ FLOP\lFNT Rt'SEARCH CF'TRI
In"c!>tlgale.r;. role of tr.Hhtional healers. I..JMy
Ten awardlÕ tor "mid-career profclÕslOnal,,". 7D
I:l.TER"'ATlO'-\L L-\BOR ORGA'ILATIO:l.
CNA suppons intemahonal con\lenllOn. 8F
Nurses al ILO Conference conrribule to world code. II QI;
lNTER...ATlO"lAL Nl RSE
' SE'\U"-\R
Six Canadian among participants. 10S
INTFRPERSO""L RELATlO'S
Crying: the neglected dimemilon. fMcGrecvv. Van Heukeleml
18Ja
The handmaiden IS nOl dead. (Logan) 25My
Prejudice In nur\mg. (Briant) 26Je
I" TERPROFESSJO'l/AL RELA TlO'l/S
Nurses will be heard. liS
Perspecllve. (Hanna, E. 4F
IR\\lN, M.A.
Plan of care: the young child on dlalysl'\. fet al) 410c
IR\\J.... Margaret
Respiratory interest group formed. liS
-J-
JAC"SO". Marion Ruth
Member-at-large. nursm,g admmistration candidate CNA. (port)
26Ap
Setting standards for patient care, IHeieren) A. 53N
JAMAICA
RecCTIt
ue'ß to CN.A.. 9D
JESSOP, Penn)
Anatonuc and physiolO@:lc dynamics. 22S
Director of Public Education. Ontano Hean Foundation. (por1)
40c
Over and over. 200c
Quick change quiz. J3S
Stepping stoncs: a road to coronary rehabililation pro(?:ram!!o. 18N
JOHNSON, B.lly
Bk. rev., 46F
JOH'I/SON. Mo)a
Transport of neonates: a matter of prevcnllon. (Ga..h) 19Mv
JONE", P.E.
I
n cducational programme tor nUr'\e prnctitioner... (ct a1) t
. 4SJa
JOPE, AJic.
Lecturer. Lakchcad Umverslty. 43D
Jl':-iE. Mona
Bk. rev., S4N
-K-
...ANE, Claire
Executive director or Planned Parenthood Onawa. 43F
KAY, Gloria
Monitonng central venous pre'i'\ur
: principles. procedures and
problems. (Kearnoç) 15JI
"E"RNS. Patricia
Monllonn
central venou'\ pre"illiiure: pnnclplcs. procedures and
prohlcms. (Kay) 15JI
"FH\ '" A"I. \ahe
Clinical nurse specialist in communily health nur"mg. Lakeshore
P'\ychlamc Hospital. 58!.u
"ELLEHER, Brooda
Mcmber-at-Iarge. nursmg admimstration candldale CNA. (port)
26Ap
"ELL \, A.r..
Bk rev.. 460
"FRcaN. Doroth)
Canadian nurscs to partlclpilte In international ..emmar. liMy
k.I:.RR. \1argaret
Obi'. (port) IOAu
"ERR, Margaret
Tnbutes. J'.u
"HtJ"HAR. David
Bk. rev.. 51My
"IDNF\
Old you know. ,70
Kidney tran"plant.. up at U of A Hospital. 120c
Plan of care. the young child on dlalysl'\. (et alt. 410c
Transplant program. II N
"'''tCH1, Jun.
Hospital for Sick Children Foundation grant. -I4Mr
"':\G.FARI 0\\. Svhia
Faculty University of Alberta. 43F
"IR
TI"IE, M)rtl. L
A '\tudy of health and related need'\ of '\emor citlzcn
In two hou..mg
complcxcs. A. 45D
-L-
LABELLE. Huguelle
Canadian nurscs to participate in intcrnational semlßar. II My
Director General. Policy. Rc
earch and Evaluation Branch. Indian
and Eskimo Affairs Program-.. Dept. of Indian and Northern
Atfalrs. (pon) 21 D
Flddlehead '\unnse. (port) IOJa
A retrospective as'\C'\'\ß'lCnt. 27Au
LABOlR SLI'PLY
Canadian women at wor\. "La differencc" persists. 12Mr
LABOl'R l'N10NS
Anne S. Gnbben memher of Ontario Labour Rel3tlons Bo.trd
41M)
CNA to provide con\ultaU(1n service in laOOr relauon... 6D
RNABC admits '\tudent memher<i. credte
lahor relation.. divi'\lOn.
8J\
LA"EHEAD U'\II\ ERSln
Faculty appointments. 44Mr. 43D
New health services program planned. 12Mr
LAMBIE. FJizabeth
Bk. rev., 50Ja
I ARSON, Linda R.
Bk. rev.. 55N
LAWSON. J,E.
Director of nUf5ing services. Nallonal Defence Headquarters.
(port, 48Je
LEADERSHIP
Canadian nurscs to participate in internallonal seminar. liMy
The problem of leadcrship in French C.madian nursiniZ. (Dc'\Jcan)
A, 60Au
IFBANON
NUA cour'\e expand'\ to foreliZn countncs. 7Ja
I.FC"IF, Irene
As'\i\tant dean of thc Faculty of Nur..m!!. LJmver"lty of New
Brunswick. 8N
VIII
LEC 11.1 E, N.
'a
Director of nursing. Douglas Hospital. Vcrdun. (}uebec. reured.
58Au
LECLERC. Alma
Program director of New Brunswick TuberculosIs and Re"ipiratory
Disea...c A
soclation. 38F
LEFORT. Sandra
A new look at cardiac cathetenzatlon cqulpment. J4S
LFGISLATIO'ì
Good samaritan law in effect i.n Saskatchewan. 14Au
ONQ publishcs h'\t of nursing procedures. IOJa
I n"l.EI\UA
Did you know. .. 49D
LFTHBRIDC;F. B.II)
The transfer process. lct aU 390c
LEWIS. Gene"'a
ÜI1ho award. 8N
LlBR \R\ [I'DA TE
5Ua.48F. 5-1Mr. 47Ap. 5
My. 561e. 4911. 65Au. 565. 5-10<.
5
N, 470
LlCENSLRE
Cross.Cana.da registration. (Blais) 22Ja
LlGO\\SII.\. Jan.
Faculty UniveT5ity of Alberta. 43F
LlNDSA \ . Susan
Alumnde AOii.SOClatlOn of Montreal General Hospital award. "'8F
LlVINGSTO"E, Jeao
Judy HI! I Memonal Scholarship, I-IS
LOC"mERG. Liv-EII.n
Rcacrung tomorrow's citizens. 29F
LOGAN, F, Jo
Thc handmaiden is not dead. 25M)
LOISELLE. Yvette
Deputy chief l.omrnlSSloner tor St. J{'Ihn Ambulance Brigade In
Canaw. 44Mr
I ORDF:-O. Donna C,
Lecturer. University of New Brun'\wlck. SN
LO\\ E. Nahilla
Public health nurse. (pon) 6N
-M-
\1ac..\DAM. Anna Claire
W,'h CARE/MEDICO on Afghamslan. 410
cCANN, B.verle)
Tcll me about your picture.... 50s
McCLEI l.AND. Robert Howard
New B.c. mini'\ter explorC's dlmen'\ionllii of he.llth care. 9F
MacDOUGALL, \ivian
Nursing coordinator for NBARN (porn 38F
McEWEN. Ada
C'.an.tdl3n nurses to partlcipalc in Inlernallonal '\
mlßar. IIMv
\tcGRFF. ". \ r Abigail
Crying: the ne
leded dimension. (Van Heukel
m' ISh,
MacGREGOR, JE"" E
T nbule to Margaret Kcn-. IOAu
Mac"A \. Roth C.
Bk. rev.. .55N
Faculty Dalhou'\ic University. 43F
Mc"NIGHT. Wend) Lynn
CNF IliiCholar<ihlp. I JOe
Und(,f'.tdnding the pJllent an emergency. 20JI
McLEAN, Margaret D.
Support (trow", for scholar;hlp agency. 12Au
Vice president candidate CNA. (port) 25Ap
.
\1acLEI.LA N, Beverly
Matthew my son: prepared childbinh al thl:: General. 38Mr
MacLENNAN. E.A. EJecta
LL.D_. Docror of laws. Dalhou"'le Vnn'crsll)'. {POrt} 1211
MacLEOD, I",bel
Tnbute to Margaret Kerr. II Au
MacLEOD. Joyc.
Coping with the aggressive patient: an aJlemali"c to punishment.
(...., aI) 1811
,"acNEIL. Barbara
H.allh helpers. (...e' all 17D
'\lcPHHJROS. !\largar.' G
Honorary professor emerita al Eucaema exercise", in Frederic10n
May 13. 1976. (pon) 58Au
MacQlTINN. Catberine
Award from Heahh and Welfare Canada. 41M)
'fcSHEtlo RE\ , Mal) Louise
CNF scholarship. /JOe
Mc\\lLLlAMS, Barbara
A"!!ol'tanl direc10r of educallon services with RNABC, -lIMy
MAJI '\IDAR. Basu
Bk rev.. -IfÞF
I
11
'\1.-\'liITOBA ASSOCIATlO'li Ot. REGISTEREIJ:\1 RSFS
MembcTS support PCWM brief on rape. 5Mr
Mamtoba labor group. SF
IANLE\", Carolin. A
Direcror of nursing al the Wmchr"'ler Mernon.JI Ho'pllal. 1211
\.IARCIL. \ i\iane
Physical a.
ses
ment of the newborn. 21 Mr
'\IARCUS, Clair.
Habitat: quality of life on a global scale. 28M}
MAR"O'\ICH. R.ita
Faculty Umversity of Albena. 43F
'\IARSH. '\Iaril)n
Member-at-large. nursing education candidate CNA_lpOr1) 27Ap
,\IATCHETT, S)hia
Ollic<< OOHNA. 41M}
IATER'i"L \\ELFARE
The concem
and coping behavior
of the single mOlherwlth a child
aged six months to eight years. (Ander;on) A. 48My
,"ATHt'SON, \\ayn.
Coping with the ag!!res
l\Ie palient: dn aJtemcltlve to puni
hment,
(...el al) 1811
UATTHH'\S. D
Plan of care. The young child on dialy
i.... (et al) 41Qc
'\IEDlC"L
IDRC investigates role of traditional healers. I"M)'
M[STAL HEUTH
Cooperation needed between mental health groupo., 8Ja
Home ec. anyone? 46Je
Research not "heahh potemlclls' . 7D
'\I[TRIC S\STHI
Notes on gOing metnc. IUI
'"IA..., '\Iaqbul
Coping wi.h the ag{!:resslve patient: an alrernau\o'e 10 pUßl\hmenl.
(__.el all 1811
MID\\1FFR\
Nu
-midwives in health care sy...tem. KJa
Ontario nurse-midwive
hold annu...1 \I,('orkshop. 12My
I
II
IILITAR\ /lot RSISG
1914-1976.48N
'"ILLER. Oorolhy
Enjoy Halifax for what II is and for what it wa.
. 3..F
'fILL..fit. Lorraine
Associate eJtecutive dlrec1or. patlrnt care services. Dr. Evercn
Chalmers Hospital. Fredencton. 4-1Mr
'"ILLS, '\Iary
E.!I.ccuu\le director of PJ311ned Parenthood Feder
lIon of Canada.
43F
MITCHELL. Carol May
Lec1urer. Vnive
ity of Bntlsh Columbia. 4:10
,"ITCHELL. Margar.'
'.Nur
e of the Year" award. Albena A
oclatlon of Regl
tered
Nurses. 14S
'\IITTON, Judi'h
Childhood cardiac .momalie'\: a rr:vlew. UlendryJ :!FlS
IIIOGGACII, HaLtl, ,,",
Brushing brigade. 26Ja
'\IONAGHA'i. Gabriell.
The market for nurses - we've come a long way. 3gD
'"OS[\, Sh.ila
81<. rev.. 4l'!Mr
'\100R[. Janni<. E.
1975 Canadian Liquid Air ltd. award, (pon) 44Mr
M()RRISO
. Constance
Director of L 'Ecole des InflrmièJ"e"\ de Bathul'"\t. (pom -WMr
MORTON, Glad)s
The pandemic innuenza of 1918. 32D
10RTO'i, Jun.
A climcal evaluation tool for student nur'e.... I uet al) :17Je
\1lLLES. Elaine "arie
lecturer.lakehead Vnlve
it}. 43D
'\Il SSALLEM. H.I.n "
Canadian nUl'"\e
to panlcipate in international "òeminar. II My
A conver-;ation with the executive dirr:ctor (pOr1) 44Ap
Executive director's repOr1. (pon) 2RAu
Tribute to Mar!!arr:. Kerr. II Au
'\11 T7. .A nn.
Alumnae Association of Montrr:al General Hospital award. 38F
'\J\OCARDIAL INFARCnOS
An atfair of the hean, (Duffie) 360c
Emergency care of the acute MI. (Gauthier. Simoneau) 34N
Self-concept of the m)OCdrdlallnfarcnon patient. (Cook) 130e
The tran'\.er proce"ò'\. (Lcthbndge.._ct alJ 390c
-J'.-
NA'\ns
38F. 44Mr. 41M"
K1.. 1211. 5R/,u. I
S. /JOe. RN. 4
D
NATlO'iAL LEM;IE t'OR ...1 RSING
NLN and ANA approve plan... for V.S. screening agency, 9JI
Forecasts zero growth rate. 110e
N ELSO', H.a'h.r
Diary of a retread. 47Au
1'<ENDlC". Pat
Extended care, -ISle
'in ROLOG\
The EMI bram
canner. tSeeram) 40N
1'<E\\ BRl :>ÕS\\IC" ASSOCIATIO... ot
RFGISTF.RED 'Ill RSES
Dlscu
resolutions on
oc and ec benefit, and condition... IOS
Flddlehead sunnse. IOJ3
Karr:n Croll. Executive SecretaT). 14S
NBARN cdebrate
60th anni\er
ry. 1011
Nurses will be heard. liS
Tough luck! 7Ja
Vivian MacDougall nursing coordinator. Iport) 38F
Worhhop on cn..i... intervenlion. KMr
IX
"'E\\ BRlSS\\IC" Nl RSE'i PRO'\ "('IAI COIl t'C1I'\ [
BAR(;AINING COLNCIL
N.B negOilatlOn:!i reach
talemate. 12S
'it\\ BRI 'S\\IC" n IItRClI OM" ""'0... \SSOl1\TIO'"
Alma Leclerc program direc1or. 3RF
Respiratory mterest group formed, liS
"'E\\S
61a, 8F, RMr. RAp, IOMy. 121e. 811, 12Au. lOS, 100c. ION.6D
SICIIOL, Celia
lcgg.penhes disease, 3Ue
NIGHT Dl T\
How do you feel about working mgh.,,-. (Que..lJonnalre, f 50c
'iORTHER' H[AL TH S[R'\ ICES
A compariu)ß of consumers' and provIders' ÐplnlonS of commu-
nil)' and health services In a nonhern Albena town. (Seymour)
A.
5D
Mary Berglund. backwoods nurse. (Bergstrom) 44S
Medical staff at Moose Factory highly advanced commumcatlOn
system. 6D
Nur;ing via satellite. (HenderMJn) 1Ua
NORTHER'" IR[I AJ'.D
Old you know? 14Au
'iORTII\\I-.!,T T[RRITORII..S RU;I'TFR[IJ
"'lRSES' ASSOCIATlO'"
Adrrussion to CNA. I3Au
First meclmg held in YeIlowkmfe. 9J1
Mandatory registration of federal nur'\es, 8D
Re
olutions of the Board of Direc1ors. 41 Ap
NOV A SCOTIA E,"t'R(;['i(,\ H[AI TH SFR'\ ICE'i
Carol Beazley, nur
ing and planmng officer. 1211
'I RSE-PATlE...T RELATlO'liS
Enforced proJtimity to stress in the chent environment. (Vachon)
40S
Sleeplessness - can you help? (Gillis) :12JI
Vnder'\landing the patient in emergency. (Mc Knight) 20Jl
VIP treatment prove
thl!! hospital reaJly care,. IGran.) 2..JI
'I RS[ PRACTlTIO...ER
An educatIOnal programme for nurse practltloner'\. IBam et alJ A.
481a
Unlver
i.y of Toronto termma'e
nurse practitioner cou
. ION
'iLRSES' "SSOClATlO'i OF THE lLo\R"[ I'iSTITt TE
OF PS\CHlATR\
Nursing publication and research award. 12Au
'il'RS"G
Cross Canada regl...tratlon. (Blalsl 22Ja
The effects of different techmques ot acupuncture on knee pain.
(Ramsey) A. 60Au
Nursing via satellite. <<Henderson) 3IJa
ONQ pubh
hes list of nur
ing proceduTe'\. IOJa
Perspectt\'e. (Hanna) E. .JM}
The problem of leadership in French Canadian nur
mg. (Desjean)
A.60Au
RNANS publì
he
guide for roles. II Ap
Refre
her perspec1lves, (Scheffer) 43Au
The up'\ and downs of commumcatlon, (Be
h I3F
Wtllthe real nurse pla
e
t311d uP? I Hdnna) E. ..Oe
:101 RSI'iG - MA:IoPO\\ t'R
Bell-lightening hits nurse
. national outlook blea.... I
h
The market for nurses we \"c come a lonl ,,'ay. (MonaEhanl 1 8D
NlN and ANA approve plan!ro for V.S.
creenlng agency 911
'il R'iING CARE
Acute nursmg care In .he ...roke unit. (Pallan!) 18F
Canadian Nur"òes' "..wclahon statement. "2Ja
A compan
on of the quaht) of care prO\ lded by regl\tered nurs.e
worlc.mg the twelve. how shift and tho
e working the eight-hour
shift in a large general hospital. (BaJnok) A. "MJa
RNABC documen.
Ituations affecting patient care. 6D
RNAO delegates examme nursing power and process. J2.k
Setting '\tandard... for patient care. (Jackson. Heleren) ". 5_'N
Sleeple
ness can you help? (Gllh
) UJI
Th3t cup of tea. f Warren) 46Ap
Wanted: a eating hean and \\-anTl h.mtl
7Ja
'I RS"G [OIl'.ATIO'
See Education
!'.I R!>I'Ij(; SISTEIL<; \SSI}{'IA Tl
"
Held It, .:!51h biennial meeting. liS
_0_
08!>TETRICS
MilUhew my 'lion: prepared clo.ldbirth at the General. (MacLcllan)
'8Mr
The treatment of masliliS in nursing mOlhcr... (Rou'i.lliòclet) 32Mr
An unu
ua' ob!!.tetrical ("dSC In Papua Ncw Guinea. (Hal1) 22D
OCCl Po\TlO'" \\ HE"L TH
The occupullOnal hc.JJth nur
e In the work C'ß\uonmcnl. (Ha)manJ
36Jl
Oflil..'"CTS elected. ODlano Occupational Health Nur<roe..' ASIroocm.
non.4lMy
Semmar in occupational hcaJlh. 14Au
"You've come a long way nurslc". 8D
OCClPATlO'\L HULTH 'lRSI::S' ASSOCl"TIO:'ll
"Vou.vC' come a long way n
lc'.. 8D
O"A, 8<11)
Focus on prc:"enllon. I7S
0"\'\(;"'" COLU.GF, "FLO\\'\, 8.C.
Judith M Skehon coordmator of nursing educô!tlOn. (POr1) 38f-
O'LEA R\ . :Ioorah A.
Bk. rev..
8Oe
OLSIA". Margarrt T.
Hie.. FC\.. (HAu
0"1.11..
he"a
Vice president candidate CN:\.. Cpom 2SAp
O/loTARIO Ll:loG A
OCIATIO', :101 RSES' SECTIO'
Don', hold your breath. 7D
ONTARIO ...IRSFS -\SSOCIATlO'"
Dorothy Fulford employment r
lations olficer. (port) "I My
O'TARIO OCClPATIONAI HHLTH 'lRSES' A
SOCIA-
TlO'
Officers el
cled. 41 My
OPERA 11"'1. ROO\!
Hospital allow,," parents In OR. IOS
ORDER OF /Iol RSLS ot Qll::.BEC
Annual meeting. 6D
Momque Fol.sy public relations officer. ..t4Mr
Pubhshes hst of nur
mg procedures. IOJa
RCOIgamz.ation. 6D
ORGA:IoIJATIO' A'D \D\lI'ISTR\TIO'
A contemporar) dllemmd In nur!>mg d.dmIßl!!o(rdtlOn (Harrl!>on)
19Mr
ORTHOPEDICS
Legg-penhe!> di",ease. <<Nichol) 3IJe
0\ ERTO
, I'eggJ
Alberta research team receIVes H & W granl. 12Mr
Assistant prole
sor at University of Alben.a. (port) 41 My
Canada Council Grant. 8N
-P-
PACE\L\"ER. ARTlHCI\L
What patients want to know about their pac
rnaker-.... 270c
PAC", Mal'}
Flr
t woman to receive Royal Bank Award. (pm) 12n
PAGE,
largarel Rulh
Member-at-large. nursing education candidate CNA. (pan) 28Ap
PA....
Chest patn .. a summary. (ParkS) 3SN
P.'LL:\NT. Cathuine
Acute nursmg: care In the slfoke unit. 18F
Siroke. (<I aI) 14F
PAPIA NE\\ GU!'.EA
An unusudl ob
tetncal ca!>e In Papua New GUinea. (Hall) 12D
P-\RAPLFGIA
TO\\,drds Independent.e fur p,mlplegic . (Hansem 2..0
PARFlTT. FJalne
Bk.
v .
6D
P-\RIS. Candace
Bk.
v .
7 Ap, 5hS
PAR"ER. :Ioora I
Chairmdn. Dept. of NUßmg. School 01 Gradudle Studie!!o. Umver-
!!Ilty of Toronto. RN
Rec
lved grant from Ontano MinisII)' of HeaJth. S8Au
P\R"S. L,nda
Che,( pam. a ,ummary. 3SN
PA TEILSO..., G""nnelh
A""lsldnt executive direl..1:or of patlen( services. Medicine Hat Ge-
neral Ho'pllal. 41My
I'''TlE'T I.DLCATlO'
Chang".... l5N
In-hospital cardiac educatIOn programs Ihe right to kno\\.
(S.odwell, Tada) 22N
T oWdrds Independence for paraplegics. (Hansen) 2
0
PEARSl". Gale
Oflicer OOHNA. 41M)
PFCHILI I
, Diane
Hk . rev.. 63Au
PEIJERSE
. Darlene
Story boardmg - a teachmg tool. (...et aJ) "2Je
PEIJI \TRICS
Adjusti\ie and affective r-esponses 0'
chool-aged I..hildren to a leg
amputallon. (Ritchie) A. 60/.u
Childhood cardiac anolT14:llies: a r
vn
W. (Hendry. Millon) :!8S'"
Edmonton group r
ceives chaner. 12M)'
Jacquehne Sue Otapman pnnclpal mvesugottOl' of federal study.
IM}
Heal.h belpers. (Burke... e. aI) l7D
Living \\lith cystic hygroma. (Brown) 37My
A new look at car-diac catheterization equipment. (LeFoo) 3
S
A nursing challenge: r
plantauon of a sever-cd ann. (Geyer) 19Ap
Operation communication. (Bala) 31N
Tell me about your plc1ure.... (McCann) 50S
VIP tr
a'ment pro....cs 01l
h05pitaJ r
ally cares. (GranO 24JI
PERC\ . DorolhJ \-1
Tnbute to Margaret Kerr. IOAu
PERE\ M\, Carol}n \-lane
Kathlecn Ellis Pnze. (pon) 58Au
PERSPECT1\- E
3Ja.
F. 5Mr. 4Ap.
M).
Je. 311.
Au.
S.
Oe. 2N. 2D
PETERS. Ne,tie
Bk. r
v.. 63Au
PH\ SICAL EX \\-1I"1/A TIO'
Canadian task lorce concludes annual pap ,med.rs nOl nec
ssary for
most women. I3Je
PH\ SICAL tlT't.SS
Good beal,h .he Y08a way, HMr
How's your mla
e? ISJe
Operation lifestyle. II N
Perspective. (Ford) E. "Je
RNAOICNA launch pilOl heallh proJecl. tiF
Workshop on fitness and lifestyle. 16Ap
PLUMPTRE, Bel'}l
Visits bargaming officers' conferenc
. I..Je
POOLE. Pamela E.
Chief of information and e\:aluatlon dn/islOn. Re!!oc.uch Progrdms
Directord.te. HeaJth and Welfare Canada. 4-1 My
POPE, Marion
Canadian health services lJ
ro by Korean Immigrants and their
perceptions of the helpfulne
of th05C sel'Jice
. A. -tRM)
PREG"'A'C
Dilemma. SIAu
x
PRICE. Cora Marie
CNF ",hola"hlp, 130e
PR....GI F, Doro'h) \Ia,
Member-at-large. nur
mg: pracllce cdndld....u
CN.-\.. Cport) 29Ap
PRODI F \1
OL \ ....C;
The sleep a"""gnment. a way to learn proolem .soh'lng (ChOl-uo)
34Au
PROtI.SSIO...\I ....STITLTE OF j\\L\ICA
Recent gue
h to CN A.. 90
PRO\ I'liClAI COI'lll OF \\O\IE"I/ OF \IA'ITOBA
MARN member
uppOr1 PCWM braet on rape. 8Mr
PS\ CHI\TR\
Clarke Insmutc create
widows' self-help agency. ."My
Coping with the d.ggr
sslve pallent: an alternative to puru
hmC'nI.
fMdthC'
on... et all 18JI
Nur\mg pubhcoltlOß and r
...earch award. 12Au
Through the looking gla!>
. <Glllerman. Gocnng)-UOc
I
-hoor psychOlberdpy. [HIll. Hoch) 30M}
PS\ CHOLOG\
PerspectIVe. (Hanna) E. 4F
PI811C HEALTH 'l RSI'liG
See Communit) heaJth
rviccs
-Q-
QIALIT\ m HE.\LTH C\IU:.
Coming out. a confmntation \\-ith realny. (Harper) 30JI
Quahly aSSl.lrance program 10 get underwa) m D.C.. 9JI
QIIR....G, Julia D.
Bk. rev, 51M}
Story boarding - a leaching rool. I ..et alJ "2Je
_R_
R"C....E, 8arbara Ann
Member-at-large. nursing adrrunistration candidate CNA (port)
26Ap
RADlOGR-\PH\
THE EMI brain :!Icanner-. (5eeramJ "'ON
RA"OCZ\, Man
The thoughts and leelmgs 01 patlenls In the wailing period pnor to
cólIdiac surgery. A. "8M)
Wailing for cardil.. surgc:ry. lOOc
RA \ISE\ . Janice
The effecls 01 ddler
nttechmque'" of acupuncture on knee pain. A.
60Au
RA TSO\ , 8ernade'
Shapln
a new fUlur
. "0\.11
Rt CORDS
Head to toe: a ,tralghtforwd.rd approach 10 patient as
e,!oment and
chanmg. (Ford) 26S
R.-GISTERI-.IJ MRSES ASSOCIATIO' OF 8RITI!>H Co.
Ll
181A
Ann T a) lor aSSlslant executive director. -UMr
AssociatIOn ofler
legal aid to D.C. nu
. IOJd
B.C. nurses seek beller car
for elderly. IOJa
Bd.rbara McWilliam", a'!!olstant dirCClOrot educatIOn services." 1 M)
Documenl ;;Ituallons allectlng pallent care. 6D
Member" to explore professional ailitudes. I :!My
Rt'GIS J FRED 'I RSES' ASSOCI \ TlO"l/
Ot. BRITISH COLl \-tBIA
R NABC admits student members. creates labor r-elations divIsion
8JI
Refresher perspeclives. (Scheffer) "3Au
Valene Hooper. óI
!!Ilstant registrar. 130c
RFGISTEREIJ "RSES' ASSOCIATlO:'ll OF '0\ A SCOlIA
All pdLked! 15Je
Glad)s Smith. pre"ldC'rd. I3Au
Holds \\-oßCiihop on cann
for a
ed. 9F
Meets \\-11h health mlnlsler. I..Au
Non-health system concerm N S nurse-;. IJAu
Publishes gUIde ror roles. II Ap
RH;I
TtRt'D 'lR'if'i \
Oll\TIO' ot O'T\RIO
Delegale--; examme nursmg power and prOLe-!' . I' Je
Doroth\ \\)lIe. OInctor. Da\I".on of
ursrng. .58Au
Laura Barr lea\ . R' -\0 nnt month. (pon) HOc
Lorrame Dau,wn appomled 10 employment r
Jalions 'olall. -t4\1r
R'IIAOICNA launch plio< ""allh proj<d, MF
Sp<C1alloan rund ror 1976 grads m Ontano. IOS
REGISTR\TlO'
Iory re
IStr3110n of federal nurseCii. 8D
RI-.HA81L1T -\ TlO'
Acule nJrsmg cwe In the slrok
unit (Pallanl) J8F
AdJusu\e and affective re!opon."'C
of school-aged children 10 a leg
ampulatlon (Ritchie) A. 60Au
/..phasia: a nJrsc's gtnde to commumcatlng wuh aphaSICS. (Co-
derre) 21F
Surslng and related needs of yotJJll: adults \\-11h posnraumahc.
splRaJ cord lesions in,be home. fTubman) A .$.8Ja
Sleppm
stones' a road to coronary rehabalualion programs. (Jes-
'opl IMN
S.roke. (Adolphus e. all I
F
StrokC' rehablhtallOn - a creah\e proces:!i. (Gnhami :!:!F
Sunn)brOok stroke team - an Inoo\atl\e cxpenence. (Adolphys)
16F
Towards indc'pendence for paraplC'gu...s. (H..msen) :!"D
REID. lna \
Home care afler- surgef) for scoliosl
. .Bf"o
A 5Ul"\e) of resourcc5 for contlnUIn
education in nun.lng m Nor-
theßlern Ontano. A. "8\.h,
REILL\,8arban
Bk rr:v 55Je
RE
E\RlH
-$8Ja.
\I). 6OAu. 53'.
5D
Adjustl\e and affeC1n.e responses of school-aged children to a leg
amputation. t Rndùe) A. 60Au
Albena research leam receives H &. \\ gJëU1l. 12
tr
Sn
hl future predu.:ted for Dun.lng research. 6Ja
Canadian health sel"\lce
used b) Korean Inumgrants. fPopr:l A.
48M,
A companson of consumers' and pro\ldc
- oplrnons of commu-
nity and health
rvlces in a northern Alberta town. (Seymour)
A.
5D
A compans.on of the quality of care pro't'ided by registered nurses
woRm, Ihe twelve hour shift. (BaJnok) A. ..8J..
lbc concerns and CoplD
behavIOrs of the single mod1er wlrn a ctuW
a
ed SIX months to el
ht years. (Anderson) A. 48M)
An educational programme for D
SC practitioners. (Bain er al) A.
48Ja
The effeC1s of different techmques of acupuncture on knee paU1.
(Ramsey) A. 60Au
Exploration of the opinions of n
mg raeult) rr:gardm
change.
(Edenl A,
5D
10'0 "heal'" pOIenlials". 7D
Nursin
and rela'ed needs of young adults With post-traumatic.
spinal cord lesIons in the home. (Tubman) A. 48Ja
Nur.tlng publication and research award. 12Au
Ontario to study Iwo-year programs. l2Je
lbc proolem of leadership In FrC'nch CamKhan nun.lng. fDesjeal1)
A. 60Au
SC'nlDg standards for patlerd Car
. (Jackson. HClren) A.
3N
A study of hcahh and related needs of sernor cltlzen5 In t\\-o hoosrng
complexes, (KJrsllO" A.
5D
A survey of resources for contmuin
education m nun.ing Iß Nor-
""'astern On'ano. (Rerdl A. -$8My
lbc thoughts and feelings of patients in Ihe wailing þCnod pnor 10
cardiac 5W}:ery. (Rak.ocZ\) A. "8'"
RE!>PIR.\TOR\ DI!>E\
ES
Don'. bold your breaIh. 1D
RFSl SCIT A no'
RCglonai trauma centre. MJa
RICH\RlJ
O'. Sharon
8k rev..
F
RIDGE. PalrÎelM E.
8k. r". 50\1)
RITCHlf, Judllh \nne
AdJustl\e and affeC1I\C responses of school aged ctulmen to a leg
amputahon. A. 60Au
R0881 EE. Su....n J.
8
re' .
8Oc
R081'ETII:.. \lJc_
Kidney II1msplan! program. II'
R08SO'. Ellie
Bk fe' . 5OM)
ROE, Donna Jean
C:-'F ",bolarsh.p, 1'0<
ROl !>.'.ELET. Den..e Theberge
Babies at n
k") 34Mr
Freezmg breast nulk at home 31 Mr
Thc treatment of mastilis ID nur..U1
mod1ers 1:!"r
RO\ I E. Joan
Bk rev SOJa 5-1'
ROZEt'. Emdy
New concepts in infam nutntlon. 18D
Rl8EC". Robert f
SUM) boarding - a leaching tool. t . et aI) 42Jc
RLDD. 'oreen L
Dr.1C'nuna.. IYousOn) 51/..u
-S-
S\8". Helen
Rellred. ExC'\.ullve Dr.rC'CtOl'. /J.R
. (portJ ..3D
'\S"\TCHE\\\' Rt."I
TERED 'lRSE'i" \S"OCI\TlO'
Holds annual mcctln
. l2Au
"arJOl'lC' Hewln nun.ing coosuhant. C port) ..3F
SAl CHl ", Anne
Bk te\ .
7Ap
SC \It E. Liz
Sk re\ 64Au
SCHfft ER. 8etlie
Refresher per
peC1l\es. -I3Au
SCH'EC". Rodn..
C"""da Councd Gran.. 8'11
SCH'l RR. \I. Therese
Member-at-Iarge. nUßlng practice candidate CNA. (pon) 29Ap
SCHOL \R
HIPS
See A wards
SCHOLDRA. Joanne Dolores
MembC'r-at-I&lJe. nUßlßg educalJon candidate CNA. (pon)
8Ap
SCHOOL HE\LTH
RC'
tung tOITKn"ow's cUizens. (LockcbeIJ) 19F
CHlLTZ, Dianne
8k. rev.
MMr
SCH\\ \8, DoroCh)
PreSIdent OOHNA. (punl
IM)
SCOTT. Doreen
Home cc. anyone?.J6Je
Seenm. Euclid
The EMI bram scanner. -WN
SEX
MAR'll members support PCWM brief on rape. 8Mr
SE\ \lOl R. DlMne
Nun.ing SUperviSor. RCglonal Ps.yctuamc Ccntre. Kmg
lon Pern-
le...ary. (pun) 8N
!>E\ \lOl R. \olargard A
A compans.on 01 comumcrs' and providers.' opmlons of commu-
rnty and health
r.itt'S an a nonhern AIx'rt3 town. A. .t5D
H.-\RPE. Glad).
0bI1. '8F
XI
SIU \, Hatlie Lee
Facull) Dalhousie UrnvC'rSlt'\' 43F
The tran,fn pnxe< fer. J90c
'HERR\RD. \I)ma
Bk re' 5-IN
IL \t RDt RG, Donald S.
SC'''en
tcp
to. s.ucce fuJ hypencn' \f:
r:C'ßm
program 250c
I\IO'E \l. \oll<hele
Emergency re 01 the acute "I. autl en N
"RO'
. Rub)
Director of rubhc beallh nun.1D1 or the \\clhngton - Durrcnn
Guelph Health VOII. 48Je
S"EL TO', Judilh \1.
Coordlilator ot nun.mg education at Olanagan CoUqr: Kelowna.
8 C . (pun) 38F
!>LEEP
The sleep assignmeni a way to learn problem sof\lng. tChoI Lao)
3..Au
Slecpleslliontss can you help") (GllllsJ 32J1
\IITH, Donna Lynn
Research i..o 'heal'" pOIeDuals" , 7D
S\oIITH. Llad..
PreslClent. R...",S. !JAu
"'111 H. \Ian G
A
lstaßl dlr
C1or of nurslDg. Weiland Coum) General Hospital.
I:!JI
S\UTH, SUSIIII D.
"urslDl Practice CoonhnatOl'. Cone
e 01. Nunes or Onlano. 130e
S\lO""G
Anll-smolung 1!roup appomb exccutl"e dU'eC1or 9F
!>OCu.. TlES
Edmoolon group receiVes charter. I
")
Mannoba labor group. 8F
Perspecll\e. (Hanna. E.
Ap
"You'vc come a long 'U) nunie' . 8D
O\lORO'. Orranuo
The transter proç
. let aJJ 390c
SPEElH
Aphasia a nurs.c.s gUide to commumcatln
u,11h aphasiCS. (CO-
derre) :!IF
SPE'CER. \ era Low..
\tembr:r-at-I&I}:c. nursing praC1lte candldalr: CNA (port) JOAp
ST. GI-.R\L.\L'. Joanne
L.a.k.ehcad Uruverslty faculty. ....Mr
ST, JOH' -\\l8lL\'CE
Jean Bad ctuer supcnDtendc:nl. -I4Mr
Yvenr: LOIselle deputy crud ComouSSIOllCl'". 4..1......
STEIDL, SUSIIII ,
[s there a nurse In mc nelghbou.rtlood"J J5JI
STl'SO'. Ann
A chrncal evaluation tool for studenl nUßCS. d aI) 17Je
Tl'SO',
hlrle) \01.
CanadliilD nunes to participate In mternatlonal seminar. II My
National aodJor regional centers for prcpanng nun.mg educalors.
17Ja
VIce-presIdent candJda1e CNA. (portl 25Ap
TOC"\\ELL. Carohn
In-hospital cardiac
ucatlOn programs the nghl: to kno
. I Tw)
2::"-
STREET. \oIargarel \01.
.oHOfIOI'2I"\' Membcnhtp". AlxnaAssocllll.lO:lofRr:gl
tercd Nw-
scs. (punl I
S
TRESS
Enforced pro'lmll\ ro '!tot
s m tM chent envlronmenl ,VIIChOIU
-!OS
STlDE"TS
Conung out: a confrontation with realit). (Harper) 3OJ)
Explor
"Images of the nurse". II Ap
Reaching lomOlTo
'
CIII.len!!.. (Lod.cherg) 29F
Sl8ASIC. Joan
Oflìcer OOHNA,
IMy
SlN"\8ROO" \It-DiCAL CE"TRE. TORO"TO
Acute nursing carc in the ,[roke unu. (PaJlant) JSF
Regional trauma centre. 8J3
Stroke. (Adolphus el al) I
F
Stroke rehabilitation - 8 creative process. (Graham) 22F
Sunnybrook !rIolroke ledm - dO mnovatlve expenence. C/
dolphu!!o)
16F
Sl'RGER\
AdjuslÌve and affectlvc Tc!!oponses of school-aged children 10 a leg
amputallon. (Rltchlc) A. 60Au
Chan
e'. . 180c
Convalescence following coronary surgery (BOISVenl 26N
Home care after surgery for scolio,i!!.. (Reid) .UN
HospiraJ allows parents in OR. IOS
Mr Jones from head 10 toe. (Ford) 16N
A nursing challenge: replantation of a scvered arm, (Geyer) 19Ap
The thoughts and feelings of parients in the walring period pnor to
cardiac 5wgery. (Rakoczy) A. 48M)
Waiting for cardiac
urgery. (Rakoczy) 300c-
S\\lNTON, Constance
Consultam with CARE/MEDICO In Solo. Indonesia. (pon) 38F
-T-
TAD-\.. JeanneUe
In-hosplraJ cardiac eduCJ110n programs: the nght to know.
(Stockwell) 2.:!N
TAGGART. Marie-Elizabeth
A practicaJ guide to
ucce
ful breast-feeding. 2SMr
TA\LOR. Ann
Assistant executIVe direc10r of RNABC. 44Mr
TF -\CHI'iG
National and/or regIOnal center
for preparing nursing educators.
(SlinsOn) I1Ja
Story boarding - a teaching tool. (Dubin .. el al) -t2Je
TELE\ ISIO-';
"lntant nutmion: a foundation for lasting heaJth". March 23.
1977,210
T"ACH,MaO)
Bk rev..46D
TOlPI'i. Marie,Anne
MembcT-at-large. SOClaJ and economic wellare candidate CNA.
Ip0r11 JOAp
TRAI"Ir.G SlPPORT
Albrna research tearn receives H & W grant. 11 Mr
TR-\
SPL-\
TAT10'
Kidney transplant program. I J N
Kidney transplants up at U of A HospllaJ. 110:
TlßMA
. l'\orma Hden
Nur'\IDg and related needs of young adults with pO
I-(faum.ilic.
spmal cord le"ilOns m the home. A. 4gJa
TlLLOCH, Edna
Recent guest of C.N.A.. (pon) 9D
nR'8llL. Lil) M
l:hicf nursing officer. World Health Organizarion. retired. (port)
1211
Tl TTLE.
lildred
OI>,I.I2JI
TYLER. Heather A)er!)t
Alumnae A!.".x.lalion ot Montrcdl Generdl Ho
pll.d Jv.Jrd. .3XF
-
-l-
lMTED 'AT10:\!>
Habitat: quality of life on a
Iooal scale. I M.ucus) 28My
1 NI\ ERSIT\ 0.' AL8FRTA
Albena research learn receives H & W granl. I:!Mr
Faculty appomnnents. 43F. -tlD
Peggy Ovenon d
Mslant profe!.sor m hedUh \Crvlces adffiJßlstra-
tion. (pOr1) -t I My
U of ..\ graduate scholarship. IOJI
1 "I\ERSIT\ OF AL8ERTA HOSPITAL. EIJMO"TO"
Did you know...multiple binh!.. Ion
1 '111\ ERSIT\ OF 8RITISH COLl \ffil-\
Carol May Milchell. lecturer. 43D
1 M\ .'RSIT\ OF r.E" 8Rl 'liS" If'''
Donna C. Lorden. Lecturer. HN
l'llI\ERSIT\ Ut M.S"-\TCHF\\A"
Community nursmg course oUered by correspondence. 9F
l NI\ ERSIT\ 0.- TORu'TO
Nora I. Parker. Chairman. Dept. of Nursing. School of Graduate
Studies. 8N
Temunates nur"e practitioner course. I IN
lROLOG\
Disseminated Ißlrava
cular coagulation. a pallent profile. (Gran-
berg...et al) -tlll
-\-
ACHOr.. \laO) L.S,
Entorced prOJtlmily 10 stress in the client environment. 405
\ A'll HEl "FI E\I. Jud)
Crymg. the n
glected dimension. (McGreevy) 18Ja
\ [RRO'''E.-\l. \In;.
Canadian Diabetic Association sponsors bursanes. JOJa
-"-
" ADD ELL. Man Anne
Health helper... (et al...) I7D
" -\GST o\H'E. Jan
A clinicaJ evaluation tool for srudent nur
es. (et aJ ) 37 Je
"ALLACE. Anne
.l..ssistanl nurse coordrnaror of the British Co)umbia and Yukon
Dlvl
ion of the Canadian Cancer Sociely. (port) 48Je
\\ 0\1 pER. Maril
n
Faculty Dalhou
ie UmverSlty. ..OF
\\ -\RRE'II. Faith
Thai cup of tea. -t6Ap
",earne. Rob.n
Nursing station Ellesmere Island. (pOr1) 8N
"E8ER. Elizabeth
Bk. r<v..
8Mr
"' FHRI F\ 9 \lal":Raret
Sudden death, 28N
\\ ELl:'H, Frances \.Jarie
Lakehead Universltv faculty. -WMr
"HAT'S N""
.$-IF.
6Mr.
2M). 50Je. 4811. 500c. 52N
"HiTE. leslie
Faculty Dalhousie UruveT
lly. -tJF
\\ HI riNG, Carol
Director of nursing services. ",elle
le)' Ho
plIal. Toronto. l-t
XII
WIDE\IA:\. Eva M
Returned trom tour of duty with MEDICO. (pon) S8Au
"ILDS
IITH, Ard)the
Faculty Dalhousie UmveTSlty. -t3F
"ILSOr.,8ob
Secretary General. Canadian Medical A
ouallon 14S
\\ Ir. TER. Catherine
To whom it may concern. JON
"OMEr.
Canadian task force concludes annuaJ pap smears not neces!.3ry for
most women. I3Je
Canadian women at work "La difference" peTSI!)tS. 12Mr
Did you know? 12S
MARN membeTS suppon PCWM bnef on rape. 8Mr
Why not? (IS
"OODS, Carol
Lecturer. Lakehead UmveTSity. 430
"ORLD HEALTH ORGA"ILATlO"
New direc1ion plotted for world health. 1111
SmailpoJl. eradication program almost ccnain to succeed. I-tM)
"ORLD \\AR I
1914-1976,48N
One of the bluebird, I N
"\ LIE. Dorothy
Dlrecror. DlviMon of Nursmg. RNAO. SMAu
-x_
-\-
\ AM\fOFF, Marie
A chmcal evaluation 1001 for siudent nur!.es. (el aJ...) 37Je
\Ol'l/(;, D
Plan of care: the young child on diaJysls. (et al) -t I Oc
\ OLISON, 8elt) \1
Dilemma.IRudd) 51/.u
\ ULE. Penn,.
Bk rev.,
8Oc
-,-
ZAIRE
NUA course eJl.pands to foreign countnes. 7Ja
ZELMER, Am) M
Faculty of nur'iomg. Dean. Umver
lty of Albertd. 43D
Le Biblloth
ue
Li1i ver
t' dlOU.wa
Echéance
The Ubrary
U'1IversUy of on.we
Oete Due
FEB - 3 1983
JÀ
4 ;
86
2 5 "ARS 1990
3 0 MAPS 199
2 5 A
.\W91 '
U d' / of OllaLJa
,/i] '[" 1...11''''111 " 1 " I I !..!!I
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