Skip to main content

Full text of "The Canadian Nurse Volume 72"

See other formats


'6 



 


--- . 


t 1 f 


--- 


. 
." 


The Canadian Nurse 


. . G..l51.a ,} 
MISS JE STOCK 
608-l11 wURJEMBu
G 
OTTAriA 2 ONI 


"?o 



 " 


.... 


t 


J 


./ 



- 


\ 


\ 
\ 


WHITE SISTER 


The Timeless Look 


--- 


\1 


\ 



 


WHITE 
SISTER 


I 


--- 


8 

-/ 


-- 
---. 


J 


. .., 


A. Style No. 46463 
Sizes 3-15 
Royale Corded Tricot 
White, Pink . . . . . . . about $26.00 


( 
) 


I
 I """ITE 
....Ð SISTER 
CAREER APPAREL See our new line of Whites and Water Colours at fine stores across Cana< 


B. Style No. 46415 
Sizes 3-15 
Royale Corded Tricot 
White, Cantaloupe. . . . . about $28.00 


C. Style No. 46850 
Sizes 3-15 
Royale Seersucker, 100% Woven 
Polyester 
White. Pink. . . . . . . . . . about $35.00 


--.......... 



76 


The Canadian Nurse 


4 
6 
13 
48 Your next CNA convention 16 
50 Frankly Speaking S. Stinson 17 
Crying: A McGreevy, 
The Neglected Dimension J. Van Heuke/em 18 
Cross-Canada Registration 22 
Brushing Brigade H.K. Moggach 26 
Blindness Can Be Prevented F. Doner 27 
Nursing Via Satellite N. E. Henderson 31 
Communicable Diseases 
and Immunization L Cranston 34 


Input 
News 
Calendar 
Research 
Library Update 


The official journal of the Canadian 
Nurses' Association published 
monthly in French and English 
editions. 


Volume 72 Number 1 


Cover Photo' 
Health and Welfare Canada 
Communications services in 
Canada s far north are presently 
undergoing expansion and 
revitalization as a result of 
technological progress. For nurses In 
the north, such as the one featured on 
this month's cover. these 
improvements mean better health 
care for their patients. Read Nursing 
via Satellite on page 31 


. 


--
 
i<
. 
..... 


"' 


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


ISSN 0008-4581 


Indexed in International Nursing 
Index, Cumulative Index to Nursing 
Literature. Abstracts of Hospital 
Management Studies. Hospital 
Literature Index. Hospital Abstracts. 
Index Medicus. The Canadian Nurse 
is available in microform from Xerox 
University Microfilms. Ann' Arbor, 
Michigan, 48106. 


J 


The Canadian Nurse welcomes 
suggestions for articles or unsolicited 
manuscripts. Authors may submit 
finished articles or a summary of the 
proposed content. Manuscripts should 
be typed double-space. Send original 
and carbon. All articles must be 
submitted for the exclusive use of The 
Canadian Nurse. A biographical 
statement and return address should 
accompany all manuscripts. 


. 


A Canadian Nurses Association. 
':::( 50 The Driveway. Ottawa, Canada, 
K2P 1 E2. 


Subscription Rates: Canada: one 
year, $8.00; two years. $15.00. 
Foreign: one year, $9.00; two years, 
$17.00. Single copies: $1.00 each. 
Make cheques or money orders 
payable to the Canadian Nurses 
Association. 


Change of Address: Notice should be 
given in advance. Include previous 
address as well as new. along with 
registration number. in a provincial 
nurses association where applicable. 
Not responsible for journals lost In mall 
due to errors in address. 


Postage paid in cash at third class rate 
Montreal. P.Q. Permit No. 10,001. 
. Canadian Nurses Association 
1976. 



2 


The Canadian Nurse January 1976 


You're 
Beautiful 
So who says your shoes have to be ugly? 


" 


 , \ \ 
\ \ 


... 
" 


.\
 .1 professional. you need shoes that art> 
comfilrtahlp and durahle. 
Bu t \ ou' re also a woman \\ ho cares ho\\ 
she look,'. So \ ou want shoes \ùth sh It'. too. 
\\'ell. \\e\e got just that shoe. BE\l'TY 
0'\ Dl"T\. Professional shoes h\- Baht. 
Comfortahle, durahle and becau'se the\-",'e 
li'om Batao also \ en- stdish. ' 
E\-en hetter, BE\lTY 0:\ DlTTY shoes 
are priced to gi\ e \ ou tht' most for 
-our dollar. 
And nO\\. 
ou can sa\ e an e:\tra 82.00 with this coupon. 
'\0\\ (I/(It's a ht',mtilirl oner
 


, 


, 


$16.99 


'-------------------, 
I I 
i This Coupon is \\'Orth $2.00 I 
I hm ards the purchase of am J 
I BE\l'TY 0'\ Dl'TY white professional I 
I ,hoes, at ,UI\ Bata store. 
1 I 
I oHer good ;mtil \Ia\ 1. 1976. <,' -, I 
I I 
L___________________
 



Ieet Thn
e Beautjful Pmfe
sj()nals 
Eaeh is distincti\l'h sh'led and features 
Baht's 3-wa
 comfilrt. S;,ft. 'qualit
 leather IIpper
. 
Cushioned insoles \\ ith arch support. Fle\.ihle 
,olt's. 
Set' the l'ntÌl'e ,election of Bata RE\l TY 0'\ 
Dl'TY ,hoe
 tolla\. at tIlt-' Bata ston' nearest \tHl. 
Then tr
 on .; pair. YOldl .1grl'l'. Thl'
 'n" 
ht',wtilirl! 



 
$18.99 


A world of comfort at your feet 




\t
 

"(\

\\ 
)t(\': 


Efl iff. 


I ne Lanaalan Nurse .J8nu8ry 1'97ti 


What is there to say about a change in 
format as radical as the one which 
faces readers of The Canadian Nurse 
and L'infirmiere canadienne this 
month? 
Either you like it or you don't. 
Obviously, we hope very much that 
you do like it. We present it in good 
faith, relying on the combined 
expertise of a skilled young graphic 
artist, an innovative printer, and our 
own collective editorial opinions as to 
what you expect from your 
professional journal. 
Plans for the new format began 
almost a year ago. Development has 
proceeded slowly, allowing for lengthy 
consultations between the artist, the 
staff of both journals, the printer and 
other CNA staff members All of this 
planning will see its first concrete 
expression in this January, 1976 
issue. 
At this stage, two weeks before 
press time, about all the editor can do 
is keep her fingers crossed and hope 
for the best. It is inevitable that there 
will be mistakes in this first trial run; I 
only hope they will not be big mistakes 
and that readers will remember how 
difficult the first few weeks under a 
new system can be. 
As for the technical details - 
those of you who have had some 
publishing experience will recognize 
the work that has gone Into the new 
format. Type faces and sizes are 
different throughout the book. Column 
sizes have changed: departments 
(news, lellers. etc.) now appear in 
new, narrower versions, lour columns 
to a page. Some of the names of these 
departme...ts have been updated to try 
to match the mood of the seventies. 
Most of all, there is a bold new 
design for the cover - one new look 
for both the English and French 
editions. This design will remain 
constant but the photos and color 
combinations will change with each 
issue. 
So much for the medium - what 
about the message? We have a new 
vehicle and, therefore, an obligation to 
make the contents live up to the 
format. One of the ways we will be 
trying to accomplish this is by 
accepting the constructive criticism 
offered by your provincial public 
relations officers. These 


representatives met recently with their 
national counterparts at CNA House to 
examine their respective roles as 
providers of information at national, 
infernational and provincial levels. 
Their comments will playa major role 
in editorial decisions over the coming 
months. 
Among other things, they said: tell 
us more about national health issues 
(not just nursing); give us more 
controversial articles: give us more 
clinical (how-to) articles; try to reflecf 
more closely the views of the average 
staff nurse; and let us know more 
about what our national association is 
doing for us. 
They also said: try to be less. 
impersonal: try for a less sCholarly, 
less pedantic approach: above all, 
look like you're having fun. 
Promises are easy to make and 
hard to keep. But those are 
suggestions we are going to try to live 
with, especially the last one. 
-M.A.H. 


Ilel-ei II 


Editor 
M. Anne Hanna 
Assistant Editors 
Liv-Ellen Lockeberg, 
Lynda S. Cranston 
Production Assistant 
Mary Lou Downes 
Circulation Manager 
Beryl Darling 
Advertising manager 
Georgina Clarke 
CNA Executive Director 
Helen K. Mussallem 
CNA Director of Information Service 
Michèle Kilburn 


J 
. 



 


f - 


ì. 


. .\.....:;,--=-... 
 


1-' 
L.. l 
f--
' 


11-- 


- ------.. 
 


There IS something special about this 
January 1976 issue of The Canadian 
Nurse that doesn't immediately meet 
the eye. For the past ten years, 
address labels for both CNA journals 
have been produced by computer, 
using a service provided by IBM 
Ottawa Data Centre. This issue, 
however. comes to you via a new 
System 3 Model 8 computer that now 
resides at CNA House. Installation 
(pictured above) took place late last 
Fall and since then, circulation staff 
have been working overtime to get the 
system operating. 
The main advantage to you. the 
reader, will be faster and more efficient 
delivery of your journal. Our thanks to 
all t 20,000 of you for your 


co-operation and patience in this 
change. If a problem should arise witl 
your own subscription, or if you knoy 
of someone who hasn't received the 
copy, help us get things straight. ThE 
information we need: 
. CNA member - registration 
number: province In which you hold 
active practising/full membership: 
label from your lasf copy received. 
. Subscriber - present address; 
previous address and, most importam 
label from your last copy. 
Next month in The Canadian Nurse. 
three nurses who work In Canada s 
first multidisciplinary stroke uOlt at 
Sunnybrook Medical Centre in 
Toronto share their experiences Witt 
readers. Patricia Adolphus CatherinE 
Pallant and Linda Graham have eacl 
worked with stroke victims for sever
 
years. In their three-part article next 
February. they describe the history 0 
the unit, the physical layout, the 
nursing care involved. and the 
rehabilitation of stroke victims. 



4 


The Canadian Nurse January 1976 


I 


The Canadian Nurse invites your 
letters. All correspondence is subject 
to editing and must be signed, 
although the author's name may be 
withheld on request. 


. 


VIEW WOUND SITE THROUGH ACCESS 
CAP, REMOVE CAP FOR EXAMINATION AND 
DRAIN TUBE ADJUSTMENT. 


1111)111 



' 


OOPS, WE GOOFED... in the report 
on the last meeting of CNA 
Directors (The Canadian Nurse, 
December, 1975, page 33) the 
statement on predicted costs of the 
1976 CNA convention should have 
read as follows: Since it is estimated 
that convention costs will increase 
by close to $15,000, registration 
fees will have to be increased to 
help cover expenses." 


\' 
, 
" .... 


'" 



 


-- 


Why Such a Long Wait? 
In the July 1975 issue of 
L'infirmière canadienne it was 
suggested that nurses considering 
going to work in a foreign country 
would be well-advised to secure 
authorization from that country before 
leaving Canada. I am writing to tell you 
of a similar experience right here in our 
own country. 
I wanted to leave Quebec to work 
in the province of Ontario. looking for 
new surroundings and new 
experiences. Of course, I intended to 
work in the field of nursing which is 
familiar to me. I had to wait eight 
months for the transfer of my license 
and I cannot tell you how many 
useless letters I received while I 
waited for the necessary papers. 
Travel can be enriching but if you 
have to make your decision a year 
ahead and delay your departure 
another eight months waiting for your 
license, the spontaneity of the whole 
project vanishes. 
Why such a long wait? Ii seems to 
me that a study of this situation would 
be in order. I urge those who have 
experienced similar hardships to send 
their comments. Perhaps your next 
trip will be smoother and more 
pleasant? 
-LP.r, N., Quebec. 



oU

 

,...\
\

 --- 
\fO

--- 
:..----- 
THE HOLLISTER DRAINING-WOUND 
MANAGEMENT SYSTEM 


KEEPS FLUIDS AWAY FRO"v1 
PATIENT'S SKIN AND GUARDS AGAINST 
IRRITATION AND CONTAMINATION. 
Skin-conforming Karaya Blanket protects skin around 
wound site. It directs discharge into odor-barrier. translu- 
cent Drainage Collector which holds exudate for visual 
assessment and accurate measurement. 
There are no messy, wet dressings to handle or change 
. . no need for painful dressing removal. 
Supplied sterile. for application in O.R. or patients room. 
The better alternative 
to absorbent dressings, 


As you suggested, CNA's 
Information Service has conducted a 
study of problems related to the 
registration process in various 
provinces. We urge you to read the 
article entitled "Cross-Canada 
Registration" that appears in this 
issue of both The Canadian Nurse and 
L'infirm/ere canadienne. 



 Write for more information 
.1 
2



!e5
wIIiOWda,e. Ont 


M2J 1 P8 


Nursing Positions Scarce? 
A copy of the following letter to 
the Ontario Minister of Health was 
sent by the author to the editor of The 
Canadian Nurse. It /s published here, 
with the permission of the author, as 
an indication of a situation which 
could have a direct or indirect bearing 
on the social and economic welfare of 
readers. If you have firsthand 
knowledge of similar situations, we 
would welcome your letters 


The Honorable Mr. F. Miller, 
Minister of Health, 
Parliament Buildings, 
Queen's Park, 
Toronto, Ontario. 


I am a recent graduate from 
George Brown College - Nursing 
Division, Nightingale Campus. 
In June of 1975 I was hired by the 
Doctors Hospital and the Toronto 
Western Hospital as a Graduate 
Nurse with registration pending. At this 
time I accepted the Doctors Hospital's 
offer of employment and consequently 
rejected Toronto Western Hospital's. 
In the first week of August. one 
month before I was to begin working, I 
was informed by Dr. V. Kirkpatrick, the 
Director of Nursing Services at the 
Doctors Hospital, that the job offer had 
been withdrawn due to budget 
difficulties. 
Since that time, although I have 
been actively searching for a job 
(nursing home at Christie and Bloor. 
Cancer Society, Red Cross. City of 
Toronto, Ministry of Community and 
Social Services, Manpower, YMCA, 
Mount Sinai, Hillcrest, Wellesley, 
Toronto General, Salvation Army- 
Grace. Toronto Western (again). 
Women.s College. Central, and 
Princess Margaret,) I have been 
unable to find a nursing position 
because all vacancies had been filled 
in May and June for Graduate NUrses. 
I feel that I was unjustly treated by 
the Doctors Hospital because they 
had confirmed my position, and then 
withdrew It when It was too late for me 
to find another job. 
I find myself now in great difficulty 
as a direct result of their unethical 
conduct. Having tried everything else I 
must now ask that the Doctors 
Hospital fulfill its obligations. I appeal 
for your help immediately. - 
Lvnda Hirtenfeld, Toront('. Ontario. 



"."U.'J 1:111'11 


POSEY SAFETY VESTS 


The Posey Patient Restrainer is one 
of the many products which com- 
pose the complete Posey line. 
Since the introduction of the 
original Posey Safety Belt in 1937, 
the Posey Company has specialized 
in hospital and nursing products 
which provide maximum patient 
protection and ease of care. To in- 
sure the original quality product, 
always specify the Posey brand 
name when ordering. 
The Posey Patient Restrainer with 
shoulder loops and extra straps keeps 
the patient from falling out of bed 
and provides needed security. There 
are eight different safety vests in the 
complete Posey Line, #5163-3131 
(with ties), 


The Posey Disposable limb Holder 
provides desired restraint at low cost, 
This is one of fifteen limb holders in 
the complete Posey line, #5163-2526 
(wrist), 


... 



, 
The Posey Keyloele Safety Belt is de- 
signed with a revolutionary new key- 
lock buckle which can be adjusted to 
an exact fit and snap locked in place, 
This belt is one of seventeen Posey 
safety belts designed for patient com- 
fort and security. #5163-1333 (with 
snap ends), 


. 
f 
, 


;- 
.,.-,.,.,.. . 
116 stt1 P 
;ofr 8 III .,.- 


.
 


-' 
. . 


i 
I 


4, 



 
I"sofra-tulle I 


'" 


The bactericidal 
dressing 



 


C_poellion 
A hg"rwelg"r 'ano-parattJn gauze dressing Impregnated with 
11iit Solramycln (hamycetln sulphate BP) 
Propøtle. 
The add.llon 01 the antlbtottc SotramYCln to the par atftn gauze 
ensures the preventIOn 01 erad,cabon 01 super1lclal bacterial 
infectIOn Irom wounds In a lew hours thereby reducing the 
need IOf systemiC antlblOhcs 
Sohamycln IS a bactencldal broad spectrum antlbfobc. etfec- 
bve agarnsl many organisms W"IC" "ave become reSistant to 
other antlblOhcs Including 
StaphylococcuS aureus 
Pseudomonas P)'ocyanea 
ESChetlChla colt 
Proteus spp 
So"amycln IS I'IIg"ly 
uble In wa.er mikes readily with eJlU- 
dales and IS not Inactivated by blOOd pus 01 serum AlthouØ1 
It IS uncommon sensdllatlOn to Sotramvcln may occur and 
cross sensitization between Solramycrn and chemically 
related antlDotJcS eg Neomycin Kanamycin and Paromomy- 
cin IS common Cross reSIStance between Sotramycln and thIS 
gfOUp 01 antibIOtiCS IS not absolute 
Actw.nt.age. 
Rap.ð e,.adlcatlon 01 oacterla "om me wound 
EJlcellent gtlyslcal prOlectlOn 
lo'#lll InCidence 01 maceratIOn even after .tlree weeks In SI'U 
Non-adne,.enl can be- retnO\l'ed piiunlessly 
Saves dressing time 
Reduces wastage 
Eac" dressing IS parcl'lment-sheatnetl IOf no-touc" handling 
SenSdlzatlOn IS uncommon 


, 


\ 


The Posey Retractable Stretcher Belt 
can be adjusted to fit every stretcher. 
guerney or operating table. This is 
one of seventeen safety belts in the 
complete Posey Line. #5163-5605 
(non-conductive), 


.nd)callon. 
TrllumaUc. LaceratIOns abrasions grazes (gravel ras") bites 
(aOlmél,'s and U"ISects) cu's puncture 
ounds crus" InJur.es 
surgICal wounds and InCISIOnS traumatic ulcers 
Ukerative: Vancose ulcers dlabellc ulcers bedsOfes tropICal 
ulc.ers 
Thermal. Burns scaldS 
Electhe: Skin grafts (dOnor and reCIpient sites, avulsion of 
t '1ger Or toenatls.cl,.cUmciSIOl1 
MJlc.naneou.' Secondan1y Inlected Skin conditions - eg 
eczema. dermatitIS herpes zoster cOk>stomy acute pørony 
c"la. Incised abScesses (packing) 1I19rC*ttn9 toenails 
C_alndlcallona 
SensItizatIOn to lan
ln or to Sotramycln 


'- 


Application 
II reQulI'ed the wound may hrst be cleaned A single I.yer of 
SOFRA-TULLE should be appl.ed directly to the wound and 
covered '#1111'" an appropriate dressing Suc" as gauze I.nen or 
crepe bandages In the case 01 leg ulcers It IS advisable to cut 
t"e dressing exactly to t"e sIZe olt"e ulcer In order to minimize 
.tle fisk of senSlllzatlOn and nol to overlap on the surrounding 
epidermis When the Inlectlve gtlase has cle.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?" 


. 


- 


l 


Director of the 1975 National 
Conference on Nursing Research, 
Shirley Stinson, makes notes during 
an address by June C. Abbey, 
assistant professor and acting 
chairperson of the department of 
nursing in biological dysfunction. 
University of California. San 
Francisco. At right is Jack Hayward, 
principal nursing officer with the 
department of health and social 
security In London, England, and 
another keynote speaker 


What is an indicator? 
"Basically an indicator is a person or 
thing that points Oul - a pointer," 
keynote speaker, Lisbeth Hockey, 
explained during Ihe opening address. 
"In relation to nursing research, an 
indicator may be a pointer to a 
phenomenon relevant to nursing 
knowledge and nursing research that 
attempts to extend that knowledge .. 
Hockey, who is director of the 
nursing research unit in the 
department of nursing studies at the 
University of Edinburgh. Scotland. 
warned Canadian researchers of the 
need to be aware of overall social 
indicators since these have Important 
implications for their own studies. 


" 


Canadian studies 
Canadian presentations were 
chosen from a list of 47 projects 
currently underway or recently 
completed. 
The most complex was one being 
carried out under principal investigator 
Dr. Moyra Allen at McGill University. 
This project, now entering phase two 
of a five-year program. is concerned 
with development of instruments, 
questionnaires, audio-and videotape 
reviews and observations by expert 
nurse-judges and other health 
professionals to measure critical 
variables (or differences) in the 
expanded functions of nurses in three 
types of settings- a general hospital, 
a community health center, and a new 
type of special health and community 
resources center. 
Marian McGee, associate 
professor, faculty of nursing, 
University of Western Ontario, 
described a project in London, 
Ontario, to determine how well 
community nurses can assess a 
family's ability to make decisions. 
"Since... the family decision- 
making is the basis of all family 
functioning, then the extent to which 
family decisional skill is accurately 
assessed and subsequently modified IS 


... 




 

1
 #I 


-.". 



 


\ "....- 


Some of the 68 delegates from seven 
provinces who attended the recent 
1975 National Conference on Nursing 


one measure of effectiveness of 
Community Health Nursing," McGee 
said in her abstract. Her project is 
working on existing instruments and 
looking at ways these can be modified 
to be effective indicators. 
Another project is being carried 
out by Jeanette Funke assistant 
professor, school of nursing, 
University of Alberta. Its purpose is to 
test the reliability of current 
instruments (such as questionnaires 
and evaluation sheets) and possibly 
create new ones that will indicate how 
women adapt to pregnancy and to 
their newborn babes. 


Two completed studies 
Fabienne Fortin, doctoral 
candidate, University of Western 
Ontario. described a project recently 
completed at a large Montreal 
hospital. 
This study evaluated a structured 
preoperative patient education 
program and found that 
preop education by nurses does 
make a difference. Patients receiving 
the preop education program were 
less impaired by surgery when 
measured against a specific set of 
desired outcomes (such as ability to 
walk, go to the bathroom normally and 
so on) than patients in a control group 
who did not receive the program. The 
differences were most pronounced at 
two and ten days after the operation 
but considerable differences were still 
found 33 days postoperatively. 
Vivien Jenkinson, nursing 
systems analyst. Hospital for Sick 
Children, Toronlo, undertook to 


, 


.. 


- 

.. 


. 
- -- 


;or 



 


'" 



,.j 
'.... " 
, 


<. 
"- 


... 


Research in Edmonton. The 
conference was the fourth to be held 
in Canada. 


develop a reliable measurement tool 
that could be used to quickly and 
effectively Judge the quality of nursing 
care of children. The final, 
single-page, evaluation sheet-called 
SAVE from the full title of Selected 
Attribute Variable Evaluation- 
contains 22 items and will allow head 
nurses, team leaders or other 
observers to assess the quality of 
nursing care given by anyone nurse to 
anyone child at any time. More than 
1,000 evaluations have been 
completed since SAVE came into use 
at the hospital in March,1975. 


Planning future conferences 
The director of the 1975 
conference was Shirley Stinson of The 
University of Alberta. Four university 
schools of nursing in the Prairie 
provinces were represented on the 
planning committee. Delegates 
agreed to ask the Canadian Nurses' 
Association for secretariat assistance 
in planning future conferences and 
CNA's special committee on nursing 
research for planning assistance. 
A limited edition of a full report on 
the conference and all its papers will 
be published in the spring. Copies will 
be available on loan through the CNA 
Library in the same way as 
proceedings of other nursing research 
conferences. 



Ine (;8n8048n Nur.. ..Janu8ry I
fb 


CNA members are 
invited to submit 
resolutions for 
presentation at the 
Annual Meeting and 
Convention, June 1976. 


Resolutions must be 
signed by two CNA 
members and forwarded 
to the Resolutions 
Committee, CNA House 
by 12 February 1976. 


" 


-t\ 


4 \ 


\ 
... 


The Marjorie Hiscott Keyes medal 
was presented last October to Dean 
Armstrong of Vancouver by Eric 
Morris: national treasurer of the 
Canadian Mental Health Association 
(CMHA) The annual CMHA nursing 
award is in recognition of outstanding 
psychiatric services to the mentally il/. 
Armstrong IS head nurse on the 
psychiatric unit of Lions Gate Hospital 
in North Vancouver 


NUA Course Expands 
to Foreign Countries 


Canada s only national 
inservice educational program for 
nurses, the Extension Course in 
Nursing Unit Administration (NUA), 
now in its tenfh year of operation. has 
enrolled a total of 659 students for the 
1975-1976 academic year. Almost 
three-quarters (72%) of these students 
are married: 43 are men: and the 
average age of the students IS 35 
years. A total of 356 hospitals are 
represented in this year's program. 
Highlights of NUA activities were 
brought out at the most recent meeting 
of the Canadian Nurses' 
Association/Canadian Hospital 
Association Joint Committee that 
administers the program. 
The NUA program came into 
being as a result of a brief presented 
by a JOint Committee of the Canadian 
Nurses' Association and the Canadian 
Hospital Association to the W.K. 
Kellogg Foundation requesting 
financial support for a continuing 
educational program for head nurses. 
Requests from ministries of 
health outside Canada have resulted 
In implementation of the programs in 
Lebanon and the Republics of Zaire 


.;;'I 


and Haiti. These projects receive 
financial suppor1 from the Canadian 
International Development 
Association (non-governmental 
organizations). 
Violence in Lebanon, where the 
first overseas workshop was held, 
prevented completion of last year s 
session and has forced postponement 
of the 1975-76 classes. In Zaire, 15 
students have been accepted this 
year. They attended an inilial session 
in Kinshasa In September. Five 
students have also been accepted for 
a similar program now getting 
underway in Haiti. 
The Extension course is an 
in service type of program planned to 
help nurses in supervisory positions 
improve their skills in the management 
of the nursing unit. It is directed 
towards those who are unable to 
attend a university school of nurSing. 
The program is conducted by 
combining home study and workshop 
methods. 
Information and application forms 
are available from Dorothy Nelson 
Director. Extension Course in Nursing 
Unit Administration, 25 Imperial 
Street. Toronto, M5P 1C1. 


Wanted: 
A Caring Heart and 
Warm Hands 


. Death is not the enemy - inhumanlly 
is. I want you to go back to your 
hospitals and seek out the enemy.-. 
Joy Ufema, internationally known for 
her work with dYing patients. was 
speaking to participants in a clinical 
day sponsored by the Royal Ottawa 
Hospital In Ottawa last November. 
"A caring heart and warm hands.' 
are the criteria for her job according to 
the Philadelphia-based registered 
nurse. Ufema explained that she did 
not promote anyone set approach for 
dealing with dying people but, in fact, 
stressed the individuality of the person 
and his right to die his own way. 
'" haven t had any experience in 
actually dying so - anything goes. ' 
she explained. She added that she 
frequently cries with the patient. and 
that she doesn.t offer any information 


the patient has not asked for. "I too 
must die," she said and "some days I 
don t want to do thaI." 
Another speaker, Joy Rodgers 
told the participants that "we are now 
married for a longer time. we invest a 
lot in one person. we no longer live as 
an extended family, and therefore. we 
put our emotional eggs in few baskets. 
The tradilions that once helped us 
cope have been stripped away. . 
Rodgers, a nurse consultant with the 
Clarke Institute of Psychiatry in 
Toronto, works with bereaved people. 
particularly widows. Problems of 
mental health. sleeping, and 
menstruation are just some of the risks 
of bereavement she said. 
Bereaved people, of which there 
are 470,000 annually in Canada can 
display anything from headaches and 
dizziness to increased alcohol 
consumption and suicide; these 
people need to believe that their 
feelings are normal and that you will 
accept them and listen, she explained. 
Rodgers stressed that feelings of 
anger and guilt cause the most 
difficulty and that these feelings need 
to be expressed verbally . Our 
program." Rodgers said, 'has found 
that other widows who have adjusted 
are the most helpful to the recently 
bereaved." We are hoping to offer our 
services to the community In the near 
future. she concluded. 
Dr. Ina Ajemian of the Royal 
Victoria Hospital in Montreal told 
participants how the' palliative unit" at 
that hospital came to be established. 
'-Patients who are termrnally ill are 
sent to this unit, and we help them 
maintain their dignity. listen to them. 
offer companionship and help them 
control their symptoms, she said She 
explained that visitors are welcome 
anytime and that even pets are 
allowed. Dr. Ajemian described the 
home care program and how It 
maintains the patients at home and 
decreases the amount of time needed 
in hospital. 


Assistant Editor 


The Canadian Nurse, a monthly 
journal published by the Canadian 
Nurses' A5sociation, needs an 
Assistant Editor. 


Requirements: R.N. and member of 
provincial nurses' association; 
bachelor's degree in nursing, 
journalism. general science. or arts, 
recent clinical experience; 
experience and/or interest in 
writing and editing; and willingness 
to tra ve/_ 


Location: Ottawa 


Qualified applicants are invited to 
send their complete resume to: The 
Editor. The Canadian Nurse, 50 The 
Driveway, Ottawa. K2P 1E2, 


Tough Luck! 


The New Brunswick Association of 
Registered Nurses was one of 85 
Atlantic province organizations invited 
by the Prime Minister s Office to attend 
a special meetIng called to explain the 
Government s anti-inflation program. 
Glenna Rowsell, employment 
relations officer for the Provincial 
Collective Bargaining Councils. 
represented the association at the 
meeting held In Halifax November 14 
In response to concern 
expressed by Rowsell regarding the 
effect of wage controls on New 
Brunswick nurses. the prime minister 
replied Ihat it was "tough luck' they 
were behind the rest of Canada in 
wages. Rowsell pointed out that Ihe 
concern was the relatively low salaries 
received by New Brunswick nurses 
compared to those in other Atlantic 
provinces. 
The Prime Minister s response 
angered many observers at the 
meeting, especially when he referred 
to N.B. nurses' wages as being 
historically behind Ontario and the rest 
of Canada. 
Mr. Trudeau later softened hIS 
stand and said that perhaps New 
Brunswick nurses could seek 
exemption from the 10 percent ceiling 
before the Government sAnti-Inflation 
Board. 



ø 


Xt>>\\-S 


The CanadIan NurBe January 1976 


Cooperation Needed Between 
Mental Health Groups 


Volunteer, government and 
professional groups for care of the 
mentally ill have proliferated, but 
unless there is cooperation between 
them there is danger that care will be 
fragmented and incomplete, warns 
George Rohn, general director of 
Mental Health/Canada. The failure of 
the "piecemeal approach" was the 
reason for the Canadian Mental 
Health Association's three-year effort, 
Community Aclion for Troubled 
People, now in its second stage. 
"We have found that informal 
cooperative agreements do not work 
either," Mr. Rohn said at the 
association s annual meeting, 
Partnership ActIOn for Troubled 
People, in Vancouver 23-25 October. 
He pointed out that everyone gives 
lip service 10 the idea of cooperation, 
but no one seems concerned with how 
to make it work. "Now is the time to 
work out more formal agreements, 
perhaps contracts, certainly 
negotiated agreements,' the general 
director said In his opening comments. 
The three-day meeting was 
attended by 489 delegates from all 
parts of Canada. About 65-70 percent 
came from CMHA's 170 local 
branches across the country 
according to Lance Hale of Mental 
Health/Nova Scotia. The remainder 
were invited delegates from 
professional groups and government 
agencies. 
"Our aim is to discover. through the 
workshop groups, how to make 
partnerships happen and how to make 
them work, he said in an interview. 
Although most of the work was done 
in small workshop groups where ideas 
for implementation into community 
programs were hammered out, the 
delegates also assembled to hear 
panels of speakers provide overviews 
on the problems. 
Keynote speaker was Pat MacKay 
of Toronto, president of the Canadian 
Council on Children and Youth, who 
said lack 01 agreement on priorities 
was a major problem behind 
disagreements between groups 
supposedly working toward one goal. 
She said fragmentation occurs 


because some groups are concerned 
only with treatment and others only 
with prevention when both are vital. 
Huguette Labelle, principal nursing 
officer with the federal department of 
health and president of the Canadian 
Nurses' Association, was one of the 
speakers discussing ways to obtain 
needed community services. She 
stressed the Importance of looking for 
cures rather than treatment for 
obvious signs of trouble. 
"Is it really Ihe answer to add extra 
policemen in a small community when 
there is a sudden increase in juvenile 
delinquency?" she asked. 
Ms. Labelle stressed that the health 
professional is essential and must 
assume a greater role as "a 
community analyst, an organizer, an 
activator and a provider of service" 
Dr. Richard Foulkes, director of the 
BC government's health security 
programs, was the most critical of the 
speakers, saying, "If we talk only 
about organizing, reorganizing and 
reshuffling, we will be wasting our 
time. Change does not come from the 
top of an organization, which is 
dedicated to maintaining the status as 
it is. The creation of social change is at 
the bottom, at the neighborhood 
level," he said. 
Jean Lupien. new deputy minister of 
the federal department of health, said 
he is concerned that the federal 
government must take a greater 
leadership role. He promised more 
support for mental health programs. 


Nurse-Midwives in Health Care System 


Nurses Involved in obstetrical care, 
some of whom are midwives, met at 
Memorial University, St. Johns, 
Newfoundland last Fall to form the 
Atlantic Nurse-Midwives Association. 
They drew up a constitution and 
objectives of the Association. Their 
main objective will be to improve 
maternal and child care throughout the 
Atlantic provinces 
The Atlantic Association hopes 
that members 01 the Western 
Association will meet with them during 
the CNA Convention in Halifax In 
June. Further information can be 
obtained by writing to: Lynda 
MacDonald, Oalhousié University, 
School of Nursing, Halifax, N.S. 
A Canadian National Committee 
of Nurse-Midwives was organized in 
June, 1974, during the last CNA 
convention In Winnipeg. The group 
provides a communication link 
between regional associations of 
midwives and related health 
organizations. Canada was admitted 
to the International Congress of 
Midwives In July 1975 


What is the midwife's role? 
An answer to this queston was 
published recently In the newsletter of 
the Alberta Association 01 Registered 
Nurses: 
The well-being of the mother and 
child is the goal of all members of the 
International Confederation of 
Midwives. According to Pat Hayes 
president of the Western Nurse 
Midwives' Association. the midwife s 
role differs from one country to 
another. being dep
ndent on the 
socio-economic levels, the type of 
health care d<1livery system and the 
general and professional education 
system. 
In many countries nursing is not a 
reqUirement for midwifery practice and 
midwives are considered independent 
professionals. The length of their 
education equals or exceeds that of 
nursing. Although traditional midwives 
are stili employed in a few countries 
their education is constantly being 
improved. 
Countries such as Canada, the 
United States, New Zealand and 
Australia consider midwives to be 
highly specialized nurses. In effect the 


midwives' role is a development of the 
traditions of maternity care prevalent 
in each country. 
If the practice of midwifery rested 
solely on the process of delivering the 
baby it is doubtful whether midwives 
would be acceptable in Canada. But 
delivery is a small part of a spectrum of 
care which stretches from conception 
to the termination of the postpartum 
period. Midwives can be responsible 
for prenatal counselling, education, 
and continUity of care. Their expertise 
is of value in care of the mother in labor 
and in supervising the mother as she 
learns how to care for her new baby, 
as Canadian midwives are now dOing. 
Many perceive the midwives' role 
as part of the tradition of domiciliary 
practice. But in countries such as 
England Switzerland. New Zealand 
and Australia there is an Increasing 
trend towards hospital confinements 
and a system similar to that in Canada. 
A team approach is being advocated 
each professional bringing 10 the 
team unique skills and knowledge 
WhiCh, through a colleagual 
relationship. enables maternity care 
to be optimized. 
Canada s association with LC.M. 
will enable nurses in this country to 
learn from others and, also, to give 
information to others as well. 


Regional Trauma Centre 
Nurses will be members of a trauma 
resuscitation team established for the 
management of the critically ill at 
Sunnybrook Medical Centre. The 
trauma team notified in advance, will 
be prepared to treat the patient as 
soon as he arrives. Surgeons. 
anesthetists. and nurses will 
constitute the resuscitation team - 
just one part of the new regional 
trauma centre at Sunny brook. 
Dr. Robert McMurtry. director of 
Emergency Services, in a telephone 
interview, said that "all Emergency 
staff will be involved In educational 
programs. to update and refresh their 
knowledge on the management of 
trauma. Nursing will be involved In the 
decision-making process in the unit, 
and a nursing committee has been 
established. ." 



\ 
, 
I (/ J 
.. 
\ 
t , 
i \ 
I 
 
J 
t 
I 
/ 


I
 I 
I , 
I) 
I 

 


A 


B 


A. S StyI. No. 467
 / 
Izes 3-15 
 
Royale Di 
White amond Tricot Knit 
Sugg. Retail $28.00 


\.J'/ 


u 


1 


B. S S!y1e No. 46214 
Izes 5-15 
Royale Wick 
Polyester Te
' 100% 
Kni
 ured Warp 
White, Mint 
Sugg. Retail $30.00 


C. S S!y1e No. 6256 
Izes 8-16 
Royale Wicke 
Polyester Te
' 100% 
Knit ured Warp 
White 
Sugg. Retail $25.00 



IU 


X
\\.S 


.ne Canachan Nurse January 1976 


The 1975 index for The 
Canadian Nurse, vol. 71, 
is available on request. 
Write to The Canadian 
Nurse, 50 The Driveway. 
Ottawa, Ontario, 
K2P 1 E2. 


ONQ Publishes 
list of 
Nursing Procedures 


A nonrestrictive list of nursing 
procedures that nurses are allowed to 
perform without a medical order has 
been published as a result of the Order 
of Nurses' of Quebec's annual 
meeting last November. The 
document also indicates the slight 
difference that exists between an 
authorized medical act and a nursing 
procedure performed under a medical 
order. It does not, however, deal with 
the independent functions of the 
nurse. 
According to the ONQ, the 
decision to administer a nursing 
procedure is a medical act, but the 
performance itself pertains to nursing. 
Therefore, doctor's orders should not 
be required for these nursing 
procedures and authorization should 
be required only for the performance 
of certain procedures under particular 
circumstances. 
Negotiations between the 
Professional Corporation of 
Physicians and the ONQ have now 
terminated without agreement on the 
definition of acts or procedures to be 
authorized. According to the ONQ, 
doctors generally believe that nursing 
is an extension of medicine; therefore 
they are convinced that they must 
grant nurses the authorization to 
perform nursing procedures. "nursing 
procedures were medical acts, then 
doctors would have to assume the 
training and control of the persons who 
perform these procedures. 
Procedures such as catheterization 
are not medical acts, but rather 
nursing procedures performed under 
a medical order. Jeannine 
Tellier-Cormier, president of ONQ, 
points out that the rules adopted by the 
medical profession and released by 
the Quebec Professions Board in 
October do not take into consideration 
the nurse's position. 
AI Ihe annual general meeting of 
the ONQ in November, the general 
assembly recommended that: 
information about nursing as a career 
and an outline of educational 
requirements be made available to 
chapters, schools. and counselors; 
consideration be given to the 
possibility and praticality of requiring 


continuing education as a requirement 
for renewal of licensure; and CNA 
consider changing the name of the 
magazine L'infirmière canadienne to 
take into account the increasing 
number of male nurses within the 
profession. 
In addition to research projects 
concerned with the definition of 
nursing, the Order plans to intensify its 
information program on the role of the 
nurse for the general public. 


B. C. Nurses Seek 
Better Care For Elderly 


Expansion and improvement of 
British Columbia's facilities for the 
care of the elderly are being sought by 
the Registered Nurses Association of 
B.C. 
In a statement to the provincial 
government and all opposition parties, 
the association has urged an end to 
the present "poor utilization of beds 
and the inhumane way we shuffle 
people from one institution to 
another. " 
The Association calls for 
improved criteria for the admission 
of the elderly to longterm facilities; 
for the introduction of regional 
multi-disciplinary assessment teams 
to apply these critena; for the 
expansion of home-care services; for 
the redesignation of longterm care 
beds to prevent "gross people 
upheaval"; and for greater attempts 
to meet the personal care needs 
of the elderly. 
The statement also notes that: 
- present criteria make no 
allowances for psychosocial needs, 
age, prognosis, institutional limitations 
or the fact "that the commodity being 
assessed IS elderly human beings." 
- there are not enough 
institutional beds available in most 
areas. 
- home-care services are 
inadequate. 
The statement was developed by 
the Greater Victoria District of the 
RNABC and adopted by the provincial 
board of directors. 



 
\ 
, , 
,
 
- 
I 


- 
- 
c..
 


<If 


.. 


StudIO C MarcIl 01lawa. Ontario 


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. 


,. 

 
t' 


: 


f
'( .. 


- 


..1 
...... 


.,.". 



 


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
 
discovered 
antibiotic-impregnated 
mSofra-Tulle OÞ in this 
larger size . . . 


.........oc,r 

<<' 
,.;.....9 ... 
. -e. 


e. 
'0
 

 0"":< 
",,0 '9oi 


10 cl11 ) 
Llue'striP (30C"" 
ø f r8" t e P . 1 "ó 
SO. SLJI P t1 8te 
ce tl l'1 
fr a r1'Ý GS 
DRE


fRI


GS 
SfERll:f55f
DDE
.vfN 
,0 o
p f ,,",0 øp.ND 
,0 C rERlf l f \lEf! 
,0 S ffllEl 
10 51 
3!i 33 
(JII'I'1 


"" 



 

 

 

 



 
.. 

 
, 
I} 

 

. 
.. 


. . . you're ready 
for all the 
other interesting 
facts that are 
revealed in this 
new audio-visual 
presentation. 


Sofra- T uHe@ is available 
in a IDcm x 3Dcm size, in addi- 
tIon to the regular IDcmxlOcm 
format. This larger presentation 
provides three times more cover- 
age to facilitate the handling and 
dressing of larger lesions. 
Both sizes of Sofra- Tulle 
contain Soframycin - an anti- 
biotic. Reserved exclusively for 
topical use, Soframycin has a 


comprehensive spectrum of activ- 
itý against organisms normally 
encountered in bums, ulcers and 
wounds. Soframycin is present in 
Sofra- T uHe in a bactericidal con- 
centration, and maintains its ef- 
fectiveness even in the presence 
of blood, pus and serum. The 
mesh is wide enough to permit 
good drainage of exudate, thus 
preventing maceration, 


ROUSSEL 


&RTM 


Roussel (Canada) Ltd. 
153 Graveline Road 
Montreal, Quebec H4T 1R4 



oUSSí
 


.... 


, 
it 



 
'" - 
\ 


. t 


! 


I. 



 


... 


............ ... .... . ...... 
I am Interested in seeing your new "Solra-Tulle : 
Facts & Fallacies' filmstrip Please ask my local 
Roussel Representative to contact me at the ad- 
dress below at his first opportunity. Thank you_ 



 
. 
. 
. 
. 


Name 



 


Position/Title 


. 
. 
. 
. 
. 
. 
. 
. 
. 
. 
. 
................................... 


HospItal 


Address 


City 


Prov 


TeL 


To arrange lor a viewing 01 this new' Solra-Tulle 
Facts & Fallacies" filmstrip, send this coupon to: 
Mr_ D. Fulcher. Sotra-Tulle Product Manager 
Roussel (Canada) Ltd., 153 Gravehne, Montreal, 
Quebec H4T 1R4. 


For full disclosure. please see page 5 



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 


\ 


"" 


.
, 


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 



Î A -:;'; 

 
:
 
 i ....1 
ã

 . 
-= 
'./
JØ
/ \ 
. '" N
 ' 

 
." ß" ']) ) I 
\ ' 
\ . 
'..fê,t 
<
 I' 
f 
/ 
-, 
2\ J.p.\ 
" y
 - 
-'- - .. 
(' .. 
, . 
,"/ '" / 
/ C' I ..,..
 
Style 821 -.>--- ,., 
, 
Polyef.er Te . Jrej Warp Kr' \
 Slyle 918-0 PantSul1 
Pleated Trõm Polyester Ribbed Double Knit 
White - BI J - ICf! 
 White 
Sizes 10-20 $24 00 Sizes 8-16 $38.00 
Half Sizes 18" $25.00 \ \ 


o/tßG
 


\ 


f 


o/tßG
 


\ 

 


CAREER CLASSICS 


CAREER CLASSICS 


\ . 
It'- ..
 
I "I,. 
.' 
 
- 


Style 822 PantS,,!1 
POIYf"-ter Tf'" .. P 
White - B..Jt - f ,Ie 
Sizes 6-16 


P,("-'sd Tr m 


I 




 

, 
4 
'
L_ 


.--vi \ 
" 


$35,00 


\
v 

 
\

ll 

J
\ 


....... 


UNIFORMS 
REGISTERED 


Slyle 814 Panl Suil 
Polyester Text Jrf"1 Warp Kr1 
White - B._e - ve ,JW - I .. M;rat 
Sizes 6- B 


778 KING ST, WEST, 
TORONTO, ONTARIO 
MSV 1 N6 


'- 


$28 00 


AT BETTER STORES THROUGHOUT 
,..uana 


Style 802 
Polyester Textured Warp Knit 
Pleated Trim 



Look what we've done!! 


. 
- 


,;..t. _J\\I..:w 


.. 


.70MAC. 
HYGIENIC CLEANSING CLOTH 


23417-010 


.." . ......................' - ....... 
lit 1'lftL 1\1"'" tCl"CU'IOI U"""-M.1.!"1-I .In 


r 


In a time of rapidly rising costs, we've taken a proven concept in postpartum care, MEDICATED 
PADS, and IMPROVED THEM SIX WAYS while LOWERING your cost! 


Here's how: 
- Each packet individually foil wrapped to guarantee shelf life 
- Larger surface area per pad 
- Uniform saturation - (no dripping or dry pads) 
- No cross contamination (with jars, patient continually puts hands back in the same jar) 
- Rectangular shape - adapts better for use with sanitary napkin 
- Less Waste - 20 packets per box (average patient stay 5 days x 4 applications per day). Naturally 
if more pads are required, a second box of 20 can easily be issued. 


All of the above is yours with the Tomac Hygienic Cleansing Cloth at a significant savings over your 
present jar system!! 


For free samples and additional information, mail us this coupon - 


.. 


,------------------------------------------- 
I 
I FOR FREE SAMPLE AND ADDITIONAL INFORMATION 
I MAIL US THIS COUPON 


I -- 
rAl... 
TOM.4C .... 
HYGIENIC CLEANSING CLOTH 


.... 
, 


Name. 
Hospital 
Title. 
Address 
City. 


, .Prov. 


..
. 
",'f u"",U,.t.þt.\Qt;.\ß1:\\ 


i6i .. .... 
tI"GILK'C. CU....s
.6 C.Ult" 


-...- 
"t' \..
T..U:.."'
_
 


- 


American Hospital Supply 
Division of McGaw Supply. 
1076 lakeshore Rd. E., 
Mississauga, Ontario. l5E 386 



..-. 
"''fmt.'''c. ClU.M.
tU.\ tl 1\\ 


. 


- 



16 


The Canadian Nurae January 1976 


\70u

I
 
neXT COn\7enTIOn 



ò 

 , 

CJ .
ø 
. 

' 
 G 


 
qj o
 
ò
 
o Q
 

 .
 
ç 


77776 
77766 
77666 
76666 


"The quality of life," a concern of most 
contemporary North Americans, has 
been chosen as the theme of the 1976 
Annual Meeting and Convention of the 
Canadian Nurses' Association, to be 
held at the Hotel Nova Scotian in 
Halifax, June 20-23. 
The Program Planning 
Committee has gone to great lengths 
to create a dynamic and innovative 
program that is in keeping with the 
needs of today's nurses. Although not 
all the names of speakers and 
participants had been finalized at 
press time, a general outline was 
available. 
During the opening ceremony on 
Sunday evening, June 20, 


WHEN YOU'RE 


IN OTTAWA 


BE SURE TO SEE ONE OF CANADA'S FINEST 
SELECTIONS OF WHITE AND COLORED 


UNI FORMS 


at 


e HOSfl.Y Wttifas 
(THE COMPLETE UNI FORM SHOP) 
WE ALSO CARRY: 


White Shoes 
Hosiery 


Nurses Caps 
Bras 


Slip 
Panties 


BELL MEWS PLAZA, BELLS CORNERS, ONTARIO 
Mrs. Catherine Buck, RoToR. (Mgr.) 


P.S. OH YES, WE. ARE OPEN EVENINGS 


international, national, provincial and 
local representatives will welcome 
delegates. The name of the guest 
speaker will be announced in The 
Canadian Nurse at a later date. 
A keynote speaker of 
international stature will lead off the 
professional program on Monday 
morning June 21. A discussIon period 
will follow. 
In the afternoon a debate is 
scheduled on the question: 
"Resolved that nurses have a 
responsibility to take action to 
preserve life in Ihe event of any 
decision by a patient, a family, or a 
professional to discontinue artificial 
life-maintaimng intervel}tion." 
Apolline Robichaud, director, Public 
Health Nursing, Department of 
Health, Fredericton, N.B. and past 
president of the NBARN from 
1971-73. will chair the debate.. 
Following the debate, an interview 
dealing with the impact of the nursing 
profession on the quality of life will take 
place, Patrick Watson, well-known 
television personality. will interview 
Shirley Post. Post is presently 
conducting a study on the need for a 
Canadian Institute of Child Health. 
Tuesday, June 22, will be devoted 
to affairs of your national association: a 
schedule will be published at a later 
date. On Wednesday, June 23, 
delegates will focus on the quality of 
life in the work world of the nurse. This 
will take the form of two sessions: the 



 


, " 


-,... 


þ 


'"'--- 


\ 
'... 


it, -: 


r:;2.,. 


first, a panel composed of four 
participants who will present short 
papers on the following subjects: 
1) the incompatibility between 
educational preparation and the 
practice setting: 2) uncertainty 
regarding the nurse's legal protection; 
3) enforced proximity to stress In the 
client environment: 4) social and 
economic pressures in the work 
environment of the nurse. 
The second session entitled "You 
and the quality of life- action for 
today" will be presented as an 
audiovisual event intended to 
challenge nurses to try to improve the 
quality of their own lives and that of 
their clients, 
The final afternoon will be 
reserved for discussion of the report of 
the Resolutions Committee, the 
installation of officers and the 
president's reception. 


Interest session on research 
An interest session planned by 
CNA's Special Committee on Nursing 
Research will be held Thursday 
morning June 24, following the 
convention. This session, entitled "Old 
you ever wonder what would happen if 
....?" will take the form of a roundtable 
discussion of research questions and 
answers. Beverlee Ann Cox, nursing 
consultant with the Department of 
Psychiatry and lecturer in the School 
of Nursing at the University of British 
Columbia, has accepted the 
chairmanship of the session. All 
interested members are welcome. 
Special interest groups interested 
in holding a meeting on the Thursday 
or Friday following the convention are 
invited to contact Hallie Sloan. nursing 
coordinator at CNA, as soon as 
possible. 


CNF annual meeting 
The annual meeting of the 
Canadian Nurses' Foundation will be 
held on Sunday June 20, from 14h to 
17h, at the Hotel Nova Scotian. 
Next month: Social program 
and tourist attractions. 



........................ 


This month's forum has been submitted by CNA 
member-at-Iarge for nursing education, Shirley M. 
Stinson, professor, School of Nursing, and Division 
of Health Services Administration, University of 
Alberta, Edmonton, 


Shirley M. Stinson 


In a current survey "The Teaching of Health 
SCiences in Canadian Universities," the 
authors, Bryans and Southall, raise the 
question. "Should there be national and/or 
regional centers for the preparation of health 
sciences teachers?" I would like you to 
consider this question from two perspectives: 
advantages and disadvantages to the health 
sciences in general and 10 nursing in 
particular. 


General Advantages: 
Potentially better utilization of "rare" 
faculty and complex A-V /library resources, 
plus the added advantage of developing in one 
or more centers a critical mass of related 
specialists; students could be exposed to a 
wide range of health science students and 
faculty; Interdisciplinary research projects 
could be a concommiltant development; 
economies of scale in the leaching of "core" 
content in such areas as curriculum 
development, health services research 
principles: centers might attract educational 
funds not otherwise available on a single 
institutional basis: centers could encourage 
large scale evaluative research of health 
sciences teacher preparation programs; 
further. if health sciences teachers were 
prepared together in an interdisciplinary 
setting, perhaps they would subsequenlly be 
capable of higher levels of interdisciplinary 
teaching in Iheir home instifulions. 


General Disadvantages: 
Even if many students are free to move to 
another city, to what extent is sheer proximity 
to programs a faclor in teacher fraining 
recruitment? Relocation would obviate 
"part-lime'. student provisions for other than 
residents in the areas in which the centers 
were located; to the extent that a substantial 
number of faculty in such centers would be 
drawn from those currenlly employed In 
various education and health sciences 
faculties across Canada. there could be a 
serious debilitating effect on the home 
universities: adequate clinical facilities for both 
teaching and research in a center of any 
consequence would likely be a problem in any 
location in Canada: there is the possibility of 
"lack of hybrid vigor" if teacher training in the 
health sciences gets too standardized, too 


Frankly Speaking 
about nursing education 


National and/or Regional 
Centers for Preparing Nursing 
Educators 


monolothic in its norms and policy control 
mechanisms; perhaps over time and through 
fairly large scale "bureaucratization" of 
teacher training, lack of responsiveness to 
new teachlng/learnrng needs could develop in 
large centers. 
There would also seem to be some 
advantages and disadvantages somewhat 
unique to nursing: 


Advantages for Nursing: 
It is possible that nursing might not be able 
to generate on its own the sociopolitical thrust 
necessary to get such centers in operation, 
and it could be an advantage to be able to "ride 
the wave" of such an innovation. In so doing, 
nursing could conceivably obtain a magnitude 
and quality of nursing teacher preparation 
beyond the scope of anyone school of nursing 
at this point in time. Further, the preparation of 
nursing educators could be carried out within 
an interdisciplinary health sciences context, a 
factor consistent with the learning and practice 
needs of today s nursing educators. 
The major disadvantages are few in 
number but important for their possible 
consequences; 


Disadvantages for Nursing: 
Approximately 60 percent of employed 
nurses in Canada are married. Many of these 
are logical candidates for teacher preparation. 
This constitutes perhaps the most crucial 
disadvantage of all, since the majority of these 
candidates have home commitments that 
would not permit them to relocate In other 
cities, even temporarily, in order to enrol in 
teacher preparation programs. 
A little less than half of university nursing 
faculty have masters' or higher degrees; and 
only 300 of the approximately 2,500 teachers 
in the total nursing teacher situation (i.e. 
university, hospital and college division 
programs), about 12 percent. are qualified 
beyond the baccalaureate level. In short, the 
number of faculty requiring graduate level 


preparation is so large that it can reasonably 
be argued that setting up a few centers would 
not effectively change this situation. 
On the other hand, it can be argued that, in 
contrast to other health disciplines, most 
nurses with even one year of university 
preparation, about 72 percent of the total. and 
97 percent of university nursing faculty) do 
have some preparation in teaching-learning 
principles, and many nursing faculty have 
specific preparation in curriculum 
development. Indeed, it might well be argued 
that fhe need for centers which offer advanced 
substantive preparation in nursing practice 
and related biosocial sciences is as great if not 
greater than the need for teacher preparation 
centers. The crux is to have something 
valuable to teach. 
There is another factor to be considered. 
On the basis of well-established occupational 
sociological principles (not feminism!), it can 
reasonably be predicted that in 
multidisciplinary settings "lower status' 
professions tend to get shorter shrift than 
those of higher status. Since it took several 
decades for nursing to establish relative 
autonomy in determining its educational 
standards, nursing educators may be reluctant 
to participate in such a venture. Medical 
faculties, on the other hand, (which have 
historically dominated health sciences 
faculties) are unlikely to have the same 
reservations. 
Assuming that. In addition to educational 
specialists, a variefy of health sciences 
educators, including nursing educators, would 
be attracted to such centers, the effect of even 
one or two well-qualified nursing teachers 
and/or nursing deans leaving anyone 
university could be quite catastrophic, 
particularly for universities with graduate 
programs. This state of affairs in itself says 
much about the crisis in nursing teacher 
preparation in Canada today: we do not have 
enough teachers to prepare the teachers we 
need. 
Should there be national and/or regional 
centers for the preparation of nursing 
teachers? What do you think?.. 



18 


.. . 


. ... . . 


A
. 
.... . 
. . . 
. . 
. 


. 


. 


. 


. 


The Canadian Nurse January 1976 


rying 


. 


. 


. 


. 
I 
. . 


. 


. 


. . 



 
. . 


. 


. . . 
... 


. 


, 


. 


. 


. 


. 

.... 


, 
. 


THE 
NEGLECTED 
DIMENSION 


. 


... 


. 


. 


. 


. 


I 


. 


.. .. 


· ;1\ 
0: :"t'. 


, I I 
. . 


I. t 


.". 
. 



Abigail McGreevy 
Judy Van Heukelem 


Crying is a phenomenon familiar to all of us. 
Although our degree of comfort in its presence 
varies greally, crying is a part of life. It is an 
essential participant in the delivery of the 
neonate, and a companion in the grieving 
process. Crying can also be a constructive way 
of releasing tension, The fact remains, that, for 
the majority of nurses, the crying patient 
represents a difficult problem. Most of us tend 
to avoid this situation or to stop the crying 
immediately at any cost. 


The crying syndrome 
Crying is a distinctly human activity that 
takes place in response to emotional stimuli. 
There are many somatic changes manifested 
during crying, some of which can be explained 
physiologically, and others whose 
explanations are rather unclear. The limbic 
system, which has an important role in the 
control of emotional behavior, probably also 
functions in the crYing mechanism. The 
autonomic nervous system, through the 
parasympathetic fibers, stimulates lacrimation 
and nasal secretion. This serves to protect the 
mucous membranes of the naso-pharynx. 
Respiratory changes, with extended 
expiration. are ultimately responsible for 
reddening of the face and eyes, edema, and 
eye closure. 
Crying in humans, other than infants, 
occurs under many circumstances. usually in 
response to unpleasant stimuli. Most writers 
agree, however, that the effects are beneficial. 
Generally, crying seems to be a safety 
valve, a mechanism for releasing built-up 
tension or excess energy, - perhaps an 
internal change taking an altitude of hostile 
aggression and dissipating its energy in a 
nondestructive manner. I 
Whether lacrimation or fluid secretion (the 
actual tears themselves) during crying is to 
prevent dehydration and subsequent damage 
to nasal mucous membranes 2 or a 
physiological local defence with healing, 
nourishing and soothing functions for the eye] 
is open to question. These are just two of the 
theories regarding the reason for the tears. 
II does appear that after crying, a feeling 
of relief and relaxation seems to be prominent. 
This is a consistent theme to most studies of 
the subject. A general result of weeping seems 
to be a feeling of relief, a calmer frame of mind 
and possibly a desire for rest and sleep. 4 Some 
studies even claim to have observed that many 
forms of illness show tendencies towards 
recovery after crying. s 
For these reasons, there may be 
occasions when we want to encourage it, both 


The authors attempt to delve into an unexplored 
dimension. . . crying, so that nurses as members of the 
"helping profession" can do more for people who need to cry 
than just "give them privacy." 


in our patients and ourselves. 
Unfortunately, therapeutic crying is not 
found on the curriculae of most nursing 
schools. We do not know how to encourage 
crying when it may be physically, emotionally 
or spiritually beneficial. 
The threshold for crying, or point at which 
emotions can be stacked no higher (the 
emotional straw that broke the camel's back, 
so to speak), varies not only from individual to 
individual, but from one level to another within 
each person, depending on circumstances, 
Sex, age, cultural background and experience 
with crying differentiate the threshold between 
individuals, Within individuals, the threshold 


Table one - Factors In threshold variance 
Between Individuals 


may be raised or lowered depending on 
suggestion (situation, environment, such as a 
sad book or movie); privacy, or lack of it; 
acceptability, both stated and implied to others 
present and as perceived of oneself; and 
energy level, or general health. The degree of 
activity of the mind also has an effect as 
absorpfron in an energy-consuming activity 
would either dissipate the emotion that was to 
have been cried away, or at least defer 
concentration on it while the mind was 
otherwise occupied. 
T able one provides some examples of 
how these factors have the effect of raising and 
lowering the threshold of crying. 


Raises threshold 


Lowers threshold 


Culture 


example - Indian culture 
expect stoical approach 


example - weeping 
expected in Italian 
culture 


Past history 


father poked fun of 
daughter's crying 


mother expressed emotions 
freely and cried at times 
in front of family 


Sex 


generally in males 
crying less acceptable 


crying equated often with 
dependence and more 
acceptable for females 


Age 


adolescents & adults 
expected to cry less 
easily 


Within an Individual 


children & perhaps aged 
are allowed to cry 
much more frequently 


R aises threshold 


tired 


Lowers threshold 


Energy available 


absorption in a task 
(energy being diverted) 


rested and in good 
nutritional state 
(able to control self) 


ill 


hungry 


Social situation 


being alone 


being in a social 
situation where 
Individual is "in charge" 


being with people 
individual isn't 
comfortable with 


being with people 
or person who 
accept individual 


Expectations of 
Others 


crying means loss of 
esteem 


permission implied 
or stated 


permission denied by 
statement or implication 


suggestion, as in 
seeing others cry 



20 


The Canadian Nurse January 1976 


Relating to crying 
HELP WANTED: 
Professional nurses, comfortable enough 
with self to deal constructively with 
crying patient. Inquire within. 
Crying is only one of several ways the 
mind and body deal with frustration, and when 
these other conventional ways are not 
available to us or have been unsuccessful. 
crying can constructively relieve tension. 
There is an element of truth in the adage that 
"tears come when words can't." 
Perhaps if we tried to answer for 
ourselves four pertinent questions, the 
discovery of a crying patient would cease to be 
the troublesome dilemma most nurses 
consider it to be. These questions which might 
help put crYing In perspective, are: 


How do I react to my own crying? 
What effect does someone else's crying 
have on me? 
What are the specific needs that crying 
expresses? 
What constructive action can I take? 


. How do I react to my own crying? 
Many people are uncomfortable 
expressing their frustrated feelings through 
crying; it makes them feel guilty, weak, 
helpless, or silly. In nursing education, the idea 
that crying is silly and unproductive is often 
either stated or implied. 
Crying is considered "unprofessional." As 
a result, the nurse has even more trouble 
crying than most people because she feels her 
professional identity is at stake. Before she 
can be comfortable with a crying patient, the 
nurse has to learn to accept her own 
occasional need to cry as an acceptable 
response for dealing with feelings. 


· What effect does someone else's crying 
have on me? 
Crying by another person can hold many 
different meanings for each of us. Some of the 
more common feelings, meanings and 
resulting actions or reactions are outlined 
below in chart form. It is not assumed that this 
is exactly what happens. These are just some 
of the results that might be seen when a 
helping person comes into contact with a 
crying person. 
This list IS by no means exhaustive, but is 
designed to help you get in touch with your own 
feelings. Perhaps this would be a g
od time to 
stop and consider what your own personal 
reaction is to crying. Use the accompanying 
table. Look into yourself and determine how 
crying makes you feel, what meaning it has 
for you and what your typical reactions to 
crying have been. When you have dealt with 
your own feelings, then you are ready to think 
of the patient as an individual and work with 
him. 


. What are the specIfic needs that 
crying expresses? 
If crying is an expression of our frustration 
at failure to meet some of our needs, then a 
nurse's understanding of these needs, both 
physical, spiritual or emotional, of what an 
individual's crying represents to him or her, is 


obviously vital to dealing construcfively with 
this person. 
The danger lies in assuming too quickly 
that we know why a patient is crying, or in 
projectmg our own feelings and needs onto the 
crying individual. It is well to remember that 
physical, spiritual or emotional distress can 
bring about a lowering of self-esteem, resulting 
in an inability to handle situations adequately. 


Physical needs 
Pain or physical distress is an obvious 
cause for crying, most often seen in our culture 
in children. Acute pain can lead to crying in 
adults as well, perhaps because it leads to loss 
of control. 
The woman who has an abcessed tooth, 
has lost the ability to chew and is aching from 
head to toe, may break down into tears. The 
young man with a debilifating case of hepatitis 
may weep silently into his pillow after a painful 
injection. 


Emotional needs 
Any number of emotional needs may be 
behind a person's crying. We feel. however, 
there is one which predominates - the need 
for self-esteem. 
The need for self-esteem might be 
compared to an opened umbrella and its 
spokes. The umbrella of self-esteem can only 
stay open when the spokes of emotional needs 
are fulfilled. 
Some of the needs that must be fulfilled in 
order tor the umbrella of self -esteem to expand 
include: physical comforts; personal warmth; 
acceptance; a "special" someone we care 
about and who returns our affection; 
understanding, both on our part and on the part 
of others towards us; the need to deal 
effectively with and to express angry or hostile 
feelings. 


Spiritual needs 
Spiritual needs, though probably the last 
to be recognized and identified, are likely to be 
expressed in crying. While emotional needs 
deal with horizontal relationships to self and 
others, spiritual needs are vertical and directed 
to a Supreme Being, and involve a person's 
relationship with his God Spiritual needs can 
be defined as "any factors necessary to 
establish and maintam a person's dynamic, 
personal relationship with God." . There is a 
basic need tor relationship and out of it to find 
forgiveness, love, hope. trust. and meaning 
and purpose in life.
 Because the individual's 
relationship to his God is a very personal one, 
and to many people the subject of religion is 
taboo, crying may be one of the few ways that a 
spiritual need can be exhibited. 
Man is a whole being, not just the sum of 
his parts. Spiritual needs are often expressed 
emotionally (feelings of fear, guilt. 
worthlessness) or physiologically (sighing, 
resllessness, crying). The loss of one's 
relationship to God. or a real or perceived lack 
in this area, can represent a deeply troubling 
experience and arouse much anxiety. Illness 
and threat of death have a way of raising 
questions regarding the ultimate meaning of 
life. For some, there can be an awareness. 
never before felt. of a need for "making things 
right" with God (establishing a relationship 


with God). For others who have been religious 
most of their lives, illness, crisis, or impending 
death can raise serious questions about the 
goodness of God, the meaning of suffering, life 
after death. They may perceive that something 
has happened to their previous relationship 
with God. Crying then can express an 
individual s struggle to deal with his view of 
God in relation to the present crisis. 


. What constructive action can I take? 
The first thing a nurse can do is fo watch 
for prodromal symptoms of crying, as indicated 
by: tighlly-drawn lips, averted eyes. rapid 
blinking, eyes filled with tears, an inability to 
talk, a quiver or "catch" in the VOIce, sniffling 
and reaching or looking for a tissue. 
On rare occasions crying should be 
discouraged, for example with an hysterical or 
overly-manipulative patient. 
Generally however, the best course is to 
encourage crying by lowering the patient s 
threshold through: suggestion ("You look like 
you need to cry"); verbal permission ("It's 
alrightto cry," or "Go ahead and let it all out. "); 
non-verbal permission, such as reaching out 
and touching the patient softly, using a warm 
tone of VOIce, presenting a relaxed and 
unrushed posture by appearing ready to stay 
and conveying the attitude that "the world has 
stopped and you have my undivided 
attention. " 
Privacy will in most cases also lower the 
threshold of crying, although this will vary 


" 


dt
 
. ..- ê ";;\ 


:.. '-t&. 
. .. . . 


tt 


-. 


greatly with the person and the situation. Some 
patients may need absolute privacy, even from 
a nurse. If an individual can be moved quickly 
and smoothly from a crowded or public area to 
a pnvate one, when the situation warrants it, 
this needs to be done. 
Beware, however, of the person who says 
he wants to be alone, but who indicates 
non verbally that he or she needs to be with 
someone who understands. If the patient 
insists on privacy, yet you still feei he or she 
needs someone, go away for a short time but 
return. 


During 
Once crying has begun, it is important to 
continue a posture of warm acceptance and to 
stay quietly with the patient. This is not the time 
to initiate or encourage conversation. 
If a tissue can be provided, do so quielly 
and unobtrusively by tucking it into the palm of 



the patient's hand. If you need to get up or 
leave the room to obtain the tissue, forget it. 
Large muscle movements will break the mood 
and the crying threshold will soar. It might be a 
good idea to always carry a tissue In your 
pocket for such situations. 


After a patient has stopped crying, be 
available \0 listen if he or she should wish to 
talk. A general leading question might be 
asked ("'s there some way I can help?" or 
"Would you like to talk about it?"), or a 
reflective statement made (" Seems like a hard 
time for you."). Be careful however, not to 
demand an explanation; there are times when 
it is impossible to give a reason for tears. 
After a long or hard cry puffy eyes, a red 
face and headache are common. A cold damp 
cloth can be soothing and reduce swelling. A 
cup of coffee or tea is often appreciated and 
the caffeine may decrease the headache 
caused by dilated vessels. If the headache is 
severe and persisfs, it may be necessary to 
obtain an analgesic. 
If possible. provide the individual with 
privacy by pulhng curtains and discouraging 
visitors, Some patients may need to sleep. 
They may be tired from the emotional energy 
spent, while others, for the first time In a while, 
may be relaxed enough to rest. If the person 
has to see others, help him wash his face. and 
if a woman, apply cosmetics. Remember, it is 
important to help the patient maintain a level of 
self-esteem. 
Often the patient needs to know you have 
not been burdened by the crying. One way to 
reassure the individual is to thank him or her for 
sharing the tears with you. The next meeting 
after the crying episode may be strained: 
awkward feelings may exist. It is helpful for 
both the patient and the nurse to be aware of 
this; otherwise, either may experience 
rejection and take it personally. 
One of the biggest personal dilemmas a 
nurse may face is her need to cry along with 
the Individual. It can be assumed that this is 
acceptable and may be beneficial to both, as 
long as the nurse s needs do not exceed those 
of the patient and she maintains a degree of 
objectivity. Though it is nof necessary for the 
nurse to cry along with the patient, this 
demonstration of feeling can be a beautiful 
way to show caring. 
When a nurse has gained a new 
self-awareness concerning her own reactions 
to crYing, she is more apt to understand the 
needs being expressed by the crying person 
and consequently. intervene appropriately. 
Crying can then be a constructive experience 
for everyone concerned." 


Abbie McGreevy (R.N., St. Claire School of 
Nursing, New York. New York: B.S.N., St. 
Louis University, St. Louis, Missouri) is an 
assocIate instructor of psychiatric nursing at 
the Kaiser Foundation School of Nursing. 
Judy Van Heukelem (B.S., University of 
Colorado School of Nursing: M.S., UniversIty 
of California, San Francisco) is a former 
instructor at the Kaiser FoundatIon School of 
Nursing and, at present, IS on the staff of the 
Nurse's Christian FellowshIp. 


References 
1. Greenacre, Phyllis. On the development and 
function of tears. Psychoanal. Stud. Child 
20:210, 1965 


4. Löfgren, L. Borje. On weeping. Int. J. 
Psychoanal. 47.377, 1966. 


5. Foxe, Arthur N. The therapeutic effect of crying. 
Med Record 153:167, Mar. 5,1941. 


2. Montagu, Ashley. Natural selection and the 
origin and evolution of weeping In man Science 
30:1572, Dec. 4, 1959, 


6. Beland, Irene L. Clinical nursing. 
Pathophysiological and psychosocial 
approaches, by. . . and Joyce Y. Passos 3ed 
New York, Macmillan, c1975. p.1088 


3. Greenacre, op. Clt., p.214. 


Feelings Meanings Actions/Reactions 
A 
 Helpless ' My hands are tied." Immediate or inappropnate referral 
"There s nothing I can do Walk, or run, away 
Inadequate "I wish I were God." Depression 
'I'm incompetent " Freeze; do nothing 
Frustrated Change topic 
Ignore 
Overwhelmed 
Cruel "I could have prevented this." Minimize situation: 
"It must be something I did." "That wasn't bad, was if?" 
Mean "I touched a sore spot." "It really doesn't hurt that much
" 
"1 made him cry." "This is almost over." 
Rotten "I'm no good. ' Reprimand: 
"I'm supposed to be relieving "You're too old for that .. 
pain, not causing it." 
Insensitive "There's no need to cry." Ignore 
Tease 
Belittle: 
"Big girls don't cry. 
"You don't know what pain really is." 
Manipulated ''I'm not in control." Frustrated Avoid 
'She's just trying to get her Anger Give in 
own way." Depressed 
B . . Pity "I fee l sorry for you " Oversolicitous 
"You poor thing. ' Loss of profesSional objectiVIty 
"Ill do anythmg for you. False reassurance: 
"I want to help. "Everythrng will be all right.' 
. 
Hopeless 'There s no way out. ' Avoid 
'This situation has to be Immobilized 
major or overwhelming 
Concerned "I care about you." listen 
Stay and help 

 
C [ Nol awa,. of Walk away 
any feelings Ignore 
Find more pressing needs 


A Focus: Self 
(My feelings about me) 


B Focus: Crying person 
(My feelings about other person) 


C Unfocused 



22 


· 0" 
· tf et \ 

eg\S 


The Canadian Nurae January 1976 


Guidance counsellor:"So, you want to be a 
nurse?" Prospective student nurse: "Yes, I 
want to travel across the country (or around the 
world) while I earn a living. I want to see new 
places, to meet new friends, to support myself 
and see the world at the same time." 


The romantic myth of mobility has 
traditionally provided nursing with a special 
aura that attracts the foolloose and fancy free. 
None of us today is gullible enough to believe 
that all we need to do to obtain work as a 
registered nurse in another province is to 
answer an advertisement offering employment 
to RN's and then report to the institution's 
director of nursing. I/je know that employers 
require an applicant to be registered with that 
province's registering/licensing body. What 
we tend to be somewñat hazy about
 are the 
precise details about how to accomplish this 
transfer of registration from one authority to 
another. Who is eligible? How long does it 
take? Where do I start? What does it cost? II is 
to provide answers to some of these questions 
that this article is written. 


, 
IfJI ! 
/1 If IA'r ...... 
- 
, I 
 
, 
} · t 
'- ..----......
 
...._
 


What is registration? 
Nursing registration is the process by 
which a graduate nurse has her name entered 
in the nurses' registry maintained by the 
professional nurses' association, college, or 
order in that province, and is authorized to 
practice as a Registered Nurse (RN). 
Licensure is the process by which a 
graduate nurse is given a permit to practice 
nursing by the provincial or territorial nursing 
authority; registration follows automatically. 
In Newfoundland, Prince Edward Island, 
Quebec and the Northwest Territories 
licensure/ registration is mandatory; that is, 
nurses must hold a provincial license and be 
registered as members of a provincial nursing 
organization in order to practice. In the other 
provinces, licensure does not exist and 
registration is not required by law. This means 
it is legally possible to work as a "graduate 
nurse," but job opportunities at that level are 
scarce and salaries are lower. 


Who is eligible? 
What are the requirements? 
The Canadian nurse who wishes to obtain 
employment as a "Registered Nurse" in a 
jurisdiction other than the one where she 
received her nursing education or where she is 
currenlly employed must register with the 
nursing authorities of the province where she 
intends to work (see table one). 
At first glance, one would expect the 
registration /Iicensure process to be fairly 
simple (which it can be) since we are dealing 
with provinces within the same country. But, 
since Canada is a federation of ten provinces, 
each responsible for its own education and 
health services, requirements and procedures 
for registration/ licensure vary slighlly from 
one province to another. 



Many nurses seem to think that success in writing CNA 
examinations automatically confers on them the right to 
register and work anywhere in Canada. This is not the case: 
applicants must also comply with various provincial 
requirements before they can obtain employment as an AN in 
a particular jurisdiction. 


Generally speaking. candidates for 
registration/ licensure must meet the following 
requirements: 
. show evidence of registration with the 
registering body of the province where they 
completed a recognized program in general 
nursing; 
. prove that they are currently registered or 
eligible for registration in that province or the 
province of last employment; 
. demonstrate fhatthey have successfully 
written the Canadian Nurses' Association 
Testing Service or National League for 
Nursing registration examinations in medical, 
surgical,obstetrical, pediatric and in some 
cases, psychiatric nursing (a pass mark of 325 
or 350 is required); 
. show evidence of competency in the practice 
of nursing, usually through reference from 
previous employers. 
. demonstrate fluency in speaking and 
understanding the official language of the 
province. 
In Ontario, Quebec, and New Brunswick, 
either English or French are acceptable for 
registration but it is a definite advantage to 
speak the language of the majority in the 
institution or region. As of 1 July 1976, all 
applicants (Canadians or immigrants) for 
registration/licensure in Quebec will be 
required to have a working knowledge of 
French.Presently, this requirement applies 
only to non-Canadians. Candidates who do 
not comply with this requirement must take a 
course offered by the Government of Quebec 
and write a French language test within a year. 
During that year, they may be given a 
temporary permit to practice if they meet all the 
other requirements of the nursing legislation 
and have been assured employment in a 
specific center. This permit is not renewable 
except with the authorization of the 
Lieutenant-Governor-in-Council when it is in 
the public interest to do so. 
All of her Canadian provinces require a 
working knowledge of English. Non-Canadian 
candidates who have taken their nursing 
program in a language other than English 
can be required to pass the Test of English as 
a Foreign Language (known as the TOEFL 
test), with a score of 450 to 500. Candidates 
must make their own arrangements for this 
test by writing to: Test of English as a Foreign 
Language. P.O.B. 899, Princeton, New 
Jersey, 08540, U.S.A, 


In Alberta, New Brunswick. Quebec, 
Saskatchewan and Newfoundland nurses who 
have not practiced for more than five years (10 
years in British Columbia) are asked to take a 
refresher or orientation course. In other 
jurisdictions, this requirement is dependent on 
individual assessment. 
Most registering bodies require that 
candidatl3s submit a birth certificate, marriage 
certificate (where applicable), reliable 
references, language test results, a 
description of the general nursing program 
completed. a transcript of student records, the 
results of the registration examinations, proof 
of current registration or eligibility for renewal 
of registration and registration number. 
Non-Canadians are sometimes asked for a 
copy of their secondary school diploma. 
All documents should be written or 
translated in the official language of the 
province where registration is sought. 


Registration procedure 
and possible delays 
The length of time required to obtain 
registration is almost impossible to determine 
in advance. The entire process may take from 
a few months to more than a year, depending 
on a wide range of factors. Steps vary from one 
province to the other, but usually include the 
following: 
The applicant writes the registering body 
expressing her intention to become registered 
or asking for information on registration in that 
province. At this point, a brief resume of her 
qualifications helps to speed up the process. 
She then receives an information packet 
and forms to be completed by the original 
registration body, by the director of the school 
of nursing where the nursing course was taken 
and perhaps by her previous employer. If the 
applicant's mother tongue is not the working 


language of the province, she usually receives 
information on the language test. 
Upon receipt of the required certificates 
and completed documents, plus the 
processing fee, the registration body takes 
note of the documents and sends for 
confidential references. Delay may occur here 
if the previous employer fails to respond. 
When these credentials have been 
assessed, the applicant is informed of fhe 
results 
Applicants who are required to take a 
language test, refresher courses, undergo 
medical assessments, obtain work experience 
or write examinations, will encounter a delay at 
this point. Other delays can occur if applicants. 
employers, directors of schools of nursing or 
previous registration body fail to send all the 
required documents. Often the transcripts are 
lacking some important information and much 
correspondence follows. In many instances, 
the application must be submitted to the 
committee on registration for consideration. In 
addition, the province to which the candidate is 
applying may have a large number of 
applications to process. When this occurs, a 
backlog forms which further delays results. 
Once the application for registration is 
complete, the applicant is advised, given a 
registration number and requested to pay the 
registration fee. A registration card will 
probably arrive a few weeks after the official 
notice has been given. 
If you follow these steps, and no special 
problems arise, your application should be 
processed smoothly in a relatively short space 
of time. Be prepared, however, to recognize 
possible sources of difficulty or delays in the 
process, handle a good deal of 
correspondence, and wait awhile before 
receiving a definite answer. 


How to seek employment 
It is the applicant's responsibility to seek 
out and find employment; therefore, it is 
desirable to have a job offer before moving to a 
province. Information on working conditions 
and job opportunities may be obtained from 
various hospitals; a lisf of these is usually sent 
by the registration body upon request to 
candidates who qualify for registration. If nOf, 
candidates are referred to reliable sources of 
information. 



24 


I 


.. 


Applicants are advised to delay their 
departure until they are assured of eligibility for 
registration. No employer can commit himself 
to hire someone as an RN unless he IS sure the 
person is eligible for registration. 
Candidates who have to go to a province 
to follow courses, write exams or take 
supervised training for a few months can 
sometimes obtain a temporary permit pending 
registration. Requests for temporary permits 
are assessed individually. 


How much will it cost? 
It is easy to forget that all this 
correspondence and duplication of 
documents, added to processing fees, 
registration fees, examination fees (where 
applicable), and living expenses pending 
registration can constitute a severe drain on 
your finances. 
Fees for processing an application vary at 
the present time from $5 to $15, and 
registration fees range from $6 to $100 
depending on the particular nursing legislation 
and the structure of the professional body (see 
table one). The cost of registration 
examinations is approximately $15 for each of 
five papers. (These costs can be expected to 
rise). 


A national system of registration 
.... why not? 
If you are now wondering why there is no 
national system of registration, read on. The 
following sequence of events may throw some 
light on the question. 
National - as opposed to provincial - 
registration has been a concern since the turn 
of the century. Even before provincial statutes 
delegating authority for registration/ licensure 
were passed in each province, efforts were 
being made to permit Dominion registration for 
nurses. One of the earliest of these was a bill 
proposed by a Member of Parliament from 
Toronto He asked the Federal Government to 


I ne L8naOlan Nuree January l!f/þ 


If you are moving to Canada... 
Over and above requirements outlined for Canadian nurses, nurses who graduated outside Canada and 
who are registering here for the first time must also meet the following general requirements: (Note: each 
jurisdiction may also set individual reqUiremenls). 
a have completed a general nursing program in a country or state where there is written nursing legislation 
(candidates having only a specialized course such as midwifery are not eligible); 
a have received during that general program between 500 and 800 hours of theory and from four to eight 
weeks of clinical experience in medical, surgical, obstetrical, pediatric and sometimes psychiatric nursing: 
a be a Canadian citizen or landed immigrant or hold a working permit (the registering body cannot intercede 
with the federal Department of Immigration on the applicant's behalf); 
a have a working knowledge of French if applying in Quebec. 
Non-Canadian candidates for registration in British Columbia, Saskatchewan, Manitoba. Ontario. and 
New Brunswick will probably have to write the Canadian Nurses' Association Testing Service examinations 
unless they have written the National League for Nursing examinations in the USA. Candidates for 


authorize creation of an Association for 
Trained Nurses of the Dominion. Although the 
bill received approval by the House of 
Commons, it was rejected by the Senate. A 
similar bill, drafted in 1938 also failed to 
become law. 
In 1932, following publication of the first 
national survey of nursing education, 
delegates to the annual meeting of the 
Canadian Nurses' Association appointed a 
Committee on Dominion registration to 
formulate some plan whereby a more uniform 
standard of RN examination might be 
established throughout the Dominion. 
The 16-member committee included 
representatives of CNA and each province. 
They studied the question for six years and 
finally proposed creation of a Canadian 
College of Nurses or Canadian Council for 
Dominion Registration of Nurses to permit 
voluntary registration on a national basis. 
However, some provinces opposed the 
suggestion and CNA decided that the question 
should be reopened when greater unanimity of 
opinion warranted further study. 
In 1956, a CNA Task Committee on 
Special Aspects of Registration Requirements 
was formed with a mandate to study this 
question again. Instead of reciprocal 
registration, the Committee recommended 
that CNA concentrate on a national 
accreditation program and adopt a national 
system of licensing examinations. It also 
pleaded that provincial registration authorities 
demonstrate greater flexibility in the 
assessment and evaluation of nursing 
qualifications and suggested that the question 
of national registration be postponed again. 


Role of the CNATS 
It seems obvious that a national system of 
registration would offer immediate advantages 
ii1 terms of individual nurse mobility. The 
political structure of this country, however, 
makes this difficult, if not impossible, to 
achieve. Canada is a federation of ten 
provinces, each responsible for its own 
education and health services. The 
organization of the nursing profession reflects 
this structure. Each province has its own 


nursing legislation: provincial responsibility for 
registration, licensure, approval of schools of 
nursing, etc. are already established. 
Standards in these areas have been set to 
meet specific needs In each province. It is 
unrealistic to expect these to be identical 
across Canada. 
Nevertheless, a significant alternative has 
been achieved. In 1970, the CNA established 
a National Testing Service to prepare 
examinations for graduate nurses seeking 
registration. All provincial registering and 
licensing bodies are free to use this service for 
both graduate nurses and nursing assistants. 
To date, the French graduates of Quebec are 
the only ones not writing the CNA TS exams. 
This is because these exams were originally 
written in English and subsequently 
translated. French Exams will be finalized 
by 1978. 
Success in registration examinations is 
only one of the requirements to become a 
provincially registered nurse, but the use of the 
same registration examinations at least 
provides one nation-wide standard for 
admission to practice. ... 


Nicole Blais is with CNA Information 
Services, Ottawa. 



registration in Alberta. Quebec, Nova Scotia and Newfoundland may be asked to take courses, sit for exams 
or undertake a few months' probation, depending on their educational background and clinical 
experience.(The regulations of the Northwest Territories Association in this matter were not available at the 
time this article was produced, since it was recognized as a registering body only a few months ago. 
Applicants coming to Canada without completing these requirements may find jobs as graduate nurses 
(although these are scarce) or obtain a temporary permit. 
At the present time, registration examinations are written in January, June and August and it can take a 
few months before the results are announced. 


If you are moving ouf of Canada... 
Nurses wishing to obtain employment abroad should take advantage of the Nursing Abroad Program of 
the International Council of Nurses. For information, write to: Nursing Coordinator, Canadian Nurses' 
Association, 50 The Driveway. Ottawa. Ontario, K2P 1 E2 
Participation In the Nursing Abroad Program is made possible through CNA's affiliation with ICN 


Table I Provincial Registering Bodies 


Registered Nurses' Association 
of British Columbia, 
2130 West 12th Avenue, 
Vancouver, B.C. V6K 2N3. 


Alberta Association of Registered Nurses, 
1 0256-112th Street, 
Edmonton, Alberta. T5K 1 M6 


Saskatchewan Registered 
Nurses' Association, 
2066 Retallack Street. 
Regina, Sask. S4T 2K2. 


Manitoba Association of Registered Nurses, 
647 Broadway Avenue, 
Winnipeg, Manitoba, R3C OX2. 


College of Nurses of Ontario. 
600 Eglinton Avenue East, 
Toronto, Ontario, M4P 1 P3. 


Order of Nurses of Quebec. 
4200 Dorchester Blvd., 
Montreal. Quebec, H3Z 1 V4. 


New Brunswick Association 
of Registered Nurses. 
231 Saunders Street, 
Fredericton. N.B_ E3B 1 N6. 


Registered Nurses Association 
of Nova Scotia, 
6035 Coburg Road, 
Halifax, N.S., B3H IY3. 


Association of Registered Nurses 
of Newfoundland. 
67 LeMarchant Road, 
SI. John's, Nfld. A 1 C 2G9. 


Association of Nurses of Prince Edward Island 
76 Euston St., 
Charlottetowr. P.E.1. C 1 A 1 W2. 


Northwest Territories 
Registered Nurses' Associafion 
Box 2757, Yellowknife, N.W.T. 


At Last... 



 
y
- 


a Canadian supplier 
fCN nurses needs 
No IftIn}IIiIg IIbout Castoms- Noduly to".,. 


\\IIHnFR\ ",wnc This 
fR II ..hite vin.1 POCKET S-\\ t'R for 
II Pf'DS. sci680rfli. etc. (,hNk bo... 00 
toupou. 


STETHOSCOPES 
'orRSF'i 
TE:THII"COPESin 5 
colours. ExceptionalsOIIM 
Inmnnurion. adJ1'llable 
ligAlweigAI bina..ral.J; 
replacemenl part. avadabk 
in Canada. 11414 Salver. 11415 
Gold. 11490 m.... 11492 
G.-ee>o, 11494]>;M. 19,00 
e.d.. lJU:hul.. iniliala 
e7lgrat,
dfree_ 
Dr-\L HEAD STETHOSCOPE 
Amplifle.øJlfr.qKe1Irie._ &wle. 
a.ction liar .xlra larg. diapAragm. 
AdJ1'llable cArome bina..ral.J. #413_ 115.95 e.ch 


SPHYG}IO\lA.,"O\lETER 


R..gged and depe-ndable, wilA 
Aneroid ga..g. callbraled 10 J()(} 
m_ m \'.Icro 10000A-<md.Aold 
--: oiiîïiìiri.." ""ff Handaume zippered CWle 

 #
 .
t
 10 y.arl/1U1nmlee #1,13. 
, .<- I2-I.!IS euh. 
IndKdea iniloal. en9"'fn.d 


""'" 


OTOSCOPE SET 
f OroeofGerma"y'a/ineal 
- m..tru.mtnta. Exceptional 
iU..minalion, powerfW 
.;. _ magnifying Ie..., 3 alandard au. 


. .pen&la. Sue C ball.riea 
mdKded M.,al rorTyIng rooe 

 lined 1L-iIA aoft clolll #309 
156.00 e.ch. 
SCI

ORS & FORCEPS 
LISTER B-\'D-\GE SnSSOR". 1 . 
A m...,for.ve11JN..,.... 
\{an..facl..red of fineal al.<'I and 
/mulled in sanitary cltrome 
#699 4',,- l2.ljO 
#700 5'1." 13.00 . 
#702 7',. - 13.75 I 
OPERA T1'1iG SCISSORS ,,
 
Slainle.. Sle.
 alTaigAI blndea. 
#705 5'"'' sharp blunt 12.85 ea<h 
#706 5" sharp sharp 12.85 n<h 
#7104' ." IRIS s<isso.- 13.65 e.ch. 
FORCFPS. 
Fineal Slainle.. SleeL 5'/. "lbng_ 
 
Kelly Forc.ps #724 Straight, box 1000k 1435 each_ 
K.lly For<.ps #725 Curved. box-IO<'k 14 35 n<h. 
Thumb D....ssing #741Straight. 5eTTatedS3.35 each 


WATCH , 
A depnuÜJbk. atlrodll . .mlcA Full 
nltmbt'n mllLltitelace. Red 6Weep 
.ercmd hand. Cltrome care. .tamlesa .. 
 
aleel back JewellRd """,.menl, black'" '! 
lealher slrop. 1 1fT. 9"<'ronle.. #900 
 
S18.5O (pI... 93 c,,,'a m Onlario!. ... .. 


1'!'oTlTL TlO'o-\L ,t R"FS: Yo rite on yourCompan) 
letterhead for our 24 pg. <a.alo<:"e. Quantity 
dis<ountsavailable. ALL \lERCHA,mSEread. 
'or shipm
Dt. 50 cent handJìng chargf" for ordf"rs - 
less than 55 10. 
------- 
Order '0. Item Col. Quant. Size 


InitW!Ii .6 df"sir
 


F('f...o! 


EQlln \lFDlC -\L SLPPL \ CO. 
P.O. BO'\ 726-'0. BROCK\ILLE. O'T_ K6\ 5\8 


a I eado... 
Seat! to: 
I Street, 
Citv: 
. P08ta1 .ode, 
--- 


I 
I 
.. 


Prm,.: 


------ 




a 


(;-/..) j d J! 
/ <


 V :

. I
(
 

 g,,/J 
g
 
1 g'
l 
-- ( 
j 
 y 
.Y 


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. 


j
 
(J
 ;?;J 
r,. --\-1 
dI 



............... Blindness 
............... 
............... can be 
............... 
............... prevented 


.............. 
.............. 
.............. 
.............. 
.............. 


-.L 


- 


, ' 



 


0#" . 
'I 
/- 
./'/ 

/ 


---.. 


- .
 
--- 
 
.
 
 


-.-- TJ-..--...-. 


, 


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 


(:9 '9 


ewo:me\6 'v 


8L 8 


paz!ueôJo 'L 6LZ '9 
vL8 '(: 000'6(: . 
 :SJaMSUV 


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 


, 
II 


I, 
, 
:j 
.' 


II 
:1 


'I 


, 
II 


il 
, 


^' 


\, , 


--
.. Hur.. 
The C___ 


January 1176 


", 



"" \. ' 
, 
.
 
 . 
" 
 


/ ,} 


, . 


-<- 
 


. , 


\ 


,J 



 
 

 


,,"' 


. I 


I 
'/ 


\ 



The Canadian Nurse January 1976 


31 


s 


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 


\ 



 

 
'
 I ' 
q..l.... 
I 
.. ' , 

 

-{ 


..,. 


- 
1..<<' 


"- 
 =-.;,- -----
 
- 
I."'-" l.1 __ ... 
--- 
 
- I.
 -.-
 
:t.. 
:' 


, 


't.. 


- 


þ 


..-. 


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 


o 

..."\... 
- ."'.... 
1 



.... 


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 



/ 
J."- 
_liìnJ 


"...
II!!!!! 


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
'ID 


33 


. 
'-, 
IIÓ
 


f. 


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 


The CanadIan N 
urBe 



Q; ^-c:; 
1:f · 0...... 

CJ ò · 
 

v 1>
 

1) 
Go
c:;Q;\

 
<j,c:;Q) 


January 1976 


Lynda Cranston 
Cana d ' 
lans are b . 
about disease ecomlng over' 
Nursessho s that can now y complacent 
for primary 

 continuously rei

 prevented. 
doses. Em h m.unlzation and o
ce the need 
prevention Pn 
SIS must be Pla
 d alntenance 
1m 0 treatment e on 
. provemen t ' . 
Immuni _ s In livin 
greatl y 
 e a d hon practices an d g C t Onditions. 
uced th . reatm 
communicable d - e Incidence of ent have 
Iseases th 
roughout t h 
e world 


,\ 


\ 


, 
.. 
" 



 


I 


',1-- 


.. 
'II 
fit. 
ø .'. 
.. 
W' 
I 


. 



I 


In Canada, for example, only fOIJr cases of 
poliomyelitis occurred in the pa
;t ten years, 
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 
t 1 rfl.1ò 001 
W8r1 é'1Olt:>U 

cno 
iiqOOr1W .81qtn 


I 
I 


opl!fT1al control 


ÖftI& ,en 
tol!i

 
3B
b 
J8YQO 
Øftt I .. ,f: 


1'( 



 


incidence of communicable diseases 


complacency 


-- 


Classification of Immumty 


1. Natural Immunity 
- species 
-race 
- individual 


2. Acquired 


A GÌ ive 
- by attack of disease 


Natural 
, 


Pa sS ive 
- by placental transmission 


A GÌ ive 
- by vaccination 


Arti fi cial 


, 
Passive 
- by injection of antiserum 
(prophylactic and therapeutic) 


with: 


live organisms 
attenuated ones 
dead ones 
toxins 
toxoids 
toxin - antitoxin 


\ 


. 



chedule of Immunizations 


D diphtheria 
P pertussIs 
T tetanus 
P polio 
0 diphtheria 
T tetanus 
P p Olio 
T 
P polio 
Tetanus toxoid 


given at 3 months, 4 months, 5 months 
and 6 months to 1 year of age 


given at 6 to 13 years of age 
every 5 years 


given at 14 years of age and over 
every 5 years 


if booster over one year (depends 
upon policy - could be from 6 months to 3 years) 
give for laceration, burn, puncture wound, dog 
bite, and cat scratch 
(Ietanus antitoxin given if no previous immunization) 


M 
M 
R 


red measles (rubeola) 
mumps (epidemic parotitis) 
german measles (rubella) 


given at 12 months of age 
in a single injection 


I 
I 
I 
I 
I 
I 
I 
i 
, 


tuberculin 


given at one year of age 
then once yearly 


r- L 


i 



Scarlet Fever 


Causetive 
Organism & 
Transmission 


I 


Organism 
Group A 
Hemolytic 
Streptococcus 


Transmission 
- by direct or 
intimate contact 
with patient 
or carrier 


[ 
, 


Incubation and Identification 


Incubation Period: 
1-7 days (usually 2-4) 


Identification 
- Abruptly by fever (39.5 0 C) 
(normal within 5-6 days) 
- Vomiting, sore throat, headache, 
chills, malaise 
-12-48 hours post onset 
tYP.lcal rash: fine erythematous 
rash 10 dark & dusk}' then to 
desquamation appearing most 
often on neck, chest, in folds 
of axilla, elbows & groin, 
and on inner surfaces of the 
thighi 
- Skin is dry and scaly 
- Strawberry tongue to raw beef 
tongue 
- Tonsils enlarged & reddened 
- Lesions - not on face 
- forehead & cheeks 
are Nushed 
- area around mouth 
pale (circa moral 
pallor) 
- Types Mild 
Septic 
Toxic 


Diagnosis 


1. Clinical 
manifestations 


2. Throat 
culture 


3. Serologic 
tests 


Treatment 
- Penicillin 
(Choice) 


Immunization 
None 


Nursing Management 
- Isolahon for 7 days 
(at home) 
- Push fluids 


Complications 
Early 
1) Cervical 
Adenitis 
2) Otitis Media 
3) Sinusitis 
4) Broncho- 
pneumonia 


- Erythromycin 


- Good skin care 


- Hot saline gargles 


- TPR-q4h 
- Bed rest 
- Lotions for skin 


Late 
1) Rheumatic 
Fever 
2) Acute 
Glomerulonephrit 


- Diet as toleraled 


(Pertussis) Whooping Cough 


Causative 
Organism & 
Transmission 
Organism 
Bordet - 
Gengou 
Bacillus 
(Bordetella 
Pertussis) 


-High 
mOrlality 
in 
infants 
(Iyr. 
-F}M-increasing 
mOrlality 
& morbidity 
rates 


, 


Transmission 
by direct 
contact, by 
droplet, with 
discharges 
from laryn- 
gealand 
bronchial 
mucous 
membranes 
of infected 

 persons. 


. 


Incubation and Identification 


Irlcubation - usually within 
10 days 


Identification 


Clinical 
Course 


1) Catarrhal 
2) Paroxysmal 
3) Convalescent 


1) Catarrhal: 1-2 weeks 
S & S of URI-Sneezing, 
lacrimation, cough, low 
grade fever - in second 
week cough more severe & hacky 


2) Paroxysmal: 4-6 weeks 
cough - explosive 
bursts, characteristic 
"whoop" (cyanotic or red 
in face) mucous, anxious, 


- Vomiting may follow 
coughing, severity increases 
1 sl or 2nd week 


- Remain at same level 1-3 
weeks. 


3) Convalescent 
- Cessation of vomiting & 
whoop 
- Fades 1-3 weeks 


Diagnosis 


1) Naso- 
pharyngeal 
swab 
(auger 
suction) 


2) Clinical 
manifes- 
tations 


Treatment 


Immunization Nursing Management 


1 Interstitial pneumor 


None at 
birlh 


Perlussls 
immune 
globulin 
for pts 
c severe 
whooping 
cough 
! Severity - One attack 
recommended -+ lasting 
for pts. immunity 
under 2 
years. 


D.P.T.P. 
(6-8 weeks) 


Complications 


- Bed rest 
as long as fever 
- Ventilated room 
- Eliminate factors 
that tend to 3. Bronchopneumonia 
increase coughing - 
- Activity, excltemenl, 
dust, smoke, 
sudden changes in 
temperature 
- Pro

r nutrition if 6. Asphyxia from 
vomiting 
_ Small frequent feedings severe paroxysms 
- 02 if cyanotic or dusky 7. Nutritional 
- Suctioning - done if disturbances 
necessary (too often 
aggravates choking 
spell) 
- Choking - turn upside down 
pat on back - remove 
mucus from mouth 
f kleenex. 
- Period of communicability 
7 days after exposure 
to 3 weeks after onset 
of typical paroxysms 
(after 4th week 
organism seldom 
found) 


2. Rectal prolapse 


4. Atelectasis 


5. Convulsions 



!1um p s (Epidemic Parotitis) 
ausative Incubation and Identification 
Organism & 
Transmission 
..Jrgantsm 
Myxovirus 
Parotiditis 


1 Filtrable 
virus 
Virus enters 
through 
nose & mouth 


Transmission 
- Direct 
contact or 
droplet 
infection 


- Mumps virus 
· has been 
C , ;


t

man 
I saliva, 
\ blood, urine 
& C.S.F. 


Incubation 16-18 days 


Identification 
- Salivary gland enlargement 
particularly parotid glands 


- Parotitis (Uni or Bilateral) 


- Orchitis (20-35% of males) 


- Fever, headache, anorexia, 
malaise/localized pain 
near ear aggravated by 
chewing 


- Enlarged gland-max. size 
1-3 days 


- T! 1-6 days 


- Swelling! 6-10 days 


Diagnosis Treatment Immunization Nursing Management Complications 
- One attack - Isolation - home 1. Deafness 
1. Serologic Symptomatic lifelong (9 days from onset 2. Neurologic 
tests & Suppor- immunity of swelling) 
(complement tive complications 
fixation) - Infants - Oral hygiene - facial 
born of neuritis 
mothers - Fluids Î-+ soft diet - myelitis 
2. History who had -post 
of exposure mumps - Nothing strong infectious 
possess or acidic encephalitis 
passive 
immunity - Bed rest 3. Pericarditis 
3 Clinical 
picture - Live 4. Arthritis 
attenuated 
vaccine 5. Hepatitis 
available 


Red Measles (Rubeola) 


Causative 
Organism & 
Transmission 
Organism 
Measles 
Virus 


Transmission 
- direct 
(droplet 
spread) 
contact 
with 
secretions 
of nose, 
throat 
and urine of 
infected 
persons 


'I 


- indirect 
- less com- 
monly 
airborne 


... 


Incubation & Identification 


Incubation 10-11 days 


Identification 
- Fever & malaise within 
24 hours normal. 
- Coryza, conjunctivitis & 
cough reach peak c 
eruption on 4th day. 
- 2 days before rash - 
Koplik's spots on buccal 
mucous membranes 
opposite molars 
- By end of 2nd day - T! & 
Koplik s spots disappear 


- Rash 
a) Rarely exceeds 5-6 days 
(Erythematous Maculopapular) 


b) Eruption appears first at 
hairline involving 
forehead, area behind 
ear lobe; upper part of 
neck 
c) Then spreads downward to 
involve face, neck, upper 
extremities & trunk 
d) Lesions on face & neck - confluent 
lesions on legs - discrete 
e) Rash fades in order of 
appearance 
f) Rash is purple-red in 
color 


Diagnosis 


Treatment 
Supportive 


Immunization 
- One attack 
lasting 
immunity 


1. Clinical 
manifesta- 
tions. 


2. Serologic 
tests 


- Passive- 
pooled 
adult 
serum 


3 Isolation 
of virus 


- Gamma 
globuhn 
causes 
modified 
symptoms 


- Measles 
vaccine: 
a) Live 
attenuated 
vaccine 
(97% effective) 
b) Inactive 
measles 
vaccine 
(75% effective) 


Babies have 
passive im- 
munity for 
approx. 6 
months, if 
mother has 
had disease 


Nursing Management 
- Isolate at home 
till 7 days after 
appearance of rash 


- Liquid or soft 
diet 


- Cough syrups - 
for cough if 
necessary 


- Eyelids cleaned with 
warm H20 
(Conjunctivitis) 


- Protect from bright 
light if 
photophobic 


- No longer 
contagious after 
5th day of rash 


Complications 
1. Otitis Media 


2. Mastoiditis 


3. Pneumonia 


4. Cervical 
Adenitis 


5. Acute 
Encephalitis 



: I German Measles (Rubella) 
I Causative 
Organism & 
Transmission 
Organism 
Rubella 
Virus 


TransmissIon 
- droplet or 
(jrect contact 
with patient 


- indirect with 
articles freshly 
soiled with 
discharges 
from nose & 
throat 


- airborne 
could occur 


- infants with 
congenital 
rubella 
syndrome 
excrete the 
virus 


Incubation and Identification 


Incubation 16-18 days 


Identification 
- In a child, 
rash is first sign 
- In adults & adolescents - 
1-5 day period of low grade 
fever, headache, malaise, 
anorexia. mild conjunctivitis, 
coryza, sore throat & 
cough 


- Rash 
a) pinkish-red in color, 
first on face 
b) then spreads rapidly 
downward (more quickly 
than measles) 
c) by end of 1st day- 
whole body covered c 
macule papules, 
d) 2nd day begins to disappear 
from face 
e) lesions on trunk - coalesce 
to form blush while lesions 
on extremities remain 
discrete and do not coalesce 
f} by end of 3rd day - 
rash disappears 


Diagnosis 


1. Clinical 
manifestations 


2. Isolate 
virus 


3. Serologic 
tests 


Treatment 
Symptomatic 


Immunization 


- One attack 
permanent 
immunity 


- Gamma 
globulin 
to modify 
clinical 
manifesta- 
tions 


-Live 
attenuated 
vaccine 
(90-95 0 0 
effective) 


Nursing Management Complications 
- Bed rest 1. Arlhritis 


- No diet 
restrictions 


-Isolate (at 
home) till 
rash gone 


- ASA if increase 
in temperature 


2. Encephalitis 


3. If exposed 
during 
a) 1st Trimester 
of pregnancy 
- Congenital 
Anomalies 
b) - 2nd Trimester 
of pregnancy 
- Premature 
Birlh 


Chickenpox (Varicella) 


Causative 
Organism & 
Transmission 
Organism 
- Varicella- 
zoster 
Virus 
Transmission 
- direct con- 
tact, 
droplet or 
..".borne 
sp' "'ad of 
secrE; .ons 
of respIr- 
atory 
tract of 
Infected 
persons 
- indirect 
through 
articles 
freshly 
soiled by 
discharges 
from 
vesicles 
and mucous 
membranes 
of infected 
persons 


Incubation & Identification 


Incubation 14-16 days 


Identification 
- abruptly with low 
grade fever, 
malaise, and 
rash 


Rash 


a) rapid evolution 
from macule through 
papule - 
vesicular - 
crusting 
(taking 6-8 hrs.) 


b) centripetel distri- 
bution of lesions 
which appear in 
crops 
c} presence of lesions 
in all stages in 
anyone anatomic 
area. 


d) eventual crusting 
of nearly all the 
lesions. 
- In typical cases 
of chickenpox, 
three successive crops 
of lesions appear 
over a three day 
period. 
- Lesions -+ crops which 
are T concentrated on 
trunk area
ore profuse on 
upper arms and thighs 


Diagnosis 


1) Clinical- 
manifestations 


2} Isolation 
of virus 


3} Serologic 
tests 


Treatment 
- Symptomatic 


- Calamine 
lotion 


Immunization 
- Gamma 
Globulin 
to modify 
disease 
to special 
high risk 
persons. 
e.g. 
t) children 
with 
blood 
dyscrasias 
2) infants 
under 
1 month 
of age 


- permanent 
immunity 
having had 
disease 


t 


Nursing Management 
- Isolation (home) 


- Transmission to others 
from approx. 1-5 days 
before onset of rash 
until all the vesicles 
have become dry. 


- ASA for fever 


- Cut fingernails so 
won't scratch lesions 
(scratching causes 
scarring) 


Complications 
1 2nd bacterial 
infection 
(Strep or Staph) 


2. Encephalitis 


3. Varicella 
Pneumonia 


4. Varicella 
Hepatitis 



l' 
Diphtheria 
Causative Incubation & Identification Diagnosis 
Organism & 
Transmission Incubation usually from 2-6 days 1. Signs 
Organism and 
diphtheria symp- 
bacillus toms. 
(Klebs- Identification: 
Loeffler - onset insidious with 
bacillus) fatigue, malaise, 2. Throat 
sore throat, fever and 
- bacillus causes acute nasal 
Transmission inflammation of pharynx cul- 
- by direct - secretion of toxin that tures. 
or indirect irritates the tissues --> 
contact fibrinous exudate 
that coagulates Into a 
- droplet tough, leathery, 
infection grayish-white 
- organisms "pseudomembrane" - not 
always present or typical 
II present in in color or consistency 
saliva and - this membrane could 
nasal occlude air passages 
discharges of - cervical adenitis occurs 
patients and - extensive swelling of 
carriers the neck (bull-neck form) 

 is possible 
- membrane could form in 
larynx - respiratory 
embarassment 


II" ""'_.._u..n nu.-_ .,.nu_ry nua 


Treatment 
- antitoxin 


Immunization 
- D.P.T.P. 


Nursing Management 
- strict bed rest, 
flat, turn q4h 
- only essential 
nursing procedures 
to decrease exertion 
on the part of 
the patient 
- isolation 
- room well-ventilated 
with fresh air 
- pulse, respiration 
and BP checked 
during administration 
of antitoxin 
- epinephrine and 
hydrocortisone kept 
for emergency use 
- tracheotomy tray, 
oxygen & suctioning 
- Tq4h, P & R q1 h 
- saline mouthwash 
- warm throat irrigations 
- ice collar 
-1&0 
- fluids p.o. or IV 
-DAT. 
- observe for 
respiratory 
difficulty 


Complications 
1. Myocarditis 


2. Paralysis of soft 
palate 


3. Respiratory 
paralysis 


4. Nephritis 


5. Paralysis of 
ciliary muscles of 
eye, pharynx, 
larynx, or 
extremities 


S II * (V . I ) . provided for 
ma pax ana a information only 


'I 


- toxoid 
to immunized 
contacts 


- newborns 
have passive 
immunity 
for 1 st 
year 
of life 


Diagnosis 


Causative 
Organism & 
Transmission 
Organism 
Poxvirus 
Variola 
Transmission 
- direct & 
indirect 
contact 


Incubation and Identification 


r, 
II 
I 


Incubation: 12 days 


1. Clinical 
manifest- 
ations 


Identification: 
- 3-4 days prodromal 
period - Chills (children 
convulsions) 
- iT (above 40 0 C) 
- Backache 
- Headache 
- Vomiting 
3rd or 4th day - ! T and 
eruptive stage begins 
- Lesions 
a) move through 
macular --> papular --> 
vesicular --> pustular --> 
crusting stage 
b) appear on mucous membranes 6. Serologic 
of mouth, throat and respira- tests 
tory Iract 
c) have a centrifugal distribu- 
tion, and lesions in anyone 
regional area are in same 
stage of development 
d) First appear on face and forearms 
and then spread to upper arms 
and trunk, particularly back 
and finally reaches lower 
extremities during pustular 
stage; i T and the constitu- 
tional symptoms return 
after 2 weeks - complete 
epithelial regeneration 
(some scar formation) 


2. History 


3. Acutely 
ill 
toxic 
person 


- Airborne 


I 
} 
I 


- Infected dry 
crusts - 
source of 
infection 


5. Local 
eruption 


4. Biphasic 
curve 


n 


- anti- 
biotics 


- Schick tesl 
for deter- 
mining 
presence or 
absence of 
significant 
antitoxin 


Treatment Immunization Nursing Management Complications 
- usually - active - Hospital - rigid 1. Impetigo 
started at immunity isolation 
beginning by - Feeding by gavage 2. Furuncles 
of pustular having 
stage disease - Eye care with 3. Cellulitis 
normal saline 
4. Pneumonia 
- penicillin - active - Oral and nasal 
or immunity discharges burned 5. Septicemia 
tetracycline by 
vaccina- - Isolation - until 6. Osteomyelitis 
- supportive tion at scabs have disappeared 
therapy 12 months 7. Septic Arth- 
then - (Contact local health) ritis 
- parenteral every 
flds. 6 years 8 Laryngeal 
(not Edema 
- eyes done if 
cleaned eczema 
ë N/S present) 




 
I I 
I 



 


j,g 1'1 Ul

 ,
Uj!J,g 
o t01'llJ01'(- 

 
If you re planning to see Europe 
and spend some time in London, this advertisement 
is of special interest. . . 


'11111 


, J I IJE
IT)' / -;/ 

 E . ,1 \./'/ 
'
WESHNO{ .

 t. . _ 


, \:; t- ?!! -;!;,,'--- 

D" .æl

 

1 
J
" 6
 

12æ5 5 {dCJ\; 
I 61 StJAMESfB 
 
 
RICHMON;; 61 .... 
PARt< W 
/
 (-
 5
 
fB S1:HEUEII 


2 MILES 


61 61 
$ 61 


fB 
QUEEN MAR\I'3 
CARSHAUON 
$ 


A Qualified nurse like 
you can now mix 
pleasure with work. Just 
a short way from the King's Road. 
Chelsea and the heart of trendy 
London. are some of the most famous 
hospitals in the city. And almost every 
one of them is looking for trained 
nurses for short term as well as longer 
appointments. 
You can choo
e the branch of nursing 
that suits you best: you name it. 
we have it. 
We can offer accommodation 
and uniform. and of course. 


there's the salary to think about- 
a good-size cheque 10 help pay 
for your costly globetrotting. 
Get in touch with us before you 
leave, then we can send you all the 
information about us and Nursing 
in England. 
We're waiting LO hear from you 


Miss Joan Clague SRN, SCM 
Area Nursing Officer. 
Merton, Sulton & Wandsworth 
Area Health Authority, 
14 Atkins Road. 
London SW12 DAD England. 



 


" "' HI)SI'IT
L
 QUEEN MAR"S H,."halllp,n" s.. JOHN'
, SI.GEORliE'S, SI. JAMES', SPRINGFIELD, I 
S'. HELlER. QUEE'" OIARY'S HOSP'T AL FOR CH 'LDREN. s.. EBBA'S, SUTTON IiENER AL) =--- 
"'" 

 


GOOD 
THINGS 
haQ ll en 
WHEN YOU HELP RED CROSS 


......,;/ 
 



 MRS. R. F. JOHNSON 
SUPERVISOR ..... 
, III 
CHARLENE HAYNES - 
l
;
!.' \ 

 
.' 'OHN. L.P.N. -- 
, 51 


,---.- 
c...... fron popu r !la_pi' ..,... l't
 abo ., des- 
cnbod bolow, Fill out Clu,.n be.... SAVE WIth 2 IDENT. 
.. 1 IfIC, 11101'1 c...-n nt and . Ipare an co.. .. lass. 


. ALL METAL...S"-h, ","n_ IPI" 2..49 1 Pm 3.25 
. 
orners Chome Pohst)ed, Satin. Of 
. 'leW Duot
 comb_n.." satin 2 Pms 3.99 2 Pms ..95 
background with polished edJas fUII'Ie
mel I

mel 
. PLASTIC LAM'NATE...s"mmel, ( Pin US (Pin US 
. broader; engl'a'oo'@d thru surflce to 
ontrastlng core color. Beveled 2 Pins 1.95 2 Pins 2.90 
border matches 
ttenng. ("""
-I lu.,..ryme 
D METAL'RAMED ..C....'" 1 PIn 2..49 1 Pin 3.25 
.. 1eslKn; snow wt1lte pblsttc wIth 2 Pins 3.99 2 Pins ..95 
smooth. polished beve
 frame (urn.Nmel 
na_' 
MOLDED PLASTIC. Simple, smart. 1 Pin US 1 Pin US 
tcOtJCJmIU' C"IØ white badcj'round. 2 PIns 1.95 2 Pins 2.90 
;)mooth rounded corners and edaes. fUl'll@namel ly,.....alT'f' 


Free Initials and Sack with roor own 
Littmanri BRAND 
Nursescopef 
Famous Littmann. Nurses' Stethoscope. widely 
preferred tor high sensitivIty, dependability. 
smarter styling Welgtls only 2 OlS. 28" over. 
all. Fle.,ble Bray. antj-colJapse tubing. non 
:;
=

:g:

e
 e:


:e
'f 
:

rl:t
1 c:r:i 
Goldtone. Silvertone. Blue. Green. Pink. YOUR 
INI1IAtS ENGRAVED FREE on c
..' piece lor 
IRdiwldual distinction and Identification. Also 
FREE SCOPE SACK includ.d. lrost.d v,nyl witb 
dust-proof closure. .New . MEDALLION" sty. 
ling also available. with tubing In colol'1 to 
matcn chest poece 
N.. 21&0 Nlnoscop./lnilla',/S.ck . . . 1695 
N.. 2I&OlIllIb.... ..M.d./liIll...I)'I....11 95 
on Duty Iree 
, 
ÞU BLOOD PRESSURE SET 

 Outstandinl Reeves Aneroid SphYI. trom Japan 
- meets IU US. Gov. specs; :::t:3mm Iccuracy 
1U8ranteed 10 years. 81ad.lchrome manometer 
ul. to 300mm. 'Jelcro. Irey cuff, antl-collapse 
,- f
l: 
=
llì.sor
 
:,

es
ttin


:

:'J; 



 
cision "ehtwelght f3 ozJ Nurus' Stethoscope in 
silver fimsh. With H
" dil. non-ctlillinl dia- 
phr'llm. FREE Scope SocII Included 
No. 4t-loo Co.pl.t. B,P. S.t . . . 33.15 
I/o. 101 s'
rr IIly/ilJbll.d .... . . . 2US Duty 

 Iree 
I .-:-:\ 

 


:ð 


MEOI-CARD SET Hindi." ref.r.nc. 
ever! 6 smoottl plastic cards (31,1" x S\2") 
f;


se
, W

t


r


O
e


:u:
"ftou


'rd 
life,s.. Temp. QC to of. Prescrip. Abbr., Urin- 
alysIs. Body Chem J Blood Ctlem. liver Tests. 
Bone MaIJow. Disease Incub. Periods. Adult 
WitS. etc. All In wtll'e vinYl leather_ 
No. 289 Card Set . . . 1.50 ... 
Initials IOld-stamped on back of 
holder I add 50, 


WRITE FOR COMPLETE REEVES CATALOG! 
TO: REEVES CO., Box 119-C, Attleboro, Mass. 02703 
NAMEPINS: SlyleNo._DOnepon 02 same name 
METAL COLOR (169 and 100 only), DGoid DSilver 
METAL FINISH: U69 and 1(0), DPo'ished DS.tin DOuo'one 
LETTERING COLOR:DBlack OWhite ODk Blue 
8ACKGROUNO:OWhite OBlack DGreen DBlue 
LETTERING 


2nd line 
NURSESCOPE: o No. 2160 DNo.2160M Color_ 
B.P. SET: ON.. 41-100 Color _ ON.. lOB only 
MEDI-CARD SET: DNo. 289 
I NITIALS as required 


\ Pi.... .dd 50r handlina/po.taao 
I enclose $ i on ord.n totallina under $5.00 
No COD's or billing to individuals. Mass. reSIdents add 3% S. T. 


Send 10 . 


Street 


CII:' State .Zip __.. __ __, 
SATISFACT.ON GUARANTEED! Pi.... .lIow time for dellv.ry 



..c 
::: 
-ro 
0Q) 
ccI 
00Q) 
:;::;:;::;..c 
roro- 
.- - c 
U 
._ 
oQ)en 
en.....E 


ro 
-<(0, 
en co 
Q) o ..... 
en Q.. 
::;-c en 
zCoQ) 
Q)._ c 
c E m 'ë. 
ro Q) u.- 
.- - :J U 
"Cro CJ) 
ro - "C .- 
c wwo 
ro 
Ü 



 
! 
I 


:ß <( ..ê E 

z_ 0 
]j 
üE
 
.g .- ëii e (/) GJ 
- 0.>"-- 
o c: (/).
 I 
 
OOGJ:t= 
 

Qj:5
!3.E 
s:::. (/) 0,- 0 
"2õ rn 
 g-ë<ë 
>C: I 
-GJZ 
ern EGJEü 
a.'C (/) 0>>> 
a.C:Eêæ.2.2 
rnrnrn_
a.o> 
(/) c: 0>!!1 GJ E c: 

Ooo:2GJC;::; 

 '5 is..; 
 '0 .
 
GJEc:s:::.rnæ 
:ð e .9 ;, CD c 
 
-a.rnc:>.Q(/) 
'0 s:::. U'': 8 rn GJ 
ñ; = 
.c - "0. 
o æ "2 
 
 .
 0 
CDs:::. s:::.GJEU 
<( c: :ß t- E E.Ç; 
Z 0 g è 
 '0 !!1 
ü GJ GJ 0 rn-. D 
GJ c: '0 ëñ iñ GJ 0 
-EO(/):ßGJ

 
õl
õ:ßêE 
o>!!? æ is..
 ..ê Qj 
C:C:s:::.0> .-'0 
-.;:: Q) c. L.O - rn 
GJEo,---OGJ 
GJGJ 
oGJ- 
E-C:
-ë5>> 
_ !!1.Q c: (/) 
 c: 
(/)(/)rnGJë'C<( 

c:::=s:::.GJ
 . 
GJ .Q -g = E c:-g 
-E'ij5u
2
e 
<( -OU::::
XD 
a.rnrn(/)GJrn 


..... ".".v.all nVIDc; ".I1UD'Y 1
'1IIl 


The Canadian Nurses' Association believes that a 
national program for coordinating accreditation of 
educational programs in the health disciplines would 
be in the best interests of the public and the health 
professions. 


The Association therefore supports the 
establishment of a national committee/agency to 
coordinate the accreditation process being carried 
out within each health profession and to provide the 
necessary liaison among all of the professions, 
agencies and institutions involved. The Association 
considers it essential that the national body charged 
with this responsibility: 
I be broadly representative of the health 
professions, the government and the general 
public: 
II be given clear and specific terms of reference 
regarding the provision and evaluation of the 
service; and 
III be encouraged to act with all possible speed, 


Terminology 
The distinction between approval and accreditation 
has a direct bearing on attempts to evaluate health 
sciences education programs in Canada. It is 
imperative that all of the health sciences reach a 
consensus on the usage of these terms before 
proceeding with the development of accreditation 
programs. 
CNA stafements and papers on the subject are 
based on the following definitions: 


I Approval 
Approval means that a health education program has 
met the prescribed minimum standards set by the 
appropriate provincial body. Approval is compulsory 
and is based on minimum standards designated in 
Provincial acts or regulations authorized by these 
acts. 


These standards usually include preparation and 
size of faculty, the nature and content of curriculum, 
the quality and type of clinical practice areas and 
administrative practices and control. This process is 
deemed necessary for the good of the public or, as it 
is usually expressed, "to protect the public from 
incompetent practitioners." 


/I Accreditation 
Accreditation means evaluation and recognition of a 
program of education according to a national 
voluntary program. 


Nursing Education Programs 
I Approval 
The process of approval has gone on for more than 
50 years in schools of nursing in all provinces. Only 
graduates of approved schools are eligible to write 
registration examinations, and only graduates of 
approved schools who meet all other requirements, 
are 
Iigible for provincial registration. 


/I Accreditation 
At present, there is no national voluntary 
accreditation program of schools of nursing in 
Canada. There is, however. a commitment on the 
part of CNA to pursue this program in collaboration 
with all appropriate organizations The principle of 
national voluntary accreditation was approved by the 
. Association in 1945 This commitment still exists 
today. 


..c 
::: 
ro 
Q) 
c I 
.Q "C 
-c 
.
 ro 
U en 
OQ) 
en en 
en..... 
<(:J 
-z 
en 
Q)c 
enO 
..... 
:J- c 
Z 
.Q 
cEõ 
.
2 E 
"CroO 
ro-..... 
cWQ.. 
ro 
Ü 


CNA believes that nurses are responsible for 
maintaining and improving their own health. At the 
same time, it is the collective responsibility of 
members of the nursing profession to do all they can 
to maintain and improve the health of their clients. 
The practice of nursing carries with it an obligation to 
improve the level of well-being of each client by 
responding to the immediate needs of the sick and 
disabled, by preventing illness and by promoting 
health. 


CNA regards health as "a state of complete physical, 
mental, and social well-being, and not merely the 
absence of disease or infirmity,-' the definition 
endorsed by the World Health Organization. 
Corollary Action 
I Nurses can help to reduce self-imposed 
and environmental health risks among the general 
populatIon through their example and actions. 


This implies the choice of a lifestyle which maximizes 
well-being: the evaluation of current patterns of living 
in the light of their potenfial risks to health; and, as far 
as possible, the avoidance of self-induced risks and 
disease. 


It also implies that education programs in nursing will 
integrate these concepts into their programs and that 
working conditions of nurses are consistent with the 
maintenance of health. 


II As practitioners in health promotion and 
disease prevention programs, nurses need to 
establish constructive partnerships with their clients 
as well as with other health and allied practitioners. 
In order to be effective, it is important that nurses 
know what community resources are available and 
what assistance their clients can obtain from other 
health and allied professions. 


This Association sees the need for more effective 
utilization of available nursing manpower to promote 
health among school children, industrial workers and 
the aged. 


III Health promotion is also an important aspect 
of caring for the sIck and disabled. During an 
illness, many patients are unusually receptive to 
suggestions for improving the level of their health. A 
nurse has more contact with the patient, his family 
and friends, over a longer period of time, than any 
other member of the health team. The ability to utilize 
this receptiveness and relationship is an important 
aspect of nursing practice. It is essential that nurses 
recognize the needs of the patient and his family and 
use these opportunities to assist them, both from 
the nurses' own resources and through referral 
to the appropriate agency. 


October 1975 



PERFDRMANCE: 
af knawled'=le · · 


Rely on these new texts 
to help students perform 
with optimum results - 
optimum patient care 


A New Book! 
FUNDAMENTALS OF OPERATING ROOM NURSING 
Designed for students with no OR experience, this new text 
presents the principles and procedures of operating room 
nursing, Discussions cover basic information on preopera- 
tive hospitalization, intraoperative care, and post- 
anesthesia recovery; electrolytes; patient needs; terminolo- 
gy; and more. Explicit illustrations of accepted techniques 
and a unique photo-quiz highlight the text, 
By Shirley M. Brooks, R.N. May, 1975. 184 pages plus FM I-VIII, r x Hr, 
207 illustrations, with photographs by author. Price, $7.30. 


- 
II 
u 
l- 
IP 
I- 

 
III 
I 
- 
II 
u 
I- 
'D 
II 
E 


.
1 


,.. 

 
, 



 


a true test 


. 


New 3rd Edition! 
COMPREHENSIVE CARDIAC CARE 
For a completely current overview of coronary care, turn to 
this vastly expanded new 3rd edition. The text continues to 
stress prevention of cardiac arrhythmias and earlv rehabili- 
tation. Emphasizing fundamental principles, it thoroughly 
covers coronary artery disease and complications; physical 
examination; management of patients with pacemakers; 
and much more! 
By Kathleen G. Andreoli, R.N., B.S.N., M.S.N.; Virginia Hunn Fowkes, 
R.N., B.S.N.; Douglas P. Zipes, M.D.; and Andrew G. Wallace. M.D. 
September, 1975. 358 pages plus FM I-X. r x Hr. 959 illustrations. 
Price, $7,90. 


A New Book! 
NURSING MANAGEMENT OF RENAL PROBLEMS 
A clear presentation of the physiologic and psychologic 
bases for nursing intervention, this unique new text offers 
in-depth discussions on: normal and pathologic renal 
function; causes of renal disturbances; body responses; 
medical therapy; and nursing intervention. Methods and 
processes of renal restoration are carefully detailed, with 
special attention to dialysis and transplantation, 
By Dorothy J. Brundage, M.N. January, 1976,204 pages plus FM I-X, 
6Y.z" x 9Y.z", 21 illustrations. Price. $6.85. 


New 2nd Edition! 
DECISION MAKING IN THE CORONARY CARE UNIT 
Revised and expanded, this new 2nd edition teaches 
students how to make decisions in the coronary care unit. 
Simulated crisis situations illustrate general principles and 
provide clinical experience in decision-making. Realistic 
cases offer adequate information to determine treatment 
goals, actions, and methods of evaluation. A new chapter 
discusses patient education. 
By William P. Hamilton, M.D. and Mary Ann Lavin, R.N., B.S.N., M.S.N. 
April, 1976, Approx. 184 pages, r x Hr, 126 illustrations. Price, $6.85. 


A New Book! 
PATIENT CARE STANDARDS 
This new text is the first to present patient care standards to 
help nurses plan, implement, and evaluate care, In concise 
outline form, it provides step-by-step guidelines for total 
patient care. More than 400 patient care standards cover 
medical-surgical, obstetric, and pediatric situations, in- 
cluding special operating room procedures. 
By Susan Martin Tucker, R.N., B.S.N., P.H.N.; Mary Anne Breeding, R.N., 
Mary M. Canobbio, R.N., B.S.IIj.; Gloria D. Jacquet, R.N.; Eleanor H. 
Paquette, R.N.; Marjorie E. Wells, R.N.; and Mary E. Willmann, R.N. 
September, 1975.420 pages plus FM I-XXII, r x Hr,71 illustrations. 
Price, $13,55. 



III 
- 
 
II 
1! 
II rw 
L - . 
E 
II 
11 
C 
::I 
.... 


New 9th Edition! 
SELF-TEACHING TESTS IN ARITHMETIC FOR 
NURSES 
This updated new edition continues to help students 
develop a strong background in basic applied arithmetic, in 
class or by independent study. After an introductory review 
of basic arithmetic, the text discusses weights and 
measures. The final section covers solutions and calculation 
of dosages for infants and children. 
By Ruth W. Jessee, R.N., Ed.D. and Ruth W. McHenry, R.N., M.A. 
February, 1975.216 pages plus FM I-XII. 7114" x 10112",15 illustrations. 
Price, $6.25. 


A New Book! 
CLINICAL IMPLICATIONS OF LABORATORY TESTS 
A concise guide to the clinical significance of laboratory 
tests, this valuable new text first discusses the routine 
laboratory screening panel. Unit II describes evaluative and 
diagnostic tests for specific entities. A table of potential 
variations of normal values compares specific entities found 
in the routine screening panel. 
By Sarko M. Tilkian, M.D. and Mary H. Conover, R.N., B.S.N.Ed.; with 1 
contributor. October, 1975. 232 pages plus FM I-XVI, 6112" x 9W', 42 
illustrations. Price, $7.90. 


New 9th Edition! 
INTRODUCTION TO PHYSIOLOGICAL AND 
PATHOLOGICAL CHEMISTRY 
This new edition clearly relates principles of chemical 
reactions to clinical medicine, covering concepts of physical 
and organic chemistry and the role of biochemistry in 
normal pathophysiology and disease states. Expanded and 
revised throughout, the text features a new section on 
thermodynamics, many new tables and new il1ustrations. 
By L. Earl Arnow, Ph. G., B.S., Ph.D., M.D., March 1976. 492 pages plus 
FM I-XXII, r x 10", 227 illustrations. Price $12.55. 


I ne \..8nSOlan Nurse ..anuary 197ti 


New 9th Edition! 
INTRODUCTION TO LABORATORY CHEMISTRY 
This popular laboratory manual presents experiments 
correlated with INTRODUCTION TO PHYSIOLOGICAL 
AND PATHOLOGICAL CHEMISTRY, 9th Edition. Exper- 
iments vary in complexity, but each uses only the simplest 
of equipment, Featuring three new experiments, the lab 
manual demonstrates that facts developed in the laboratory 
are basic to chemistry, biochemistry, and medicine. 
By L. Earle Arnow, Ph.G., B.S., Ph.D., M.B., M.D. March, 1976. 102 pages 
plus FM I-XVI, 5112" x 8112", 43 illustrations. Price, $4.45. 


New 12th Edition! 
ROE'S PRINCIPLES OF CHEMISTRY 
Clear and compact, this new 12th edition presents the 
fundamentals of inorganic and organic chemistry and 
biochemistry for student nurses. Relating principles to 
practice, this current revision includes updated material on 
molecular and anatomic structure; a new chapter on "The 
Physical States of Matter"; a new appendix on logarithms; 
new illustrations and tables. More emphasis is placed on 
biochemistry than in previous editions. 
By Alice Laughlin, B.S., M.S., Ed.D. March, 1976. Approx. 464 pages, 
6:Y4" x 9:Y4", 122 illustrations. About $12.55. 


New 7th Edition! 
ROE'S LABORATORY GUIDE IN CHEMISTRY 
A favorite for many years, this laboratory guide is designed 
to accompany ROE'S PRINCIPLES OF CHEMISTRY, but 
can be used with any other text. This new 7th edition 
features a variety of experiments requiring only inexpen- 
sive apparatus. New additions include: a periodic table; 
greater variety of chemicals used; and new illustrations of 
the Florence flask and volumetric flask, 
By Alice Laughlin, B.S., M.S., Ed.D. March, 1976. Approx. 216 pages, 
5112" x 8112", 47 illustrations, with 2 color plates. About $6.85. 


New 13th Edition! 
PHARMACOLOGY IN NURSING 
Now in a new 13th edition, this leading text outlines current 
concepts of pharmacology in relation to clinical patient care. 
Thoroughly revised and updated discussions cover 
mechanisms of drug action, indications, contraindications, 
toxicity, side effects, and safe therapeutic dosage range. 
Two new chapters examine "Antimicrobial agents" and 
"The effects of drugs on human sexuality, fetal develop- 
ment, and lactation," 
By Betty S. Bergersen, R.N., M.S., Ed.D.; and in consultation with Andres 
Goth, M.D. February, 1976. Approx. 732 pages, 8" x 10", 143 illustra- 
tions. About $14.20. 


New 2nd Edition! 
NURSING CARE OF THE PATIENT WITH BURNS 
This unique book serves as a concise yet detailed resource 
for bum care, from first aid treatment to prolonged care of 
bum patients. Updated and expanded to include a chapter 
on fluid therapy, this new 2nd edition places more 
emphasis on pathophysiology, causes and prevention. 
By Florence Greenhouse Jacoby, R.N. January, 1976. Approx. 176 pages, 
6112" x 9:Y4", 15 illustrations including 2 color plates. About $7.30. 



e 
a 
.- 
iI 
I- 
M 
II 
.- 
e 
.- 
E 
-a 
II 
III 
III 
I 
II 
I- 
M 


.. 
II 
II 
:1 
II 
II 
.- 


) 


A New Book! 
THE NURSING PROCESS: 
A ScientIfic Approach to Nursing Care 
This compilation of theoretical concepts explores all four phases of 
nursing process and discusses tools used in their implementation. 
Each chapter includes an annotated bibliography. 
By Ann Marriner, R.N., Ph.D. June, 1975.242 pages plus FM I-XIV. 61,/2" )( 91,2", 
illustrated. Price, $7.10. 


" 


., 


A New Book! 
NURSING SERVICE ADMINISTRATION: 
Managing the Enterprise 
This practical new text examines the fundamental structure of 
administration and provides a knowledgeable baseline to identify 
and deal with its strengths and weaknesses. 
By Helen M. Donovan, R.N.. M.A. October, 1975. 272 pages plus FM I-XII, 
7" )( 10", illustrated. Price, $7.10. 


A New Book! 
THE PROBLEM-ORIENTED SYSTEM IN NURSING: 
A Workbook 
This first-of-its kind workbook presents the problem-oriented 
system as a theoretical and practical basis for comprehensive 
health care management. All stages of the process are explained. 
By Beth C. Vaughan-Wrobel, R.N., M.S. and Bet1y Henderson, R.N., M.N. 
February, 1976. Approx. 184 pages, 7'14")( 10'12", 19 illustrations. About $7.60. 


'. 


"", 


--. 


'- 


A New Book! 
MANAGEMENT FOR NURSES: 
A Multidisciplinary Approach 
Articles from a variety of sources supply basic concepts necessary 
for the development and improvement of management skills. 
Discussions examine structural, personnel, and economic factors. 
By Sandra Stone, M.S.: Marie Streng Berger, M.S.; Dorothy Elhart, M.S.: Sharon 
Cannell Firsich, M.S.: and Shelley Baney Jordan, M,N. December. 1975. 280 
pages plus FM I-XII, 6
4" )( 9
4". 24 illustrations. Price, $8.65. 


A New Book! 
CHRONIC ILLNESS AND THE QUALITY OF LIFE 
Exploring the psychological and social problems faced by 
patients with chronic disease, this unique text shows 
how nurses can help patients and families adjust. Case 
studies dramatize the need for further understanding. 
By Anselm L. Strauss, Ph.D. June, 1975, 160 pages plus FM I-XIV, 
6'}4" )( 9'}4", Price, $6.05. 


New 2nd Edition! 
TEACHING CHILDREN WITH DEVELOPMENTAL 
PROBLEMS: A Family Care Approach 
Directed toward the care of dÜ,abled children in infancy 
and preschool years, this new edition discusses: nursing 
responsibility, child development and handicapping 
conditions, family reactions, and more. 
By Kathryn E. Barnard, R.N., B.S.N., M.S.N., Ph.D. and Marcene L. 
Erickson, R.N., B.S.N., M.N. May, 1976. Approx. 184 pages, 6" )( 9". 
16 illustrations. About $6.25. 


A New Book! 
HUMAN SEXUALITY IN HEALTH AND ILLNESS 
This useful new book prepares students to counsel 
patients on: sexual development; adaptation to events 
that threaten sexual integrity; and adjustment to diseases 
and disabilities that affect sexual function. 
By Nancy Fugate Woods, R.N., M.N. April, 1975.232 pages plus FM 
I-X, 6" )( 9",7 illustrations. Price, $7.30. 


II 
u 
e 
II 
.- 
u 
III " 
- 
II - 
I- 
a 
.- 
> 
II ... \ . 
\. 
J: 
II 
.a 



46 


III 
II 
.- 
L. 
II 
III 
III 
II 
> 
.- 
.... 
u 
II 
a. 
III 
L. 
II 
a. 
11 
c 
II 
II 
u 
.- 
.... 
u 
III 
L. 
a. 
i! 
II 
L. 
L. 
:I 
u 


New Volume I! 
CURRENT PRACTICE IN 
OBSTETRIC AND GYNECOLOGIC NURSING 
Students and practicing nurses can probe far-ranging 
issues in obstetric and gynecologic nursing with this 
new book. Useful, original articles offer information 
on the physical and psychological needs of parents 
during pregnancy and delivery; fe.tal and neonatal 
care in normal and abnormal births; gynecologic 
surgery; abortion; genetic counseling; and more. 
By Leota Kester McNall, R.N., M.S. and Janet Trask Galeener, 
R.N., M.S. February, 1976. Approx. 224 pages, 6
" x 9
", 39 
illustrations. Price: about $11.05 (clothbound); about $7.90 
(paperback). 


New Volume I! 
CURRENT PERSPECTIVES IN 
PSYCHIATRIC NURSING: 
Issues and Trends 
Thought-provoking articles examine current trends, 
issues and disputed topics in psychiatric nursing, 
Topics include: clinical supervision; the nurse- 
physician relationship; conflicts between the nurse's 
roles as a human being and a professional; counseling 
the rape victim; behavior modification; social- 
psychological approaches to family mental health; 
and much more. 
By Carol Ren Kneisl, R.N., M.S, and Holly Skodol Wilson, R.N., 
Ph.D.; with 24 contributors. February, 1976. Approx. 256 pages, 
6
" x 9W', 9 illustrations. Price: about $11.05 (clothbound!; 
about $7.90 (paperback). 



- 


ø 
 


IIIII::' "èlflaUIGIII"UI_ "'ClIIUClI, .8.... 


New Volume I! 
CURRENT PERSPECTIVES IN NURSING 
EDUCATION: The Changing Scene 
Here, nationally known educators explore the mul- 
tidimensional aspects of nursing education, from 
history to international perspectives. Timely articles 
discuss how to: ed ucate a sufficient number of nurses 
to meet growing needs while raising the level of 
education; provide opportunities for individuals 
with diverse backgrounds; and other current topics. 
Edited by Janet A. Williamson, Ph.D., R.N,; with 18 contributors. 
February, 1976. Approx. 208 pages, 
"x 9'Y4", 12 illustrations. 
Price: about $11.05 (clothbound); about $7.90 (paperback). 


New Volume I! 
CURRENT PRACTICE IN 
ONCOLOGIC NURSING 
Experts from 14 different cancer centers contribute 
original articles on early screening and detecting of 
cancer; therapy; maximizing the quality of life; and 
rehabilitation. The nursing process is emphasized 
throughout, including the nurse's role from detection 
clinic to terminal care in the home, Pertinent 
assessment guides precede appropriate chapters. 
Edited by Barbara Holz Peterson, R.N., M.S,N. and Carolyn Jo Kellogg, 
R.N., M.S.; with 26 contributors. February, 1976. Approx. 232 pages, 
6'Y4" x 9'Y4", 2 illustrations. Price: about $11.05 (clothbound); about 
$7.90 (paperback). 


New Volume I! 
CURRENT PRACTICE IN PEDIATRIC NURSING 
These original articles present new attitudes toward 
the roles, theories and tools in pediatric nursing. Part 
I discusses infant day care, transcultural nursing, etc. 
Part II emphasizes family needs during fetal de- 
velopment and early childhood. Current concepts and 
methods of nursing care of children with special 
problems are presented in Part III. 
Edited by Patricia A. Brandt, R.N., M.S.; Peggy L. Chinn, R.N., Ph.D., 
and Mary Ellen Smith, R.N., M.S. February, 1976. Approx. 240 pages, 
6'Y4" x 
" , 13 illustrations. Price: about $11.05 (clothbound); about 
$7.90 (paperback). 


IVIDSBV 


TIMES MIRROR 


THE C V MOSBY COMPANY. L TO 
86 NORTHLINE ROAD 
TORONTO ONTARIO 
MilB 3E5 



Nature gives it. 
Zincofax * keeps it that wa
 


o 


)' 


Afcer every bach, every diaper change and in becween, 
soothing Zincofax proteCts baby's nature-smooth skin, 
ProteCts againsc chafing and diaper rash, against irritation 
and soap-and-water overdry. 
But Zincofax isn' t i ust for delicace baby skin, It. s for 
you and your entire family-co soothe, smooch and 
moisturize hands, legs and bodies all over. 
Whac's more, Zincofax is economical, even mOre 
important now wich a new baby at home. 


\, 


. ,\ 
-;. ",. 
, 
-'--. 
 
..f - 

 , 
'"' \ " , 
'" \ 

 
-\ - 

 .. 

 
f 



 


 . 

 ZinèofaX' 
t - 

R BABY-S sIIJII _ 


 a -: -- --" Zincofax 
'a 
 ,,'S SI<I" 
t fofl SAS 


keeps a family's 
smooth skin smooth 


501 


-Trade Mark 
W 3056 



 
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 
: 
 W. B. Saunders Company Canada LTD. 
L 833 Oxford Street, Toronto, Ontal'i 0 M8Z 5T9 


Yes! Enter my subscription to the Nursing CI inics 
tor one year beginning with the March 1976 i:;sue. 
o I enclose check for $15.15. 
o Please bill me. 


Full Name_ 


Home Address 


City 


Province _ __Zone 



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 


'" 


, 


I.
 
-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 



-
 

 . f . 
- (dr' rom... 
.......'--. 
 
 




/ -- 
'. .....- -.:,1"'$: 



 

 

. 
.: - .
.(J


 

.L-- 
. - 
 



... 
,... 
. - /J : 
 / I. 




.... .. 
-1' I' .


,.,



 
: I f 


...--

 
. I ,

 
 
I' .J 
0"" 


. 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 



\ 
i.\
rq 
I 
'., 


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. 


. . 
.. ^f , 
I, 
\ 
. 
- ., . , 
'!!/"" _. . 


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 


'" 


.. 


--- , 


--- 


.1 


... 


. 
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 


\ 


I 


ro. 


., -, .... 
\
 ( , 
 
I 


The Canadian Nurse 


E
750ld6

35 
I I . 1 \1 E H! ) 1 r '( 0 F ù T TAw ^ 
Nu
SlnlJ LI'
fU.{V j 
Of TAW A O,HA::U.J 
KIN-óN
 



 


,. 


'\0.. 


l 


.. 


_. 


.- 


.... 



Super Fashion by White Sister 



 


i 
f 


'\ 



, 

: 
'" 
, 


'\ A) Style No. 46481 
Sizes 3-13 
f Royale Corded Tricot 
White, Yellow 
About $29.00 
B) Style No, 46528 
Sizes 3-13 \ 
Pristine Royale \\ ' \ 
White, Pink 
About $23.00 \' 
A C. Style No. 6883 \ 
Sizes 8-16 
Royale Seersucker 
100% Woven Polyester -_ . tI 
White, Yellow 
About $35.00 


I
 I ""HITE 
.. wÐ SISTER See our new line of Whites and Water Colours at fine stores across Canadé 
CAREER APPAREL 



A SPECIAL OFFER OF INTEREST TO 
CANADIAN NURSES 


t2j 
 
------ 
= 
 to:I !:o:I fI:I 
 
 1'1 I :'I TTTITITITITITIIIIII 
" 
 
 
 
 
 i 
 \ 
"a. 
 
-8 f I í i. I I f 
$I æ 
ø. Q. ;- .- ;- f f 11111111111111111 
-. .... jii .. II .. all all a: III \ 
o:t II' . :! 

 C" '" = '" f :1- 
 i .. \ 
:2. i 
 , i = , t- . f fl. I 
"" , 
i II " II' . . . 

 ;: :s ::I = !!. X' X' .. . --- 
; e. 
. " ; .. , 
::s ;:;- g SIt · I I 
æ. .... 
.., III 
t:> - 
o:t 
t .... , 

 - ---..
' NOW 
::t. . 30 
. -- 
. 
,. VOLUMESI 
.. 


THE new ENCYCLOPAEDIA BRITANNICA 
Now available at a Special Group Offer Discount 


For over 200 years Encyclopaedia Britannica has been recognized as the reference standard of the world, Now. . . the world's 
most authoritative and complete reference work has been redesigned and totally rewritten to bring a far more readable, 
usable, informative encyclopedia than ever before. You can choose either the Heirloom or Imperial binding and select 
your choice of valuable options - included at no extra cost. All this can be yours at a Special Group Discount - a price lower 
than that available to any individual. 
More useful, in more ways, to more people- 
Now arranged for 3 reasons into 3 parts. 
In a dramatic 3-part arrangement that makes seeking, finding and knowing 
easier than ever, THE NEW ENCYCLOPAEDIA BRITANNICA provides quick facts 
clearly and concisely for the school-age child, and at the same time can moti- 
vate student and adult alike into the magical world of self-enrichment. 


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- 
the-point articles so readable that 
never before has Britannica been as 
useful and valuable in homework 
assignments, 


2. TO DISCOVER THE MEAN- 
ING OF THE FACTS. This 
need is served by the 19 
Knowledge In Depth volumes 
containing 4,200 articles pro- 
viding understanding and in- 
sight to make the facts come 
alive with meaning. 


3. TO EXPLORE ENTIRE 
FIELDS OF KNOWLEDGE, 
This need is served by the 
revolutionary one-volume 
Outline and Guide which 
is a readable guide to the 
whole of human knowl- 
edge. 


Together, the three parts ofTHE NEW ENCYCLOPAEDIA BRITANNICA combine to 
achieve a breakthrough in publishing history and result in a family reference of 
extraordinary and unequalled usefulness. 


We have prepared a special, new Preview Booklet 


.'Ii!!'f 
- \0 
\he; 


If you are interested in receiving our new preview 
booklet which pictures and describes the All-New 
Britannica 3 in detail, plus further details of this 
Special Group Discount, please fill out and mail the 
postage-paid reply card. If the card is missing, please 
write to Britannica Special Group Offer, Box 501, 
Station F, Toronto, Ontario, M4Y 2L8. 


" 
...-dØ::CJ>.
 
. ",{1'I\J'"'

 


YOU CAN SELECT 
YOUR CHOICE OF 
VALUABLE OPTIONS 


OPTION NO.1 


;+ 

 

 :
 

;

 
,TIT i i II : i I iT,:- 
'1 1 1l1!11j' 
Ii! : II i IIí i ; 
-------- 


15-Volume Set 
Britannica Jr. Encyclopaedia 


OPTION NO.2 


----- 


I 


, 


, 


.. 


Britannica World Atlas 
and Webster's Third New 
International Dictionary 



, 


.h- 


. . 


. 


. 


II 


THE 
CLINIC 


SHOE 

 k
 j",UJhat@ 



 


o 


----- 


,\ 
 


.. 


... 


STYLE #314 - also available in colors. 


.., 


r 


. 
-.. 


.., 


SOME STYLES ALSO AVAILABLE IN COLORS. SOME STYLES 3Y2-12 AAAA-E. ABOUT 22.95 to 3195 
For a complimentary pair of white shoelaces, folder showing all the smart Clinic styles, and list of stores selling them, write: 
THE CLINIC SHOEMAKERS · Dept. CN-2, 7912 Bonhomme Ave. . St. Louis, Mo. 63105 



276 
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& 


') 


.. 



 -I . 
... 1_ 


. 
--- 


"The Ups and Downs of 
Communication" are the subject of 
this month's forum, Frankly Speaking 
(page 13). Author, Lorine Besel asks: 
"Are we makIng the best use of our 
time with our patients? What effect do 
variations in eye level have on 
communicatlonsT The photo 
illustration for this feature and the 
cover were provided by Health and 
Welfare Canada 


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


ISSN 0008-4581 


" 


Indexed in International Nursing 
Index, Cumulative Index to Nursing 
Literature, Abstracts of Hospital 
Management Studies, Hospital 
Literature Index, Hospital Abstracts, 
Index Medicus. The Canadian Nurse 
is available in microform from Xerox 
University Microfilms, Ann Arbor, 
Michigan, 48106. 


The Canadian Nurse welcomes 
suggestions for articles or unsolicited 
manuscripts. Authors may submit 
finished articles or a summary of the 
proposed conlent. Manuscripts should 
be typed double-space. Send original 
and carbon All articles must be 
submitted for the exclusive use of The 
Canadian Nurse. A biographical 
statement and return address should 
accompany all manuscripts. 


A Canadian Nurses' Association, 
'bI" 50 The Driveway, Ottawa, Canada, 
K2P 1 E2. 


Subscription Rates: Canada: one 
year, $8.00; two years, $15.00. 
Foreign: one year, $9.00; two years, 
$17.00. Single copies: $1.00 each. 
Make cheques or money orders 
payable to the Canadian Nurses' 
Association. 


Change of Address: Notice should be 
given in advance. Include previous 
address as well as new, along with 
registration number, in a provincial 
nurses association where applicable. 
Not responsible for journals lost In mail 
due to errors in address. 


Postage paid in cash at third class rate 
Montreal, P.O. Permit No. 10,001. 
Canadian Nurses' Association 
1976. 



4 


I)()'-SI)()(-. i
.. 


The CanadIan Nurse February 1976 


A couple of books people are talking 
about these day, with titles that go a 
long way towards explaining their 
contents, are: "When I Say No, I Feel 
Guilty" by Dr. Manuel J. Smith and 
"Don', Say Yes When You Want to 
Say No" by Jean Baer and Dr 
Herbert Fensterheim. 
The subject of these books - 
assertion therapy or assertiveness 
training - is a behavior concept that 
gives everyone something to think 
about. In essence. it says that each of 
us has the right to express his own 
needs, convictions and wants openly, 
in a direct and positive manner. The 
underlying Iheory, and one with a 
certain irresistible logic, is that, if we 
communicate our needs and beliefs 
clearly and convincingly, they are 
more likely to be understood and 
respected than if we camouflage 
them behind a subservient or diffident 
"don.t care" attitude. 
The aim is appropriate 
expression of these rights as we see 
them. It does not imply angry or 
overtly aggressive attitudes It does 
imply mutual respect and acceptance 
on the part of ourselves and our 
associates. 
Assertion therapy presents 
nursing with some interesling 
conundrums. Already, many 
individual nurses- whether or not 
they have undergone formal training 
or read the books, have changed their 
professional attitude in response to 
this concept. These nurses have 
stopped saying "yes" to 
unreasonable demands and are, 
sometimes to their own surprise. 
saying "no" or at least "why?" They 
are finding that the sell-confidence 
and self-respect they gain when they 
know their ideas and needs will be 
listened to, means that they can 
provide their patients with more 
appropnate care. 
For years, nurses have been 
caught between two absolute and 
often opposing lines of authority - 
administrative and medical. 
Psychologists point out that when a 
person is constantly made to feel 
subservient and subordinate, without 
being allowed to express annoyance 
or anger, that person otten vents his 
anger on unthreatening people in his 


immediate envirooment. It may not be 
appropriate to take out our frustration 
on a helpless palient but all of us have 
been tempted to do it. 
What happens. though, if the majority 
of the nursing profession accept the 
need to assert themselves and to 
participate openly In 
decision-making? What will be the 
new rules for the "doctor-nurse 
game" that has not only allowed but 
even encouraged nurses to 
manipulate and wheedle the medical 
profession into making the decisions 
nurses wanted? Will nurses be able to 
establish new lines of communication 
and patterns of interaction with the 
medical professioD and administrative 
hierarchy based on mutual respect 
and recognition of each others 
talents? It s worth thinking about, 
isn't it? - M.A.H. 


II.. .-.. i II 


Editor 
M. Anne Hanna 
Assistant Editor 
Liv-Ellen Lockeberg, 
Production Assistant 
Mary Lou Downes 
Circulation Manager 
Beryl Darling 
Advertising manager 
Georgina Clarke 
CNA Executive Director 
Helen K. Mussallem 
CNA Director of Information ServicE 
Michèle Kilburn 


..,. " 

 ..,....... 


i
 


.;::...., 


p
o by Gabor 
zllasl 


Next month The Canadian Nurse will 
feature a series of articles especially 
chosen to complement the work of 
nurses whose clients include mothers 
and their newborn offspring. Topics 
include a look at how drug use 
(prescription and non-prescription) 
affects lactation as well as a useful 
guide to helping new mothers 
establish a successful breast feeding 
routine. 


The Canadian Nurse has joine 
a small but growing number of 
Canadian publications that are 
computer typeset. (Optical characte 
recognition is the name printers use 
In theory. elimination of the possibiht 
of human error at a certain stage 0' 
production could result in error-free 
copy. Sometimes strange and 
unpredictable things happen howevE 
and this month s copy included 
several paragraphs that looked like 
this:' 0-- T1... _....__ VYc o ....__ %i 
5_C o @#/{_ (%01%) V1JW#.!%T 
1}%%oß_% Y....[- T1...i %ß{i %ß{ 
coß{i /1% ,__ ß_ % ß" % V1%0 ....Y 
...UT .%) ....}T%1.%} ß1 {1'CJo t 
ß_% .. JT 1V ß_% 
001001...%0%__ J}% 
171>-- %%o}...ß/}Co__i 
It is reassuring to know that tho 
printing gremlins that used to give u 
"sherdlu" in the old days have 
survived the computer age and are 
alive and well and living in prinl shop 
across the country. 



b"legant New :*}OJt LOOK Jor 
pnng 
I 


) 


J ' 


o 


\, 


A 


AT YOUR FAVOURITE STORE 


i 


designer's 
r



 choice 
A PROUD CANADIAN NAME 
IN THE FASHION INDUSTRY 



 
,,

I'III"III:;
1 
 I 
I 


I- 
'1 
! I 


A) Style No. 46570 
Sizes 3-15 
Pristine Royale 
White, Mint. Cantaloupe 
About 529.00 
B) Style No. 46540 
Sizes 5-15 
Pristine Royale 
White 
About 525.00 
C) Style No. 46585 
Sizes 3-15 
Pristine Royale 
White, Slue 
About 528 00 



111]){lt 


Nursing in Quebec 
In Quebec Nursing Shortage Not 
Due to Immigration (October, 1975) I 
am quoted as saying:"The shortage is 
more acute In other countries than in 
Quebec. Canada will have to train 
more nurses." Actually, I said:"lf it was 
proven that we have not enough 
nurses to give the nursing care 
required by the population, Canada 
will have to train more nurses." 
In the paragraph regarding Bill 22, 
you said that the bill will apply to 
Canadian nurses from other 
provinces as of July 1 st, 1976. This is 
not correct. As of July 1st, 1976 the 
requirement of a working knowledge 
of the French language (Bill 22) will 
apply to all nurses from other 
countries, other provinces, or from 
Quebec. 
Also, you state that after the 
temporary permit has expired, nurses 
will not be allowed to practice in 
Quebec without a certificate. This is 
not clear. After the expiration of the 
one-year temporary permit, a nurse, to 
be recognized and qualified to practice 
in Quebec, must obtain a certificate 
attesting that she has a working 
knowledge of the French language. 
Gertrude Jacobs, N., B. N., Registrar. 
The Order of Nurses of Quebec. 


Sex Talk and Nursing 
One of your respondents (Letters, 
Sept. 1975) mentioned a program, 
Human Sexuality and Fertility, 
conducted by McMaster University in 
Hamilton as one with which she was 
familiar, and she encouraged the 
development of other similar courses. 
I want to inform your readers of 
another program that is currently in its 
second year of existence. Conducted 
by the Health Sciences, Continuing 
Education Division of Algonquin 
College, in Ottawa, the program is 360 
hours in length extending on a 
part-time basis from September to 
April. It is multi-disciplined with all 
students holding a previous diploma or 
degree in nursing, social work, 
theology, education, counselling, and 
related areas. 
As human sexuality is a relatively 
new educational area I strongly feel 
that those of us involved in teaching it 
should be aware of what others are 
doing so that we can share and 


constantly improve our programs. If 
any of your readers wish further 
information about our program, I 
would be most pleased if they would 
contact me. 
My sincere thanks to The 
Canadian Nurse for publishing the 
original article "Sex Talk and 
Nursing." Hopefully, it will stimulate 
nursing educators to implement 
courses in sexuality in basic nursing 
programs. 
Lorraine Hill, R.N., Algonquin 
College, Continuing Education, 
Health Sciences, 
2135 Knightbridge Rd., Ottawa, Ont. 


A description ofthis course offered by 
Algonquin Community College was 
also sent to the editor by Rosemary 
McDonald, B.S.N., Ottawa. 


Editor's Note: "Sex Talk and Nursing, .. 
(June 1975), the first forum written by 
CNA member-at-/arge, LOflne Besel, 
deserves critical acclaim for its 
long-term box office appeal. 
Responses to this column continue to 
reach both the author and editor. 
Although we appreciate your interest, 
the author is concerned about the 
possibility that other significant issues 
are being overlooked. She asks that 
you express your convictions througf' 
positive action rather than further 
correspondence on this subject. 


A Liberated Male 
I find it rather ironical that some 
of your authors, who profess to be 
feminists, commit a self-defeating 
error in their efforts to bring equity to 
women. I refer specifically tothe use of 
the gender"she" or "her" in making 
general statements about nurses. All 
nurses are not female. Believe it or not 
- there are male nurses in the world. 
Men need liberation too. We must 
be conscious of these subtle 
discriminatory addresses if women 
are to really gain social equality, 
instead of becoming female 
chauvinists. 
May I suggest to potential future 
authors the use of "the nurse" or 
he/she after the person in the article 
has been identified by their full name. 
Christopher Lemphers, R.N., Old 
Masset. B. C. 


A Pat on the Back 
The article Caring for the 
Untreated Infant ( December 
1975) proposes an approach to a 
problem that many nurses have faced. 
The author comes to grips with the 
basic question of how a nurse is to 
care for an infant that others have 
decided is to die. This is a situation that 
faces nurses regularly and one for 
which nurses have been ill-prepared. 
Young students find this situation of 
"letting a baby die" basically opposed 
to their personal value system and 
what is taught them in nursing. Colleen 
McElroy has written the definitive 
paper on the subject. Her concern for 
life and her commitmenl to nursing as 
it should be practiced are impressive 
She should be awarded the gold star 
for excellence. 
Eileen Mountain, executive secretary, 
Canadian Association of University 
Schools of Nursing, and assistant to 
the secretary-treasurer, Canadian 
Nurses' Foundation. 


Nursing Heritage Preserved 
A year ago you published a letter 
in which I explained my concern that 
no archives in Canada was 
assembling a collection of material 
that would tell future generations the 
story of the nurse in the north. Since 
that time, I have worked toward the 
establishment of such a collection and 
feel that many of your readers would 
be interested to know of the work 
being done. 
In cooperation with the archives 
of the Glenbow-Alberta Institute, an 
eighl-part documentation has been 
established. It consists of: 1 )original 
writings (that is, letters or diaries) 2) 
written reminiscences; 3) copies of 
short published writings; 4) 
photographs; 5) documents and 
memorabilia; 6) taped interviews; 7) a 
bibliography of major published works; 
and 8) a cross-indexed file of 
resources. Readers who wish to 
contribute material to this collection 
should contact me. Items need not be 
permanently relinquished but will be 
photocopied and returned if the owner 
so requests. 
This fall I received a Canada 
Council grant to continue my work on 
the colleclion and expand the taped 
interview section. I am currently 


assembling names of nurses with 
northern or early frontier experieno 
who might be considered suitable 
interview subjects. I would urge any 
your readers who have had this type 
experience and would agree to an 
interview, to contact me as soon a
 
possible. 
Joy Duncan, R.R 3. High River, 
Alberta, TOL 1 BO. 


Primary Care Practitioners 
We are a group of Nurse 
Practitioners working in primary car 
settings, who have formed an intere: 
group, with the intent of sharing an 
seeking solutions to common 
problems, and adopting unified terrr 
of reference. 
We are interested in hearing fro 
other similar groups across Canad1 
regarding membership, function, ar 
the problems they have faced and 
solved since being in existence. 
Please contact Margaret Nixol 
c/o Klinic Inc., 567 Broadway, 
Winnipeg, Man. R3C OW4. - 
Margaret Nixon, Nurse Clinician, 
R.N., S.R.N. 


Comprehensive Care Model 
The article Nurses and the My 
of Full Employment (September 
1975) has stirred my interest. It is , 
fact that the health care delivery 
structure is changing. As hospitals 
change, nurses must also change, 
and the central problem is whether 
nurses can change appropriately. I 
found it disappointing that Monaghc 
would suggest nurses use their 
background as a basis for movemel 
into administrative support service 
positions. Granted, we will need 
administrative support - but these 
people do not need to be nurses. Th 
shift from training in a hospital for é 
specific role within that organization t 
education in an institution of higher 
learning, has already suggested a 
broader role. The nurse of the futur 
must be a practitioner of the science c 
nursing, and be prepared to care fc 
people in whatever setting they are 
found. 
James D. Parsek, R.N., Instructor t 
Nursing, The University of 
Wisconsin /Milwaukee, Milwaukee, 
Wisconsin 



c 


'- 


SKI
 
MILl' 


'" 
" 
..... 


. 


I 


-- 
- 

RIFJf" 


.... 


............ 


Nlazola 
CORN OIL 
100 0 PURE 
HUILE DE MAíS 
"- r....... . 32 oz fI 909"" 
'''VGS .........-IT_-- 


, 
 


Best Foods 
Living up to our name. 


I 


. 


. 


. 


. 


I 


. 


An important study of a nutritious diet 
designed to reduce serum cholesterol. 
Not long ago, an encouraging study was re- 
ported from the University of Minnesota on a 
dietary program to reduce serum cholesterol. 
The diet tested was a palatable, well-balanced 
regimen that included skim milk, poultry, 
fewer eggs, fish, lean meats, and Mazola 100% 
pure corn oil. 
Results: Serum cholesterol levels were effec- 
tively reduced by an average of 17%. 
For a detailed report of this timely study, please 
write to Nutritional Information, Best Foods 
Division, The Canada Starch Company, P.O. 
Box 129, Station A, Montreal, Quebec H3C 1Cl. 
Mazola Corn Oil contains: 
54% polyunsaturated fats and 14% saturated 
fats. 







 
O V



 
1""- c,
O

 
I ",,-"
ø- 


"- 



8 


The Canadian Nurse February 1976 


X""'.S 


--;:;;s- 
-- ,. 
- 
- .- 
- 
-.... _. --- 
... ----- 
-... ..,-.,
 - 
 
- - - 
- - 
- '... 
-.--- - - ::r. 
-- 
-- 
- 
... - 
-- 
- iJ 
.1 . 

., 
I '
 
IJ \\- 

 r 


Blueprint Committee 
Studies 
Comprehensive Exam 


The dream of a comprehensive 
examination lor all Canadian 
registered nurses is a step closer to 
realization after two recent planning 
meetings in Ottawa. The "Blueprint 
Committee on Comprehensive 
Examinations.' set up by the CNA 
Testing Service, met at CNA House in 
November and January for a total of 
eight days to begin work on a bilingual 
blueprint for a Comprehensive 
Examination for R.N.s that should be 
ready for use by 1978. 
The blueprint is based on a 
conceptual model developed by the 
Ad Hoc Committee on 
Comprehensive Examinations and 
accepted in June 1975 by the CNA 
Committee on Testing Service. The 
new examination will emphasize a 
general, multidimensional approach 
to nursing, rather than using a variety 
of tests to measure knowledge of 
specific clinical areas. This change 
reflects the shift 10 more integrated 
nursing education programs across 
Canada, and will result in an 
examination more closely attuned to 
the' real" world of nursing. 
The Committee is composed of 
four French and lour English- 


StudiO Cnamplaln Marcil 


speaking members. Pictured 
above during the most recent meeting 
of the committee in January, are (left 
to right) front row: Denise Dionne. 
Montreal; Helen Evans, Willowdale, 
Ontario; Myrtle Kutschke (chairman) 
Sudbury, Ontario; Margaret McCrady, 
Winnipeg; back row: Claire 
Kermacks, Vancouver; Michelle 
Charlebois, Montreal; and Velma 
Wade, Moncton. Absent for the photo 
was Madeleine Corbeil of Montreal. 
Further information about the 
work of the Blueprint Committee and 
the development of the 
Comprehensive examination will 
appear in future issues. 


Manitoba labor Group 
A new independent labor organization 
called the Manitoba Organization of 
Nurses Associations (M.O.N.A.) has 
been established to replace the 
Provincial StaN Nurses' Council. 
Provincial bargaining units, now 
composed of 48 certified Nurses' 
Associations, are members. 
Nurses' elected to the Provincial 
StaN Nurses' Council last May will 
finish their terms as members of the 
Executive Council of M.O.NA The 
President of the new organization is 
Shirley Codd of Winnipeg and the 
vice-president is Kathleen Connors of 
Thompson. 


CNA Supports 
International Convention 


The Canadian Nurses' Association 
has replied to a questionnaire on 
conditions of work and life for nursing 
personnel, prepared by the 
International Labor Organization. 
Results of the survey will be 
discussed at the 61st session 01 the 
International Labor Conference in 
Geneva in June, 1976. 
Among suggestions proposed by 
CNA' 
- the International Labor Conference 
should adopt an international 
instrument on the situation 01 nursing 
personnel; - 
- this instrument should take the 
form of a convention, rather than a 
recommendation; 
- the instrument should apply to two 
levels of nursing personnel, the 
professional nurse and the auxiliary 
nurse, as described in the Report on 
the Joint Meeting on Conditions of 
Work and Life of Nursing Personnel 
sponsored by the International Labor 
Organization and World Health 
Organization. 
Adoption of a convention based 
on the ILO - WHO repor1 would 
involve both provincial and federal 
government in Canada' since both 
levels of authority have Jurisdiction 
over working conditions of nurses. 
CNA's response to the ILO 
questionnaire was prepared at the 
request of the International Council of 
Nurses by Glenna Rowsell (CNA 
member-at-Iarge for social and 
economic welfare) and Margaret 
Wheeler, associate secretary and 
consultant in labor relations, Order of 
Nurses of Quebec. It was ratified by 
CNA directors at the October 1975 
meeting. 


An Addendum to the 1974 Edition 
of the Index of Canadian Nursing 
Studies is now available on request 
from the Canadian Nurses' 
Association. (Price $1.00) Both the 
1975 addendum and the basic 
index were compiled by the CNA 
Library. The index update lists 
studies on which information was 
retrieved between July. 1974 and 
October, 1975. Copies of the basic 
index are still available at $5.00. 


RNAO/CNA launch 
Pilot Health Project 


From January 20 to March 20, 197 
CNA , in collaboration with the 
Registered Nurses' Association of 
Ontario will implement a health 
promotion pilot project at Toronto 
General Hospital. The project is 
aimed at raising nurses awareness 
their own health standards and 
promoting changes in their lifestyle 
It will provide for the measurement 
the "health status" of individual 
nurses. using some of the tests 
demonstrated at the 1974 CNA 
convention In Winnipeg Once their 
present stale of health has been 
determined, nurses will be given 
assistance to establish fitness 
programs that suit their individual 
needs Provision will be made lor 
continued follow-up of their progres 
This project is intended for use in 
in-service educational programs. 


4 .. 

:' 

( 
t "-- 
r 
., 
'" 


A report on the demonstration 
project will be made to the CNA Bo
 
of Directors in February 1976. 
Directors will then consider extendi 
the program to other provincial 
nursing associations. 
The plan is being implemented 
meet a directive from CNA 
members at the Winnipeg meeting 
"BE IT RESOLVED THAT CNA 
explore ways and means of 
developing a plan of action to 
sensitize or raise the level of nurSE 
to lifestyles conducive to optimum 
health. 



The Canadian Nurse February 1976 


9 


New B.C. Minister Explores 
Dimensions of Health Care 


Brit;sh Cofumbia"s new health 
minister IS sure there IS an expanded 
role for nurses but not so sure how It 
can be developed. Six days after 
being named to the portfolio, Health 
Minister Robert Howard (Bob) 
McClelland, 42, admitted he is not 
'too familiar-- with Ihe expanded role 
program. 
"I guess that s a subject for 
discussion with the doctors. 100. I 
think the nurses in our community can 
take a much greater role in delivering 
health care to people, yes. and I d like 
to see that happen..' 
Asked whether he sees this as a 
prerogative of Ihe medical profession, 
he replied: Well, I think that's why I'd 
have to talk to the doctors. I'm sure 
some of them think that it is. There 
must be areas where we can provide 
a cheaper form of care without 
endangering the patient. I feel that 
probably doctors don t know where to 
go on this one either." 
McClelland said he could not 
express an opinion about 
apprenticeship training of licensed 
practical nurses, as it is being urged 
by the Hospital Employees Union 
and opposed by the Registered 
Nurses' Association of B.C. 
He said he has no plans to 
interfere with present legislation 
covering professional licensing 
bodies, but may extend licensing to 
other groups. Acupuncturists were 
the only example given. 
Continuation of the public health 
nursing freeze, imposed by the former 
NDP government several months 
ago. depends on the extent of 
provincial financial problems, he said. 
"I don t like to see a freeze on 
essential services. I'm very surprised 
there hasn t been an uproar aboul it 
from the public health people. The 
freeze prohibits replacemen1 of public 
health nurses or hiring of additional 
staff. 
The former opposition health 
crillc said it was too early for him to 
say whether B.C will require a 
spending freeze similar to that 
imposed recently by the Ontario 
health ministry. Hospitals have been 
given financial restrictions "10 live 


within their budgets" which "may in 
effect cause a freeze,'. he said. But he 
added, "hospitals are nol doing this 
and there will be deficits." 
There is a $17 million 
overexpenditure in hospital programs 
for which funds are not available, he 
said, snd medical services costs are 
over by about 54? to $48 million but 
Ihese will be parUy covered by 530 
million in the Medical Commission 
reserve funds. 
McClelland IS a former moving 
van driver. broadcaster and publisher, 
and has served on the board of the 
Langley, B.C. Memorial Hospital. He 
became interested in health care 
while serving on a committee 
eslablished some years ago by the 
former Narcotic Addiction Foundation 
in Vancouver. 


RNANS Holds Workshop 
On Caring For Aged 
"Old age is not a disease, it is 
something that comes to all of us," 
Frances Moss. Executive Secretary, 
RNANS, said in opening the 
association's recent workshop on new 
approaches to meeting the needs of 
the aged. "Old age can be a time of 
loneliness and depression, but it can 
also be a time of serenity and quiet joy 
The difference is sometimes the 
presence of a caring nurse, a nurse 
like those of you here today who have 
come here because you are touched 
by the theme of this workshop 
'Someone Like You':" 
The workshop was open to R.N.'s 
and Adminislrators of Nursing Homes 
and Homes for the Aged. Nearly 70 
people participated, the majority of 
them nurses from Homes for Special 
Care. 
Shirley Campbell, Director of 
Nursing at Ocean View Manor and 
Chairman of the new RNANS Special 
Committee on Needs of the Aged, was 
general chairman of the workshop. 


Anti-Smoking Group 
Appoints 
Executive Director 


The Canadian Council on Smoking 
and Health, a national anti-smoking 
lobby group with headquarters In 
Ottawa, has appointed Kurt 
Baumgartner as Executive Director. 
Baumgartner was head of health 
science program development and. 
later, coordinator of allied health 
programs at Algonquin College in 
Ottawa. 
The council IS composed of 
national voluntary health 
organizations which share an Interest 
in smoking and its hazards to health. 
Activities include examining legislative 
approaches intended to prevent 
smoking. publishing information on 
adllances in related research, raising 
funds for research projects and 
disseminating technical data on 
smoking and ils consequences. 
CNA is represented on the 
1975-76 Board of Directors of the 
Council by Jane Henderson, 
Associate Executive Director of the 
national nurses' association. 


.. 


-... 


I -t 


'. 


Did you know? 
That nurses across Canada look to 
CNA for information on continUing 
education? In answer to these 
requests, CNA library staff maintains 
an up-to-date list of all short-term and 
non-degree courses available to 
graduate nurses across Canada. 
This list provides information on 
tille, duration. date, fee and location of 
the course as well as names of 
persons to contact for further 
information. It's available at no charge 
from the CNA library. 


Community Nursing 
Course Offered By 
Correspondence 


, 


The first correspondence course in 
nursing to be offered at a Canadian 
unaversity was developed in 
Saskatoon and is now under way. The 
course, a half-class in preventive 
health care, was prepared by the 
College of Nursing at the University of 
Saskatchewan and is available 
through the University's Department 
of Correspondence Courses. It will be 
followed by a full class at Intersession 
or Summer Session on community 
health nursing, during which the 
practical and clinical aspects of the 
nurse's ro1e will be emphasized. 
The package was developed for 
degree graduates in nursing whose 
undergraduate programs did not 
include a course dealing with 
preventive health care in a community 
setting. 
Professor A. E. Caplin, of the 
College of Nursing, points out that in 
recent years there has been a growing 
emphasis on communify nurSing 
through public health departments 
and private agencies such as the 
Victorian Order of Nurses. In the 
College's five-year degree program, 
phased out in 1971, community 
nursing was an optional subject and 
some of the students, as well as some 
from other universities, graduated 
without experience in this growing 
field. As a result, they are at a 
disadvantage if they wish to seek 
community nursing positions in health 
regions or elsewhere. 
The objective of the 
correspondence course is to help 
nurses understand their role in a 
changing health delivery system that 
is placing increasing emphasis on 
preventive health. Health 
requirements will be analyzed in terms 
of factors such as basic human needs. 
the environment and quality of life, 
disease and disaster. 




 
\ 
, 
, 
\ , 
\. , 
, 
\. r 
\. , 
\ , 
\ 
, 
. 
Q 
"- 
. 


HJ 333 
3 Piece Suit 
Double Knit 
100% Polyester 
Colours: Green, Blue, 
Pink, Yellow 
Sizes: 3-15 
Suggested Retail $45.00 


s: 


HJ 31 
2 Piece Sl 
Plain Warp Kr 
90% POlyest. 
1 0% Nylc 
White on 
Sizes: 4-1 
Suggested Reté 
$35.( 


,/ 


./ 


ø 


'-, 


. 


. 


...
.



(f))
 
1'- 
 \
 from 
.Ie latest \00 o White Cross 


, 


For additional information' HAMP TON MFG ( 
. . 1966) LTD. 



qt? q ilable at your favourite St 
ol"e 



 


J 15 
F->ce Suit 
a Warp Knit 
Polyester 
JC Nylon 
t19 only 
z ): 3-15 
J<Jested Retail 
i)O 


f) 
\--- ' 



 


ð'
 

 


/ 


HJ 321 
2 Piece Suit 
Corded Jersey 
60% Polyester 
40% Nylon 
White only 
Sizes: 4-16 
Suggested Retail $26.00 


,. 


.
 


\ 
A. '-cI ) 
\
 
 


\. 


- 


- 


HJ 306 
2 Piece Suit 
Double Knit 
100% Polyester 
Colours: Green, Blue, Pink, Yellow 
Sizes: 4-16 
Suggested Retail $32.00 


1?1:\ J=I PlJlI
J= PlJI(')fl.ITCC1'.1 


T
I . OA') ')nnc 



KeelJS 
hinl drier 


Instead of holding 
moisture, Pampers 
hydrophobic top sheet 
allows it to pass 
through and get 
"trapped" in the 
absorbent wadding 
underneath. The inner 
sheet stays drier, and 
baby's bottom stays 
drier than it would in 
cloth diapers. 


, .., 
.:- 
- 


Saves 
you tiIl1e 
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. 


I - \.(t 
Þ ð 
l>el's 


,J 


... 


. 



 



 
.. 


'".. 


.. 


, \ 
,
 


'III 


., 


rROCTER . C"'NBLE CAR.3ZZ 



The C8n8dlan NUlM February 1976 


13 


........................ 


his month's forum has been submitted by CNA 
1ember-at-/arge for nursing practice, Lorine Besel, 
)irector of Nursing, Royal Victoria Hospital, and 
'ssistant Professor, School of Nursing, McGill 
,/niversity, Montreal. 


Frankly Speaking 
about nursing practice 


The Ups and Downs of 
Communication 


I 


"='" 


I 


.- 


\7,. I 


, 


- 


Lorine Besel 


Try this experiment. Take a friend home to bed. 
Distortions in experimental results may occur if one 
)f you is male and the other female. There is 
experimental evidence that males tend to dominate 
conversations by the simple mechanism of using up 
the available speaking time. So, for the pilot project 
at least, let's stick. to inviting the same sex as 
yourself to your bedroom. 


Experimental Proced_ure 
1 Keep readinq, This is serious, 
2 Choose agenda betore adjourning to bedroom, 
a) Social Agenda. Two topics such as books: 
movies, concerts which both have experienced. 
b) Sickness Agenda. Two areas of poor health 
which are of concern to your friend e.g. headaches, 
constipation, sleeplessness, lost loves. whatever, 
3 Have available a 3-minute timer and a recorder 
4 Have available a chair - to be used only as 
instructed. 
5 Friend is to lie down on bed covered by blanket 
(patient roJe). 
6 Have chair available near the bed and close 
enough to sit if you wish to do so. Start timer and 
tape recorder at beginning of each sequence. 
7 Discuss one Social Agenda item for 3 minutes 
while remaining standing beside the chair. Note 
reactions in self and friend, 
8 Discuss one Sickness Agenda item for 3 
minutes while remaining standing beside the chair. 
Note reactions in self and friend. 
9 Discuss one Social Agenda item for 3 minutes 
while sitting down. Note reactions in self and friend. 
10 Discuss one Sickness Agenda item for 3 
minutes while sitting down Note reactions in self 
and friend. 
11 Variations on the experiment can include; 
. wearing a uniform in one set of the Social and 
Illness Agendas, but not in the other. 
. reversal of roles 
. ... try the experiment in hospital with real patients 
and variations such as high or low beds, standing 
over sitting patient, or sitting beside sitting patient. 


Observations and Reactions to be 
Recorded 
Are there differences in the sense of comfort or 
discomfort experienced by each of you in relation to 
variations in eye level of communication between 
the sitting and standing positions? Does the length 
of time that each person speaks change as you sit 
or stand? Does the content of each person's speech 
change as you move from the sitting to standing 
positions? Does this vary equally with the Social 
and Illness topic, or do process and content vary 
more significantly with the topic than they do with 
the position in space of one of the parties? Does the 
standing person tend to ask questions of the person 
positioned at a "lower level" regardless of the 
agenda topic? The person in the "lower level" 
position has a smaller range of body movement (a 
communication mode) available to to him - how 
does this make him feel in relation to the standing 
person? Does the standing person feel more 
comfortable standing while on the Illness agenda 
than on the Social agenda? What of the urge to sit, 
or not sit, in that convenient chair? If you feel more 
comfortable sitting or standing. how does it affect 
the participation of both parties in the interaction? 
The questions to be considered are as endless 
as your own curiosity and concern about the nature 
of nurse-patient interaction, 
These days we are all concerned about 
truly "communicating" with patients. We sometimes 
have the mistaken notion that this is happening 
when we listen and they talk or when we talk and 
they listen. 
Here IS an unproven hypothesis and further 
unanswered questions; The person who stands 
above the other will assume dominance in amount 
and content of communication. Would we allow this 
dominance to the patient by sitting below his/her 
eye level? Would we gain more data this way? 
Would this affect our helping role favorably or 
unfavorably? 
Time is precious. Time studies have shown that 
patients experience a 3-minute "sitting" helper 
being there for longer than 3 minutes. and a 
3-minute "standing" helper being there for less than 
the actual 3-minute period. We spend endless hours 
complaining that we do not have "time to spend 
talking to patients." 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 


. ....:.:.
::...:............. 

 ..::...::
...:
::..:..... 

. .....:..:,.. . 
.' ,.:...:.,... ...': '. 
-'. ........ - .
'" ". .......... 
'. ..... .
, _".0'. . ..... 
..:...:............. "-.' ........ : ........ 
.
-:: '. .. '.' '.:..: :":':'. . '.:.. ,. ... 

. ' . 
 
 '"::- :

.AÙ
/
}:..:;:::
t 
. . ..:
 
 ...:.
 "':..:....:....:....... 
...:: 

 :-....'"' 
'. 
. .... ..... .... -":;:" 
,..... 
': '
.'. '.: .
:.:>:: ':
:<':':":'. ": :::::*:"':, 

 '
 .... . ..' . . . . . ','., '.' 

 

 .
 :::
 :....:...:.:
:.
.}.::..
 
 : .:. ::::::\.:::.:.:.:-.-:::.
::
;: 
.... 

, :::: ,: ::::::":":":'.: .'::-:':::.':-::::"'::::".0:':. 

, :so. '0 '. '. '. '. . ...... .. ........ 
y.:.
 
 .,., ,
: .::.::.::.:: '.:,,::. 
 '. :.;.:. ::'::':', '.:
.:.:: .'.: '.'. 
'
:o.. "'
:'.:.... . ...... _......... :....!".ò..--:- . 
 "''''''':'' .,... ....:': ...... 
"::;"'
o::-" "" ............ 'o
. . ,.
, '. '. . 
".,....,. . 
..
. ..'.... .'" ':":' .:.,.......,. ,..... .,...... ...., .,....... 
. . ."".... ..... .' 0... o. .
.,........... '.
. '. '. '. '. '0 '. . 
'.'. '. '.'. '. . o.......-.::.-:s.-..... -,;,. ....,.,... ....,.,. 
.......:..:-.,::.:. . ""'. .......::-.:-::-.....
:.::.::. ::.::.: :':'. 0::.:.. 
'. "'". '. . '. '. ......'...................0 
' '. '. '. . '. ...... ,
. .... '. '. '. '. '. '. '. . 
' '. '. . .' ...... '. "",. '. '. '. '. '. '. '. '. 
' '. '. . . ". ....... .
 '. '. '. '. '. '. '. . 

.,. .::
:
:. \/gy> 
\ . . .....:-.....
.
:.::
 
.... .... -... . 

{ 
" , 
"'. 
.. 
.0 
... 


".<..
 
. .. 
 .:' 
.. 
.. 
...... 
.. 
.... 


ß 


cP'''' 
Svf\Y'Ibf. 

OS L1 
t' 


I) 



I ne \..ønøOl8n nu..-se r80r-ua"-r I fll a 


Graham 
Linda 
palla nt , 
catherine taft 
. ,AdOlphUS, e nursing S 
patriCia bers of th Toronto. tor 
a re me
 I centre, dm inistra 
th O rs M dlca . 9 a . a 
1h e aU ok e n ur s1n Ila nt IS 
Y bro . the . pa 
of Sun
 do1ph US IS catherr
e d Linda. 
patriCIa 
I serv'iCeS'tro ke un,t. a
ecialist In .....a s 
of spe CI se in th e . s 'cal nurs
 SthiS artiCle 
staff nu r , ' S the chnl m aterialln C U ncil of . 
ham 1he . n 0 In 
Gra b1itation. canadla t october. 
reha I d to the se s , la s 
prese.nte sc ular Nu r 
cardlOlla 
Montreal. 


.. . 
 
.. 
. e.:e:.:
' '
'.... '..:: .
.'. ..... . 
..... ..
. ..... .
. 
. :..:.....
.. ..... . 
. . .......:.:.-:-
. ...:......:. ..
.... e. 
. - - -. ..' ....-...... ..' . . .. 
. . . 

 ,. .... .... ......,.... -.....,. . .... . ... .... 
......., .......:....:. ........:-.. .......... '.. ............. .
..... 
.. .. .. .. .. :::: .. - .. .' ... . -.. ..' - . 
j07f7\\
??:
:
{>}.:
;../r5f>>ttt%k \;

 
:.'.., . 
 
.'.... 
 . .....: '.., ...::.::
.:...:.:::........:...::.:.::.:.:...:.....: .:' 
',: ",:: :
... 
',:-:-,":', 
': :
:
: }.: :
,,:

,:,:'.:.:m

.:.:.:..'.:.:.:',:',
":'" ..-::.:
:

':..::.:
.:: 

 . . . . 
 


 ." ........... 
. . 
J. .:-". ......: ...;..
:'".. ",. ,.:.:.............:........:.: .; . '"a.'". 
1 ... - .. ...,. '. ......' .... . . '. .... . .. . . ....... . . ' '. .. 
. . ...... . ,, ". . .
.... 
, .''-.- .......... --.. . ................ ... .. 
..: .:.
 ........:..
.
........... . .... .:.:....:......:..:.:...... '... . 
\ ..
.......
... ....,................ 
 
:' .:.. -: '. ... '.....:......'-.:.
...1:..:.:.::....:.... .: . 
\\.. ------ '. "--- 
 .... .
, .. . '. . '. .. . 
, ......... ...... 
 '.. .....,... . .. . '. . . . 
'

'. 

 .

........... .... '. ".'. .... ...... .... ..... .... . 

.. .....
 
9'''.::'': . ......
.. 
. .. . . 
L. 
 

.. 
 :
 
 .
.. .::$:.
--
 
:


 :....'. .:::
 .
.. ',' .....
 
\' "-.. .
. .. 
 ..' .' . .. . . .' '. ' . ......-..;; 
'. :
:. .:'. 
 . . ..........::.:... :.:-, .... .:.:.. 
 . 
 

' "
%:
'" ,
 : .::.:.:...:.....:..: ..::::.'.. ::.:.'. ....:.. '''
 

 
 "" .'.
' ...::.
 ' . ::::::.::::::::.::
 "::::. .... ..::::
:'....:....'
.
' .....:.::... ..... 

 ... . .... . ... . ..... . . . '. .' .... .' '. . . .... . 
'. -.. .., .--..... . 
...... .,...... .... .' '..-:-- .. ....."..... ...:....
 .:
.. 

-I','" ......
 
 -. ,:':'::". ': :......:..:. ':'::::: .........: ':.'..'. 

'F""" W ' .;... 
 .-.ðt..:::::',:"::.:.
'.. ....:::::...,....:...:::::
.. . :'.:
:' .:..:.-..,. ' 
,'. 
 \. 
'" . . 
'--- . 
.::......:.: .... :..::.........:.. .:.:....:..-.:.... . 
 ..

. ..:.............. 
... ... .
 .. .... . ..... . '. .... ....:::.-;:. 
 . '.. 
.. ..
 . - ...:. ........ ..... ...,.......... ..
.. 

 

 :.... 
 
....
 
. :0.; .'.. ,",'. - ..:::0, .'. .'. :-..'-
 ..... ...-... 
'. .... . ..... .. ................. ........ ..
 
 ...,.
 
...
 ..
...:.... ... ........:.:.:.....:...'-
..
 . ...:..... 
.-. .

 ...-. .. .......,..............,
., """"'-.' ........ 
. . .. 
:

. ................ ...... ........
.
:.:.:..:..,.................:.:....:........:"-'... 
 :...... ........ 
..
 

" .." . ':':;. .. ..........,......
.....:;f:..:........:.
...*
 .....

 

:,". ....:..... ;.......:.:.,. :;.
.. ',:.:.:::::": -:'.:'., ::
:'?':è
 \ .::..:.........'.:..:.::::/.....
.:::::
..>.:..., 
 .. 
 .

 
. :
. 
." . 
 .
.:..,...:...::..
 '-. .... .:..... .,...., . ''':,,,:.,:::,:::,.::,:.::::..:..
:::.,,,:
,,, 

 ...:.
 :........:::.....::. '.::.:
...: ..... ..... \.:.-:.........:......:.:..:
 .. 
 ., 
 
. 
'.
 ....-.....:.... ::...... . .... ......... .:....... . ..:........:..::...:
.:..:.:.-:.-- 
'-

.... . .. 
. ......... ..,-. .. .............. .,.................
.


.. 
'. ....:
.:. .... ...... .....
 ... ,-" .
....-.:. ,..:............:....:......:....... . 
I .' , . .'- .' .." ... '..-' . .... .' .' .' .' . 
.... . 
" ..:. .. 
 -,..:-.. . "...' 
 ' .....'.....- :'.:-'.
 ',:.:::.
.-.:. .' .::.::..,::.........::.
.::::...:. .

.. 
. " 
 .'. ..
 ....,. ........ ..'........... . 
':-:.... 

-..:. . '} "'il'-'- ...
..:
.. . . .::......::'..:.::.:.:.; ...... 
. 
....:...
...,....,:::-:....... t ...... :,.-:-
:.. . ..
....:........................ 
'1 , . . 
 
.:.:'.::.

 .':.'.
:
.i . .' - il :'
'
:' 
 
. .......::.
........:.:;:.: ...
..:..../.. 

.. .'. ...... ..... 
. '.'. '.
. 

 . 
.. 
 
 -. . . -. . .. 
:. ..:../:

....::..:....::::..:.:.
.::
:..-.::.. '.:-. 

 ....?
:
., Cerebrovascular accident is the third largest killer of 
I
 .... :.
)//}.-:-:
t:::. Canadians. On January 6.1975 Canada.s first 

,. 
':":'''::':::''':. .' .-- "
:-:'. multidisciplinary stroke unit admitted its first patient. 
,.;.... . 
::\:."...:....""",-: 
 . .': . . .:"
'-"." . ....:.... The three authors present an overview of the unit and the 
l:ft1
:(
:\/.:..:. '.> .;:.... .... . rehabilitation process of stroke patients. 


... 



16 


The Canadian Nurse February 1976 


Stroke 


SUNNYBROOK 
STROKE 
TEAM 
AN INNOVATIVE 
EXPERIENCE 


In the first year of operation 134 patients were admitted to the Stroke Unit. 
The following statistics were gathered: 


Total Number: 


Stroke 
101 
59 (66") 
42 (75") 
91 
10 
8.6 days 


Non-Stroke 
33 


Dia g nosis: 


Males (mean a g e) 
Females (mean a g e) 
Cerebral Infarction 
Other ( SAH, SOH, etc .) 


Ep ile p s y 14 
O ther 21 
2.6 days 


Average Duration of Stay: 


Only 8 deaths occurred during the year: 7 strokes; 1 diabetic coma. 
The "Report of the Joint Committee for Stroke Facilities" notes that, in general, 
50 percent of stroke victims die within the first month. 


Further statistics, gathered on 39 stroke patients, follow: 


Total Number: 
Incidence of Arrh y thmia: 
Ty pe o f Arrhythmia: 


Patients with 
cardiac disease 
30 
13 
7 
'4 
2 
1 
1 
1 


Patients without 
cardiac disease 
9 
2 
2 


Premature ventflcular beat 
atrial fibrillation 
Parox y smal atrial tach y cardia 
p remature atfla l b eat 
nodal rh y thm 
ideo ventricular rhythm 


" The range of ages was: for males 48-87 for females 49-82 


There are many definitions of a "stroke" or 
CV A, but for the purpose of this article it is: a 
rupture or blockage of a blood vessel in the 
brain. depriving parts of the brain of blood 
supply, resulting in loss of consciousness, 
paralysis or other symptoms depending on 
the site and extent of brain damage. 
The main cause of CVAs is a hardening 
of the arteries to the brain which in turn is 
related to high blood pressure, diabetes, and 
other factors producing a progressive 
hardening of the arteries. In Canada, 
cerebrovascular accident is the third largest 
killer after heart disease and cancer, and is 
probably the most common cause of 
long-term disability. 
Stroke patients in most hospitals are 
cared for on medical wards and have often 
been regarded with despair and frustration. At 
Sunny brook Medical Centre, we have been 
treating stroke patients on the neurological 
ward. and to further improve on diagnosis, 
treatment, and rehabilitation of these patients, 
we have opened an acute stroke unit. The 
patients stay in the unit for 4-5 days and are 
then transferred to the neurological ward for 
the remaining time in hospital. We have 
established a team approach in treating these 
patients, combining the skills of neurologists 
cardiologists, neurosurgeons, 
neuropsychologists, physiatrists," nurses, 
physiotherapists, occupational therapists, 
speech therapists, and social workers. 


History of the Unit 
A few years ago, a man named 
Graham MacLachlin suffered a stroke. He 
was admitted to Sunnybrook Medical Centre 
where he made steady progress. Upon 
discharge, he was unable to assume his 
previous position in the business w.orld and, 
being a man with an active and inquisitive 
mind, he became interested in the cause and 
effect of strokes. 
To gain knowledge in this area, he spent 
many hours in medical libraries reading books 
related to strokes. MacLachlin initiated a 
stroke fund and within two years it amounted 
to more than $100,000. Once approval was 
obtained from the executive director and 
board of trustees, a stroke committee was 
formed. 
Many hours of discussion, planning and 
looking at equipment ensued. Final results 
were as follows: 


" Physician who specializes in rehabilitation 
medicine. 



Two four-bed wards were remodeled into 
five-bed intensive care uni1.(See figure 1) 
A central area was partitioned with glass 
provide a working area. i.e. central monitor. 
ødications, telephone, etc. (See figure 2). 
Panels were installed featuring: oxygen, 
Icuum. compressed air, time-lapse clock. 
nergency buzzer directly to "locating" for 
Irdiac arrests. emergency buzzer to the 
ain nurSing station, sphygmomanometer. 
ld control of overhead examining lights with 
timing device. 
Adjustable I.V. poles were mounted in 
e ceiling. 
A cardiac monitor was installed af each 
: 
dslde, capable of monitoring ECGs and BP 
I rnul1aneously. (One has an extra feature - 
omtormg intracranial pressure). The 
.cision was made to install cardiac monitors 
i ?cause of the close relationship between 
I .art disease and strokes: 
- if the heart is falling as pump, there is a 
lance that not enough blood will reach the 
ain. 
- a damaged heart is more likely to throw 
boli that could occlude an artery leading to 
e brain. 
if atherosclerosis (the mosf common cause 
coronar.y disease) is detected elsewhere in 
e body, then there exists a high possibility 
,al it is also present in the arteries leading to 
Ie bram. 
By monitoring these patients, we hope to 
tablish a relationship between cardiac 
regularities and brain function., Since the 
.ening of the unit. we have observed cardiac 
egularities in 70 percent of stroke patients. 
Stretcher beds were chosen to facilitate 
lobility to and from X-ray for arteriograms, 
ain scans. EEGs. etc. 
An air conditioning unit was installed and 
1 oil painting donated by the founder. 
Because of the size of the unit. it was not 
'asible to staff it separately. Therefore. it is 
1der the jurisdiction of the head nurse on the 
18urology ward, and all staff nurses from the 
ard rotate through as they develop 
lowledge and expertise in caring for these 
atients. 
One of the main problems we faced was 
ow to prepare nurses for a unit with which no 
ne had any previous experience. We 
ecided to approach the problem by using 
lore aids to assist in our nursing care and 
þbse
vations, and by realizing that the 


I 

 
I 


,--- 


rne l::anaOlan Nursa February 197ti 


patients would be similar fo fhose we had 
been nursing on the neurological ward. Our 
preparatory program included: 
- a series of lectures and discussions 
regarding neurological conditions, including 
strokes, under the direction of our 
neuroscience nurse clinician, a neurologist 
and a neurosurgeon 
- a course in basic arrhythmias, the 
completion of which was a prerequisite to 
working in the unit 
- discussions with the staff regarding 
progress and whaf to expect once the unit 
was in operation 
- instruction in chest physiotherapy 
- an intensive orientation of staff as soon 
as the unit was ready 
- a demonstration of the use of the panels, 
monitors, and stretcher beds. 


Canada's first multidisciplinary stroke Unit 
admitted its first patient on January 6, 1975 
(on nights) and all systems were go. As could 
be expected, there was a lot of discussion 
regarding the criteria for admitting patients to 
the unif, such as age limits, infarction only, 
hemorrhages only, efc. 


Criteria for admission to the unit: 
. First complete stroke 
. Stroke in evolution 
. Transient ischemic attacks 
The largest group of misdiagnosed 
admissions has been people in 1ne posllctal 
state of a seizure. 


Goals of the Unit: 
1 To enhance the diagnosis. treatment. 
and rehabilitation of stroke pafients by: 
- providing a suitable environment with 
modern equipment to facilitate the intensive 
observation and care of these patients 
- providing nursing staff who have 
advanced preparation in intensive care 
nursing of neurological patients 
- providing a multidisciplinary team with 
special interest in cerebrovascular disease. 
2 To undertake an ongoing evaluation of 
new diagnostic and treatment methods. 
3 To establish a mOdel unit 10 increase the 
awareness of the factors involved in stroke 
management. 
4 To evaluate the effectiveness of such a 
unit in the progress and ultimate recovery of 
the patient. 


--. ___ 2 , 


17 


In addition, we hope to create a climate of 
understanding, patience, and encouragement 
within which the patient is supported 
emotionally and motivated to function. We 
hope to help him and his family understand 
the problems related to his stroke and help 
them learn to cope. 
Medical Coverage 
Two neurologists take turns as director of 
the unit on a two-month rotation. One 
neurologist does all the protocols daily and 
one is responsible for the care of the patients. 
Once discharged from the unit to the ward, 
the patient is turned over to his appropriate 
doctor. 


Current situation 
At the present time, almosf exactly a 
year after the unit opened, sleep EEGs are 
being done on many pafients to identify the 
relationship between the disturbance shown 
and the part of the brain damaged. A pattern 
is emerging - patients who show normal 
sleep patterns on admission are likely to do 
well; those who do not show normal sleep 
patterns either die or will need chronic care. 
Also, 
- Classes in arrhythmias are being 
continued 
- Instruction in chest physiotherapy is being 
continued. 
- Multidisciplinary conferences take place 
three times per week with neurologists, 
nurses, neuropsychologists, physiotherapists. 
occupational therapists, and speech 
therapists. The patients are discussed and 
plans for their care are made. 
- A weekly conference is held with 
cardiologists, neurologists. and nurses to 
discuss the cardiac status of the patients. 
-:- All patients are referred to the 
neuropsychologist for testing of Intellectual 
impairment. 
- The standardization of the medical 
assessment of strokes is being developed. 
-- Cerebral blood flow studies using Xenon 
are being carried out. 


Patricia Adolphus (R.N.. Sherbrooke 
Hospital. Sherbrooke, Quebec: Certificate in 
Nursing Administration, University of Toronto) 
is the nursing administrator of special 
services at Sunnybrook Medical Centre, 
Toronto. 



 


II 
.\ , 
\ III 
.- a I 1 
_J 
 I ,. 

. 
" l: '-. ..../!t 
-; 

 .. 
 

" i 



18 


The CanadIan Nurse February 1976 


S'troke 


ACUTE 
NURSING 
CARE 
IN THE 
STROKE 
UNIT 


5 1 


. 


. 


--.- 



 -"'- 
..u.. 


. 


I 


. 


. 


....RL 


,...." 


.....&. iL. 


................. 


........:Jo ]
 


Until recenlly "the altitudes of many health 
care professionals toward stroke patients have 
been those of despair, hopelessness, 
disinterest, and avoidance."1 At Sunnybrook 
we discourage these attitudes and promote an 
innovative multidisciplinary team approach to 
the care of stroke patients. 
As a member of this team, the nurse in the 
Stroke Unit provides an acutely ill person with 
consistent nursing care, preventive 
rehabilitative measures, and psychological 
support. She also plays an important role in the I 
research and education involving the unit. With 
comprehensive knowledge of strokes, their 
etiology, types, and effects, she is belter able, 
to understand the stroke patient and meet his I 
special needs. 
The effects of a stroke depend on the site 
and extent of brain damaQe. A stroke in the left 
hemisphere (see figure 3) results in impaired 
motor ability on the right side. Sensation and 
proprioception are decreased on the right and 
tactile discrimination IS poor. The left 
hemisphere is 88 percent dominant in the 
speech center for both left- and right-handed 
people; therefore, a left hemispheric stroke 
results in speech difficulties such as receptive 
or expressive aphasia or dysarthria, These 
patients may have difficulty with concepts and 
abstractions and may have a poor short-term 
memory. The patient could lose the ability to 
judge solutions to verbal problems and retain 
the ability to hear and follow visual commands, 
but to a lesser degree. The patient may have 
difficulty understanding the words he reads 
and be confused by a variety of stimuli. Those 
who suffer a left hemispheric stroke tend to be 
slow, methodical, and anxious. 
A stroke in the right hemisphere (see 
figure 4) results in impaired motor ability and 
sensation on the left side. The patient's 
balance may be poor and he may have 
perceptual difficulties, such as difficulty 
judging positions, distances, rate of 
movement, form, and the relation of his body or 
its parts to the objects around him. Impaired 
spatial learning or motor memory is possible 
and he may neglect his affected side, may 
have difficulty with right and left discrimination, 
or have poor tactile discrimination. Those who 
suffer a right hemispheric stroke tend to lack 
prudence, are easily distracted, have a poor 
memory, and are emotionally labile. 
A stroke in the brain stem basically results 
in cranial nerve abnormalities and the patient 


3 


f" HEMlSÞi-t
 
\.-E'r-" - - 
t:: 
../ 
-I 88 0 "Ó dominant 
tor speech 
. Motor control Impaired on rig :Ie 
( . Unable'o solve verbal proble"..'" 
. Can hear and follow visual In NJ 
. Ottflculty wdl1 speech lant 
. Otfflculty with the (1. word 
. Bener al undefSlandlng than speakll"lg 
.... 


'oatlon 


) 


-1" 
 '- 
\
 



)mplains of such things as vertigo, diplopia. 
impairment of vision, 


Admission procedure 
Most patients are admitted to the unit 
rectly from Emergency but some are referred 
other hospitals. The nurse completes an 
1 jmiSSiOn note with the help of the family, 
cluding information about the patient's past 
,Iedical history, allergies, medication, diet, 
/imination habits, hygenic preferences and 
')Cial background. Witl"l this information the 
rse develops a care plan that is revised as 
e patient progresses. The family IS o!iented 
the Unit and ef1couraged to visit, one at a 
e, for short periods between 1100 and 
00 hours. Neurological rounds are made 
ree times weekly and all members of the 
am are invited to participate. Everyone is 
IUS familiar with the patient's progress and 
sists the nurse in keeping her care plan 
, -to-date. 
Immediately upon admission to the 
troke Unit a head injury routine that includes 
n evaluation of the patient's level of 
onsciousness, pupillary reaction, motor 
ower, and vital signs is done by the nurse. 
;ee figure 5) Patients admitted to the Stroke 
'nit are on head injury routine every one or 
YO hours for the first twenty-four hours and 
len every four hours. The physical layout of 
le unit permits the patient s neurological 
tatus to be monitored and any change is 
T1mediately reponed. Even a slight alteration 
a patient's level of consciousness or pupil 
ize may be indicative of paîhology requiring 
'rompt attention. 
As soon as the patient is admitted to the 
nit, cardiac monitoring is initiated and 
ontinues until discharge from the unit. 
,Ion-stroke patients in the unit are monitored 
I s a control group for research purposes only. 
, Besides poviding research data, the 
iardiac monitor and the nurses' ability to 
Iscognize abnormalities have resulted in the 
l 'arl Y detection and prevention of cardiac 
rrhythmias. According to the docfors, seventy 
,ercent of stroke patients studied have had 
ome form of cardiac disease or have 
,isplayed arrhythmias. Twelve lead ECGs and 
ardiac enzymes e.g. LDH, SGOT and CPK 
ire obtained the first three days after a 
hatient's stroke to rule out myocardial 
hfarction. The cardiologist does rounds 
,,'eekly with the neurologists to familiarize 
I 


4 


;í HEMISPHc
 

00 ______ ---.... 
 
0.,--/ 
 
/ Not dominant 
, lor apHC:h 
. Domnanr 'or sparlal learnIng and 
molor memorIes 
. Mo1or contr
 Impaired on left Side 
. Lack dscrehon 
. Perceptual dfficunaes 
'-- ð .(\ 
( >/ ) 

 -Jl 


1--. 


"-- 



.... _a, __" .. ......._ . çw,,,.,w .01 ... 


himself with the patients and their cardiac 
status. 
The nurse's role In research also involves 
the sleep EEGs The EEG runs continuously 
from 2300 --{)600 hours and it is the nurse's 
responsibility to begin, discontinue, and 
monitor the recording. These EEGs are 
studies of the sleep patterns of stroke 
patients. The doctors would like to discover 
whether or not the disturbed sleep patterns, of 
which there have been many, are 
environmental or pathological. A strong 
relationship appears between degrees of 
unconsciousness and the sleep pattern, and 
there may also be a relation between the site 
of pathology and the sleep pattern. 
The patient's fluid'balance is monitored by 
accurately recording intake and output on 
each shift. Intravenous solutions are 
administered to those patients whose oral 
intake is below 1500 ml per day_ If a patient is 
unable to drink due to motor impairment or 
unconsciousness, tube feedings are given. 
The feedings have one calorie per ml, and the 
patient is started on quarter strength and 
builds up to full strength feeding, Patients are 
given 200 - 400 ml five times a day 
depending on their needs. While 
administering a nasogastric feeding it is 
important to keep the patient's head elevated 
to prevent aspiration. The patient IS 
encouraged to take sips of fluid even with the 
tube In place so that it may be removed as 
soon as possible. 
Acute stroke patients need individual 
consideration with regard to bladder function. 
Our patients are not automatically 
catheterized and the need for ar. indwelling 
catheter is assessed by the nurse and the 
physician. A bladder IS often flaccid for the first 
48 hours after a stroke and then becomes 
spastic. The return of tone in the bladder 
appears to coincide with the return of tone in 
the affected arm. Our rehabilitation 
consultant, believes that the best method for 
bladder training is intermittent 
catheterization (catheterized q4 hours to 
residual below 100 ml then q6 hours and then 
q8 hours). The second choice is a catheter 
clamping routine (clamp for 2 hours then off for 
20 minutes, gradually increasing time). This 
retraining begins in the unit because an 
indwelling catheter increases spasticity and 
decreases the capacity of the bladder. 
Incontinence can be the result of mental rather 


than motor dysfunction and bladder tone must 
be preserved to spare the patient additional 
difficulties in rehabilitation. 


Preventive Nursing Care 
The nurses in the Stroke Unit realize the 
importance of preventive rehabilitation. We 
strive to avoid the effects of prolonged 
immobility such as pneumonia, contractures, 
and discomfort in the affected hmbs. We work 
to maintain skin integrity and to promote range 
of motion in the joints. 
Pneumonia is always a threat to the 
elderly and bedridden patient. We turn and 
position our patients at least every two hours 
so that both lungs expand as much as 
possible. The physiotherapist is active In the 
patient's care from the first day - clapping, 
vibrating, and suctioning congested chests. 
The nurses provide this therapy during the 
evening and night shifts and on the weekends 
when the therapist is not available. If the 
patient is able to cooperate, he is encouraged 
to deep breathe and cough five times in one 
hour. Sputum specimens are sent for culture, 
and sensitivity and antibiotic therapy is 
initiated if necessary. 
Maintaining skin integrity IS an important 
part of the nursing care of an acute stroke 
patient. Because many of these people are 
unable to turn themselves they risk decubitus 
ulcers. The patient is turned and positioned 
every two hours and pressure points are 
inspected and rubbed. When the patient is 
turned he is lifted and not pulled across the 
sheets. We attempt to keep pressure off all 
honey prominences, e.g. by elevating the 
heels with a small pillow. using Posey booties, 
and elbow pads. Turning sheets are also very 
helpful in preventing skin breakdown. An air 
mattress that changes pressure points is used 
for patients whose skin IS difficult to protect, 
Keeping the patient and the linen dry is 
essential to prevent skin breakdown. If the 
patient has developed a decubitus ulcer or is 
admitted with one, we have found that the 
following steps are effective in promoting 
healing - the patient is kept off the area, the 
ulcer is exposed to the air, and it is kept dry. 
The steps are easy and basic but surprisingly 
successful. 
The development of contractures or pain 
in the patient s affected limb can badly hamper 
his rehabilitation. While the patient is in bed he 
is placed in a variety of positions and the length 



20 


The Canadian Nurse February 1976 


Stroke 
of time on the affected side is limited. Correct 
body alignment is maintained using devices 
such as pillows, footboards, and sandbags. 
When being turned the patient is lifted 
with firm support under the joints; subluxation 
or incomplete dislocation of the shoulder 
:ould result from pulling on a patient's arm to 
T10ve him. The patient is encouraged to assist 
n turning, but only to the extent of his ability. 
While positioned supine, the feet are 
placed against the footboard at right angles to 
fhe legs - this prevents footdrop. Knee flexion 
is avoided because "knee flexion contractures 
of more than twenty degrees leads to inability 
to learn to walk; transfer from bed to chair; or 
chair to toilet. "2 While the patient is supine we 
try to prevent a frozen or tight shoulder by 
supporting the patient's affected arm on a 
large pillow that is tucked well up in the axilla. 
When positioned on his side the patient's head 
and trunk are in alignment and the arm is . 
supporfed away from the body at shoulder 
level. elbow slightly flexed. with the hand in line 
with the forearm. To prevent dislocation, the 
affected hip is not allowed to drop forward and 
the leg is supported with pillows to prevent 
pressure. Because an armboard prevents 
early mobility of the arm, intravenous solutions 
are not infused into the affected arm. The care 
of the intravenous could also result in 
damaging manipulation of the limb. 
Passive range of movement is "the extent 
of movement within a given joint achieved by 
an outside force, without the assistance or 
resistance of the patient. "3 This is a vital 
therapeutic routine for it can prevent 
permanent or long-term disability. The 
physiotherapist visits the patients in the unit 
daily and the nurses incorporate 
range-of-motion exercises into the patient s 
daily care. Each movement is done slowly in 
smooth motions about five times, the patient 
is never pushed beyond his existing range of 
motion and force is never used. By watching 
the patient's facial expressions, the 
movements are kept pain-free. 
Our patients are encouraged and 
instructed to do some of their own exercises as 
soon as they are able. Even in an acute care 
unit many patients can become involved in 
their rehabilitation. One of the easiest 
exercises is shoulder flexion - the patient 
holds his affected arm, grasping it at the elbow 
and then lifts his arms to shoulder height and 
down again. repeating two or three times. 


Patients in the Stroke Unit are mobilized 
out of bed on the fourth day, if their 
neurological and cardiac status is stable. This 
early movement is helpful in preventing the 
effects of immobility and gives the patient a 
psychological lift The family of the patient is 
always pleasanlly surprised to hear that their 
relative has been up. They are encouraged to 
provide the patient with his own housecoat. 
slippers and toiletries. Having his own 
belongings often improves the patient s 
self-image and stimulates a healthy interest in 
his own appearance. 


Psychological Support 
The nurse in the Stroke Unit not only 
provides acute nursing care and preventive 
rehabilitative measures; she must also cope 
with the patient's psychological response to 
his stroke. A previously active person who is 
suddenly paralyzed and unable to speak, 
reacts with fear. anger, depression, frustration 
and emotional lability. 
The nurse realizes that the patient is 
afraid he will be incapacitated for the rest of 
his life and will never be able to return home. 
She assists per patient to work through his 
feelings of depression and frustration. She is 
aware that improvement will be inconsistent 
and never chastises the patient for being 
unable to perform. By stressing the 
day-to-day improvement she encourag
s the 
pallent to take one step at a time. She does 
not allow him to attempt too much, 
understanding that as the patient becomes 
fatigued he is less capable and more easily 
discouraged. She reassures her patient that 
these feelings are normal and helps him to 
redirect this energy toward rehabilitation. 
If the patient is emotionally labile the 
nurse explains to him that she understands he 
cannot always control his feelings. It is also her 
responsibility to help the family understand 
and cope with their relative's emotional 
response. It is not uncommon for a patient to 
cry at the sight of his family but this certainly 
does not always indicate unhappiness. 
As a result of the stroke. the patient's body 
image may be disturbed. He may perceive 
himself differently because of visual 
disturbances, or his appearance may be 
distorted as the result of a facial droop or 
flaccid limb. The nurse endeavors to improve 
the patient's feelings about himself by 
maintaining his individuality, e.g. a female 


appreciates the application of cosmetics, a 
male enjoys a daily shave and most patients 
feel more hke themselves in their own 
sleepwear. The individual is always addressed 
by his proper name and is not given a 
nickname. 
The nurse must be empathetic but not 
sympathetic. She must encourage and 
reinforce any improvement, stressing the I 
positive and accepting the negative. She musl' 
understand what each patient's disability 
means to him and to his future. Most important 
the nurse must come to terms with her own 
feelings about stroke. 


Catherine Pal/ant (R.N., Ottawa Civic 
Hospital, Ottawa) is a staff nurse on the 
neurology floor at Sunnybrook Medical 
Centre. Toronto. 



The Canadian Nurse February 1976 


21 


APHASIA 


A NURSE'S GUIDE 
TO COMMUNICATING 
WITH APHASICS 


.. 1. Help the aphasic maintain a desire for communication by encouragmg all his 
attempts at communication. 
.. 2. Jf the aphasic makes errors in his speech, it might be good to correct him. But If you 
are not familiar with his own means of facilitation, then say the word or the sentence he 
wants to express and encourage him to try a second time. 
.. 3. Avoid raising the intensity of your voice when speaking to an aphasic. 
.. 4. Give instructions clearly but naturally. Use simple sentences and if necessary put 
emphasis on the most important words. Remember that the aphasic s comprehension of 
language is better If you speak about an event, an object or a person present in the 
situation. 
.. 5. If you cannot understand what the patient is trying to say and If he nevertheless 
persists unsuccessfully in his attempts, then it is better to change the subject of the 
conversation and tell the patient: "We will leave it at that tor the moment and come back 
to it later on. " 
.. 6. If the patient is totally unable to express himself, then formulate your questions so as 
to have "yes" and "no" answers. But you have to know your patient very well to be sure 
that the signs he uses really refer to "yes" and "no", 
.. 7. While performing your clinical activities, you can contnbute to the language 
stimulation by verbalizing what you are doing. But avoid unnecessary verbiage with the 
aphasic: you must insist that he keep silent while you are conducting your treatment 
.. B. Encourage the patient to use social expressions like "hello" "how are you," "J'm 
fine." "how's the weather," etc. 
.. 9 If the patient is severely dysarthric or apraxic without a concomittant aphasia, you 
can encourage him to wTlte what he wants to say. If he has a paralysis that prevents him 
from writing, have him point to letters of the alphabet. 
.. 10. Do not be surprised if the patient swears when he is unable to utter a word. Give him, 
if possible, the word he is looking for. 
.. 11. Give the aphasic all the time he ne ds to express himself Do not interrupt him by 
offering him all kinds of words or sentences that can only contribute to increasing his 
confusion. If his attempts are unsuccessful, give him the missing word or the begmmng of 
the word so that he can finish it by himself. 
.. 12. Do not hesitate to make Jokes with the aphasic. He can sometimes enJoy them as well 
as any other person. 
.. 13. Avoid carrying on a conversation in the midst of background noise Turn off the 
television set and ask the others present not to interfere. 
.. 14. If you have aphasics regularly in your department, a scrap book with illustrations of 
dally activities in a hospital is recommended By pointing to them, the aphasic will be able 
to make his needs known. 
.. 15. Avoid changing the routme activities without preparing the patient. For example, if 
the patient has to change rooms. prepare him in advance and give him explanations. 
.. 16. Ask the family to bring photographs of the aphasic's children and his favorite 
magazines_ Have information about his work, his habits. and his hobbies to start a 
conversation on a familiar subject. They can also be used to understand what the aphasic 
is trying to communicate. 


This guide was prepared by Louise Coderre 
speech pathologIst The Rehabilitation Institute 
Montreal Quebec_ 



22 


The Canadian Nurse February 1976 


Stroke 


STROKE 
REHABiliTATION 
A CREATIVE 
PROCE$ 


9 


-..... 


" 


\f f;J 

, - - 
- - 
GJ 00 
00 


. Velcro is a Registered Trademark of Velcro Corp. 
. Dulcolax is a Registered Trademark of 
Boehringer Ingelheim 


6 


7 


.#If 
#-. 
..." 


" >\ 

l' 
:
. ,. 
i _.. '-; . 
1 ,--...,\\;ø
j:' 


\ 
ttLt 
- 
.\ \... 


. 


What do Robert Louis Stevenson, G. 
Frederick Handel, and Louis Pasteur have ir 
common? They all suffered strokes! More I 
important, they all recovered sufficiently to 
continue their life's work. Handel wrote the 
Messiah and Louis Pasteur accomplished 90 
percent of his research after having a stroke 
The lives of these men offer unquestionable 
evidence that a cerebrovascular accident 
need not result in total disability. 


Rehabilitation is a creative process that 
begins with immediate preventive care 
in the first stage of an accident or illness. 
It is continued through the restorative 
phase of care and involves adaption of 
the whole being to a new life. 4 
Rehabilitation is also a teaching-learning 
process in which the patient is actively 
involved. At Sunnybrook, because the patien 
is cared for by a multidisciplinary team, his 
rehabilitation is not only physical. but also 
mental, social, economic, and vocational. The 
team members use the same fundamental 
approach for each patient and therefore are 
able to supplement and complement each 
other. The major portion of rehabilitation is 
carried out on the neurological ward and the 
central focus of the stroke team is the patient. 
The team must care for not merely a 
body with impaired functions, but rather a 
human being whose disability is an integral 
part of his total person. As part of the team, 
the nurse must be capable of exercising 
initiative and judgment In making nursing 
diagnoses, in planning and implementing thE 
patient"s care, and in evaluating and 
modifying the plan of care as the needs of the 
patient change. 
The three basic alms of the team, and 
particularly of the nursing members, are: 
prevention of further impairment 
- maintenance of existing abilities 
- restoration of as much function as 
possible. 


Prevention of Further Impairment 
To prevent further impairment, a nurse musl 
be future-minded. "Far too many patients 
have a prolonged or postponed rehabilitatior 
program because of the need to correct or 
minimize a problem that should never have 
been allowed to occur. "5 Correct positioning 
is a basic nursing measure and important 


8 


""" 


, 


1t' 
/ 


I 
.. 



. 
, 
"'" 


Î111...
 


. 'Ìo. 
I 



The CanadIan Nurse February 1976 


23 


'Vhether the patient is sitting in a wheelchair or 
tanding. While sitting. the patient must keep 
11S body aligned. This is difficult for most 
;troke pafients due to the hemiplegia and 
,isual disturbances. Subluxation or partial 
1islocation of the shoulder and edema of the 
1and could occur because of the hemiplegia. 
:>ome of the preventive aids thaf we use at 
:>unnybrook are: 
a trough with Velcro' straps for the arm of 
he wheelchair to keep the patient s affected 
3rm in a comfortable position (See figure 6) 
t a pillow across his knees to support the 
bHected arm 
occasionally. a sling. (See figure 7) 

 portable full-length mirror allows the patient 
o see how he is sitting and thIs helps him to 
T1aintalO a total body image. A patient. 
Jositioned comfortably in the wheelchair. 
leeds to shift his weight every few minutes to 
.Jrevent skin breakdown. and the patient and 
taff should check frequently for any signs of 
'riction, cuts or bumps resulting from transfers 
o the wheelchair. or the use of the 
Nheelchalr. 
A patient s rehabilitation progresses 
more safely when the nurse and the patient 
ollow these few precautions. 
For patients who are able to walk. correct 
I posture is less tiring than incorrect. When a 
cane is required, it is held in the unaffected 
'"land (See figure 8). If the paralyzed arm is 
laccid. the patient wears a sling to prevent 
he arm from getting in the way, being injured 
f sensation is diminished, and dragging the 
;;houlder down. If a sling is worn, it must be 
laken off perrodically and the arm exerCIsed 
Proper body positioning is an important 
part of the patient s rehabilitation program. 
Bladder retraining is important because 
I,ncontinence IS unacceptable in our society. 
Regardless of the bladder program 
ollowed, adequate fluid intake is a must. and 
Ifrequently the patient is unable to see the 
Iglass of juice in fronl of him. reach and grasp 
.t easily, or ask for something he likes to drink. 
As a result. he easily becomes dehydrated 
which creates several problems. e.g.. dry 
skin. burning on urination. The most obvious 
way to check his Intake IS by output. If he IS 
I voiding small amounts of concentrated or 
foul-smelling urine. his fluid Intake IS 
!ncreased Fruit juices, water and soups are 
I encouraged. More than a couple of glasses of 
milk a day are discouraged as the calcium 


may create further kidney and bladder 
difficulties in the inactive patIent. Most stroke 
patients try to drink 3.000 ml of fluid spread 
throughout a 24-hour day. 
A daily bowel program is extremely 
important for stroke patients as they tend to 
become constipated easily. The patient s 
routine prior to the stroke is followed as 
closely as possible and the nurse encourages 
fluids and roughage in the diet. His bowel 
movements are charted daily and if he is used 
to having a daily bowel movement and 
doesn t. he receives a laxative. 
The use of a commode is helpful since it 
is a more comfortable and natural position 
and allows more privacy If a patient is 
confused and the date of the last bowel 
movement is not known. a rectal examination 
is done. With most patients. a Dulcolax' 
suppository works more effectively and less 
fraumatically than an enema 
The prevention of further impairment 
requires a total team approach. The nurse 
uses many of her basic nursing measures to 
meet the individual patient s needs. The 
nursing care plan Indicates these needs and 
allows for modification after evaluation. 


Maintenance of Existing Abilities 
Maintaining the patient s existing abilities 
is accomplished by getllng hIm out of bed and 
encouraging activity. Every day of immobility 
requires three days of activity 10 regain the 
strength and endurance lost. 6 


Restorative Phase 
Restoring function is a goal most patients 
and all team members eagerly pursue. A 
couple of the basic rules are: 
. assist the patient when necessary. but do 
nol "do.' for him 
. progress slowly, gradually Increasing the 
patient s abililies and tolerance 
The main aspects of the restorative phase are 
speech, activIties of daily hVlng. and the 
family 


I Speech 
It is during the restorative phase of 
rehabilitation that the patient must become 
actively involved in the teaching-learning 
process. For the patient to effectively learn, 
the teaching process must be adapted to 
meet the needs of each particular person. For 
the patient who has suffered a stroke in Ihe 


left hemisphere, the fotlowing guidelines 
apply: 
- don't overestimate the patient s ability to 
comprehend speech; use simple word 
commands 
use simple demonstrations 
- break any task into small steps 
- give frequent encouragement 
For the patient with a right hemispheric 
stroke: 
- use verbal cues. few visual distractions 
and slow movement around the patient 
- keep the room well-lighted 
- break a new learning task into small 
segments that the patient completes one step 
at a time. 
- watch to see that the task is safely 
completed because the patient frequently 
overestimates his abilities. 
The speech of a patient who has had a 
stroke can be affected in several ways. The 
main difficulty is aphasia, which means that 
the patient has a disturbance in 
understanding others and in expressing 
himself. 
AphasIa is classified very generally as 
receptive. expressive and global. Receptive 
aphasia is the inability 10 comprehend spoken 
and/or written symbols. Expressive aphasia 
is the inability to express ideas In speech and/ 
or writing. Global aphasia is a combination of 
a complete receptive and expressive deficit 
This deficit means that not only is a 
pallent s speech affected, but also his 
understanding of speech, reading. writing. 
and arithmetic. A patient can seldom be 
classified as having expressive or receptive 
aphasia; more often than not, a mixture of the 
two problems appears, although one deficif 
may be greater than the other. 
Some key findings from recent Interviews 
with post-stroke patients 7 regarding their 
aphasia, follow: 
. The capacity to understand returned very 
shortly after the stroke and it consistently 
increased long before the patient was able to 
respond 10 what he heard. 
. Staff need to speak more slowly and 10 
present one question at a time. 
. People need to be aware of their subtle 
signs of impatience while waiting for the 
patient to speak. e.g. audible sighs and eye 
movements. This behavior affects the 
patient s morale. motivation. and progress 
adversely. 


r 12 
\ 

J 
" 
, '-

 
il f 
 ,.. 
\ . "- 
 

 
'" I 
J · A.. .
 
' , 
 \ 
 

 
. ." <-- 
. . 
 ..,
 

 --_.
 . II ' 
't ,t(" '. 
 " \ 
"r -- .... - "-- t 
1.
 
 - 
.. - \. 
f

\ . '" 
< 1 
\ 



24 


The Canadian Nurse February 1976 


Stroke 
The aphasic patient usually has 
complicated problems to solve. He is 
evaluated by the speech pathologist who 
works with him on an individual basis; during 
the rest of the day, team members follow 
through with a similar approach. (see box) 
The speech board (See figure 9) is a 
device used to assist the patient. He points to 
the item desired, the nurse names the article 
and the patient repeats it. The patient can 
also be asked to describe the article or point 
to a specific item. If a patient is having trouble 
finding a word, it is not supplied for him 
immediately. However, if he has attempted 
the word a couple of times and is 
unsuccessful, the word is spoken - he is 
then able to repeat it. 
The patient's speech tends to be 
inconsistenl from day to day. The ability to say 
a word or a phrase one day does not mean 
that he can do it the following day; comments 
like, "but you said it yesterday" only increase 
the patient's frustration. His speech is usually 
best early In the day, before he becomes 
physically tired and emotionally frustrated. 
The patient's family needs a lot of 
support and explanation. Some examples of 
problems we have encountered are: 
. Following his stroke, a patient spoke his 
native language of Finnish rather than his 
second language of English. The family were 
told that bilingual patients usually find it easier 
to use their native language rather than the 
acquired language. 
. A deaf and mute woman had to relearn 
her hand signs. 
. A patient, who had seldom sworn before 
his stroke, was using strong profanity 
frequenlly following his stroke. The family and 
staff had to learn to accept this language 
without comment or displeasure as the patient 
was using automatic speech and was unable 
to stop the responses. 
The key things to remember are that 
aphasia affects each person differenlly, and 
that it can involve a disturbance in 
understanding others as well as expressing 
oneself. 


II Activities of Daily Living 
Activities of daily Iiving,ADL. include the 
patient s ability to transfer to the wheelchair 
and toilet seat, bathe, dress, and feed himself 
With ADL, the physiotherapist, the 
occupational therapist, and the nurse work 


14 


"'-,... 


closely together in order to coordinate and 
reinforce each other's teaching. 
Most stroke patients use a wheelchair 
until they learn how to walk again. 
A one-wheel-drive wheelchair is 
available for the patient, but is not necessary 
since most hemiplegic patients can propel 
and steer a regular wheelchair with one foot 
and hand. 
However. an extension of the brake 
handle on the paralyzed side may be 
necessary. To facilitate transferring, the 
wheelchair is always placed on the patient s 
unaffected side. This allows the patient to see 
the wheelchair and lead with the stronger 
side; thus he has less chance of "tripping" 
over the weaker leg, and can protect the 
affected side. (See figures 10 - 13) 
A knee lock is used on the stronger leg in 
order to prevent the knee from buckling or the 
foot from slipping during the transfer. The 
patient gradually progresses from being 
assisted by two people to eventually being 
unassisted. 
When transferring, he is encouraged to 
place most of his weight on his stronger leg, to 
stand tall, and to look where he is going. Once 
in the wheelchair, the patient is taught how to 
position himself correclly. 
Bathing and dressing with only one arm 
can be extremely difficult andfrustrating.There 
are regular bathtubs available with safety !Jars 
for those patients who are able to use them. 
However, many of the patients wash 
themselves at the bathroom sink. With 
practice, most of the patients are able to 
brush their own teeth and dentures. The 
female patient s hair is usually curled by the 
staff, although there is a hairdresser located 
within the hospital. An electric shaver is 
available for the male patient's use. 
Frequenlly, a patient may neglect to shave 
one side of his face and a genlle reminder is 
necessary. 
To feed himself, a stroke patient may 
need to use a few aids to replace the 
functions of his paralyzed arm. A rocker knife 
(See figure 14) with a serrated edge allows 
the patient to rock the knife back and forth to 
cut his food and the prongs on the end of the 
knife can be used as a fork. A plate guard 
(See figure 15) prevents the food from being 
pushed off the plate and a non-slip mat can be 
placed under the plate to hold it firmly. 
A bread-buttering board (See figure 16\ 


15, 



 


with suction cups holds a piece of bread 
steady while the patient butters and cuts it 
Each patient is assessed by the occupational 
therapist and the necessary devices are 
provided for assisting in the patient's activities 
of daily living. If the patient is able to function 
independenlly, his self-esteem is greally 
improved. 
Relearning how 10 dress and undress 
himself is always a struggle for the patient 
However, once he has mastered even a small I 
part of dressing himself, he begins to regain 
his dignity and self-respect. As soon as the 
patient leaves the Stroke Unit, he begins to 
learn how to dress independenlly. The nurse 
and occupational therapist work together, 
reinforcing each other s teaching. 
The stroke patient finds it easiest to get 
dressed in the wheelchair since he is sitting 
upright. To put on a shirt, blouse or sweater, 
the patient is taught to begin by pulling his 
weaker arm through the sleeve with his 
stronger arm. He pulls the shirt as far up his 
arm as possible, brings the other sleeve 
around behind him and puts his stronger arm 
through the correct sleeve. He then pulls the 
shirt down and does up the buttons, beginning 
at the top of the shirt. If the buttons are too 
small, he may need to use a button hook. 
(See figure 17) replace them with larger ones, 
or use Velcro tape. It is important to 
remember that the patient does not have the 
use of one arm, and therefore loses the ability 
to stabilize whatever he is doing. As a result, 
any device that is used must have a 
stabilizing effect. 
Underwear and pants are also easier to 
put on while silting in the wheelchair. The 
affected leg is put in the pant leg first and then 
the unaffected leg, The pants are pulled up 
the legs as far as possible and then the 
patient can either stand and pull the pants all 
the way up or continue to sit and, with a side 
to side mollon, pull the pants up a litlle at a 
time. Once he has his shirt and pants on, the 
patient checks that his shirt front and pants 
are straight, that his shirt collar is arranged 
properly, and that he is not silting on any 
wrinkles. 
The patient may need to use a sock-aid 
to pull on his socks. Elastic shoelaces are 
available that remain tied and allow the 
patient to put his shoes on like a loafer. He 
may need to use a long-handled shoehorn if 
he has difficulty with his balance when leaning 


H
 


". 
- .'" 
 

 
. .... , 


, .) 
. ..r."..'! 
. .., 
,. . 


, .' t 1 
_ :r.. lJíl.::( II.: ..J
 ", 


J 



)Ver. Zippered shoe laces (See figure 18) can 
be tied into the shoe, allowing the patient to 
emove his shoes by pullinq the zipper down. 
A few essential "extras" are necessary 
o help the patient feel like a human being. 
130me patients have difficulty judging the 
Jassage of time, so they need to wear their 
,Natches. Obviously, the desired effect is lost if 
he nurse merely puts the watch on the 
Jatient's wrist without winding and setting it. 
erfume, cosmetics, and jewellery for the 
.vomen, and aftershave for the men, are 
Ilmportant if they were used before the stroke. 
Slasses, properly positioned and cleaned, are 
a must. The vision of many of the patients is 
already blurred, so why increase this difficulty 
with sticky, smeared glasses? 
Throughout their lives, all patients have 
established routines for their activities of daily 
living. Following a stroke. these elderly people 
must relearn or change their ways In order to 
adapt to a new lifestyle. Most of them can 
learn to cope effectively. How untrue the 
clicM - "older people are set in their ways!" 
As stated earlier. rehabilitation is also 
vocational and economic Vocational 
assessments are done by the occupational 
therapist on most patients. A kitchen 
assessment is done with all housewives and 
suggestions are made to help the patient work 
out any problems she may be having. 


III The Family 
Stroke patients are in need of personal 
support, especially during later stages of 
recovery: it is at this time that they are most 
often Ignored. There are several ways to offer 
support to the patient. When referring to the 
patient"s body. the stronger and weaker sides 
are mentioned rather than the 'good"' and 
"bad" sides. For the patient who already has 
a one-sided neglect, referring to that side of 
his body as "bad '. only increases his negative 
body image. 
Once a week, Sunnybrook provides a 
therapy group for stroke patients led by the 
occupationallherapist and the author (a 
nurse). This IS a five-week rotating program 
starting with a film illustrating how people 
I cope with various disabilities. A member of 
the Toronto Stroke Recovery Association' 
visits and discussions follow on various aids 
that are available. the effects of the patient"s 
disability on his lifestyle, and the various 
coping mechanisms others are using. 


17 


"IV"'......IIoII'.,I...""..... I Ç"UI-'F lOll" 


The family members are counselled 
throughout the patient's hospitalization on the 
best ways of supporting the patient, and they 
receive a booklet describing the rehabilitation 
of the stroke patient. Most patients go home 
with the occupational therapist for an 
afternoon. This time IS used to assess the 
home for the patient's return and to offer 
suggestions for improvements. The patient 
then goes home for the weekend. This vis if 
allows the patient and his family to practice 
what they have learned in the hospital. The 
home visit is followed by a family conference 
with the team, where problems, encountered 
in the home are discussed. The patient and 
his family need factual information as well as 
practical solutions to the problems that they 
are having. Gradually, the family learns about 
the various deficits the patient may have 
besides the obvious ones of hemiplegia and 
aphasia. 
The patient may have problems judging 
the passage of time and the family should 
make use of clocks, radio, and television to 
assist him. He may have difficulty judging 
distances, e.g. from the table to the chair; and 
the use of verbal directions, keeping the 
furniture to a minimum, and not moving it 
unless necessary will be helpful. The patient 
may have unilateral neglect of his affected 
side and may need to be reminded to watch 
his positioning. He could have homonymous 
hemianopsia and thus be unaware of any 
objects or activities past the midline toward 
the affected side. If fhe patient is emotionally 
labile and begins crying for no apparent 
reason in the middle of a sentence, the family 
needs to know that he has no control over 
these outbursts, and that it is better to ignore 
them and keep on talking. Drawing attention 
to the outburst only prolongs it unnecessarily. 
Most patients continue to receive 
occupational therapy or physical therapy 
either in their home or at a rehabilitation 
center as an outpatient. The patient and his 
family are also taught the warning signs of a 
stroke 8 , including: 
- sudden, temporary weakness or 
numbness of the face, arm or leg 
- temporary difficulty or loss of speech, or 
trouble understanding speech 
- sudden, temporary dimness or loss of 
vision, particularly in one eye 
an episode of double vision 
- unexplained headaches, or a change in 


18 
I 


'" '" '" 


. 
. 


c::=.- 


,"" 


- - - 


.' " 


...-J 
. 


- 




 


the pattern of headaches 
- temporary dizziness or unsteadiness 
- recent change in personality or in total 
ability. 
Summary 
At Sunny brook, the creative process of 
rehabilitation is carried on throughout the 
patient's hospitalization. The patient and his 
family have been through a teaching-learning 
process involving all the members of the 
multidisciplinary stroke team. Because a 
stroke affects each person in a unique way, 
the stroke team has also learned from the 
patient- we have acquired more knowledge 
about a stroke, and have found more 
alternatives tor solving problems. 
When the patient is discharged from 
hospital, he takes with him the beginning 
ability to adapt to his disability... 
Linda Graham (B.Sc.N., University of 
Toronto; MS., Ohio State University, 
Columbus, Ohio) is clinical nurse specialist In 
rehabilitation at Sunnybrook MedIcal Centre, 
Toronto. 


References: 


1 Report of the Joint Committee for Stroke 
Facilities. IV. Guidelines for the nursing care of 
stroke patients, by Nursing SII..,
y Group. Stroke 
3:5:637, Sep.lOct 1972. 
2 Bonner. Charles M. Medical care and 
rehabilitation of the aged and chronically ill, 
by...and Freddy Homburger, 3ed. Boston, Little, 
Brown and Co., 1974. p.43. 
3 Ibid.. p.40. 
4 Stryker, Ruth Perin. Rehabilitative aspects of 
acute and chronic nursing care. Toronto, Saunders, 
1972. p.13. 
5 Ibid., p.36. 
6 Kottke, F.J. The effects of hmltation of activity 
upon the human body. JAMA 196:826, Jun. 6, 1966. 
7 Skelly, Madge. Aphasic patients talk back. 
Amer. J. Nurs. 75:7:1140-1142, Jul. 1975. 
8 American Heart Association. Body language. 
New York, N.Y., n.d. Pamphlet. 


, The T.S.R.A. is composed of stroke victims and 
professionals who provide recreation, 
socialization, support and dissemination of 
information to other stroke victims and families 



Viewpoint 



 
'" 

 


. 


\ 
\ 


\ ' 
" 


.. 


(j{(f
 What are the bonds . 

QPJ) between the fetus and the uterus? 



 ..... 
- - 


. --- 
,. 


þ 



.... :1 
'- 


'- 


..., 


, . 

 , . 
'-. 
.... 
II 
J 


f
 

 '" 


fl' 
__;a \I i 
, 
. 1 


....... 
m, 
 _


 4t,mr __ ' 


oJ 
. 


'- 


- 
. -- , 


... 



? 


( 


. 



toe lLoilnilQliln nurs., reurUllry ':ilIa 


ecause of her role as a provider of health care, the 
lUrse's involvement in the debate on abortion may be 
reater than she thinks. 


mcent W. Adamkiewicz 
.. 
n order to discuss the biological aspects of 
. bortion it is well, first. to distinguish between 
i bortion and the various methods of birth 
'ontrol. as follows: ; 
Birth control methods p'revent, by natural 
-r artificial means, the union of the male sperm 
lith the female ovum at a time when the 
loman is not pregnant and whe
 there is no 
etus. 
Abortion on the other hand, is an 
xtirpation or removal of an existing fetus from 
a woman who is pregnant precisely as a result 
f the union between a sperm and ovum. Far 
rom preventing conception, an abortion 
annot take place without conception. It 
appears therefore, to be rather beside the 
point to argue in favor of abortion by appealing 
to arguments and reasons which are really 
concerned with birth control, family planning or 
the spacing of children. 


Woman's right over 
her own body 
"A woman's right over her own body" 
could be called upon in support of abortion in 
those cases where pregnancy resulted from 
parthenogenesis. This is a biological 
phenomenon in which the ovum develops into 
a fetus without an intervention of male sperm. 
Because of the genetic laws that govern the 
inheritance of sex, a woman's parthenogenetic 
babies would all be girls. Parthenogenesis is 
relatively easy to show. for example in rabbits 
But in spite of the affirmations of some 
specialists, parthenogenesis among women is 
probably as rare as the Immaculate 
Conception. In any case, the two historical 
examples of human birth without male 
intervention, first cited apparently in Buddhism 
and later in Christianity, could not have been 
parthenogenetic because they produced boys. 
Nevertheless. Buddha's sex is uncertain, 
I since this personality is variously depided as 
male, female or neuter. 
Normal pregnancies occur as a result of 
fertilization of the mother's ovum by the 
father's sperm. Consequently, the fetus is as 
much the "father's body" as the mother's. 
Therefore. the saying:"a woman has a right 
over her own body" loses much of its meaning 
when applied to the fetus and used as an 
argument in favor of abortion. The least a 
pregnant woman could do before ridding 
herself of the fetus is first to find out the father s 
wishes in the matter if at all possible. 


The genetic message 
The main discussion on abortion, 
however, concerns an entirely different 
question: "Is the fetus a human being?" 
Because if the fetus is not a human being, its 
extirpation by means of an abortion merely 
becomes one more simple surgical operation. 
On the other hand, if the fetus IS a human 
being, the act of terminating a human life by 
extirpation falls under the provisions of the 
Criminal Code. 
Let us examine this question in reverse, 
beginning with the end, which is birth, and 
ending with the beginning of the pregnancy, 
which is the fertilization of the ovum by the 
sperm. 
A newborn child, that is a fetus delivered 
after a full term or even prematurely, is a 
human being in all respects. Who would dare 
to consciously deprive it of life? Our conviction 
in this matter rests mainly on its anatomical 
resemblance to other human beings. If 
physiological resemblance is a criterion, we 
find, for example, that a two-month-old fetus 
already has a brain which emits brain waves 
(E.E.G.), and that a 20-day-old fetus has a 
heart which beats (E.C.G.) as in other human 
beings. Indeed, it is quite possible to study the 
nine months of fetal life by means of the 
various disciplines of biology, from the most 
macroscopic (anatomy) to the most 
microscopic (molecular biology), and show 
that, at each instant. the human fetus displays 
innumerable human characteristics: physical, 
chemical and biological. 
Indeed, the difficulty a biologisf 
encounters when retracing in reverse the life of 
the fetus is not in finding out that each instant it 
is a human being. Rather, the difficulty lies in 
establishing, at the very beginning of its 
existence, the fraction of the second, the 
electrifying moment, when the new individual 
is not yet! 
The male sperm and the female ovum 
carry within their nuclei a complete message 
containing all the information required to 
create a new human being. This genetic 
message is recorded on ribbons 
(chromosomes) by means of a special 
substance (nucleic acid) and in the form of 
various chemical molecules. 
Nevertheless, neither the sperm nor the 
ovum yet constitute new human individuals 
They are still part of the father and of the 
mother, and carry their genetic messages. 
Is it during fertilization, when the message 
in the sperm combines with the one contained 



 


in the ovum, that a new human being is born? 
Is birth a rearrangement of what already exists 
to produce something which did not exist a 
while ago? This newly conceived being is 
undoubtedly like its mother, since it carries all 
her message. It is also like its father, because it 
also carries his message. At the same time it is 
very different from both parents because ItS 
own message is a combination of the other 
two. This is the great paradox of which life is 
made: how to be different while at the same 
time remaining identical. 
The combined genetic message 
regulates the development of the human being 
during all the various stages of its life: fetal, 
infancy, adulthood and old age. It governs 
inexorably the form it will take, its bodily 
functions and its behavior. 
Gregor Mendel demonstrated by 
experimenting with peas how the genetic 
message regulates the form of living things. In 
the century since, many others have 
demonstrated the universal importance of the 
genetic message on the functions of all Jiving 
beings, ranging from viruses to man. In 1973, 
the Nobel Prize was awarded to Lorenz, 
Tinberger and Frisch for their demonstration 
of genetic controls over the behavior of 
vertebrate animals. 
Nevertheless. genetic control itself cannot 
escape the biological "difference-identity 
paradox." This is because, while transmitting 
the inexorable identity from one generation to 
the next, the genetic message continues to to 
be 'flexible". Indeed. each biological birth is 
necessarily and always accompanied by 
variations in the inherited resemblances 
(genetic variation). (Thus, "although the eyes 
of all women are beautiful. how much more so 
are the eyes of my beloved"). 
The triad: form, function and behavior, is 
not. however. enough to describe a human 
being. This is because, unlike other living 
things, man thinks. He has the ability to 
conceptualize, 
Of all the various human attributes, should 
the ability to conceptualize or think alone lie 
outside the control of the genetic message? 
Reason makes this difficult to accept. The 
founder of analytical psychology and 
psychiatry, Carl Jung, postulated the 
existence in man of archetypes, conceptual 
models which we need not learn because we 
recognize them automatically. Jung never 
explained the origin of archetypes, in spite of 
IJeing undoubtedly aware of the work on 



28 


The Canadian Nurse February 1976 


Wllë!
 ë!r
 
r-,e bonCl5___ 


heredity of animal behavior done by his 
contemporaries. 
Would not the existence of a material link 
between the genetic message (heredity) and 
the archetypal conceptualization constitute a 
molecular basis for man's conscience and, 
who knows, perhaps even for his idea of a 
Supreme Being? Should indeed such a link 
exist , it will undoubtedly be demonstrated 
sooner or later. We can only hope at present 
that the fetuses which have inherited the 
appropriate combination of genetic messages 
and have undergone the genetic variations 
necessary to elucidate this relationship will not 
have been aborted in the meantime. 


How to reconcile the 
rights of three separate beings? 
The mother's uterus is a special 
reproductive organ within which the fetus 
develops. 
What is not known generally is that the 
uterus also protects the fetus against possible 
harm from its mother, since the fetus, which is 
partly the father's body, constitutes a foreign 
tissue for the mother. Were it not for the uterine 
protective barrier, the mother would 
experience an allergic reaction against the 
fetus. Her body would destroy and reject it, as it 
destroys and rejects any implanted foreign 
tissue, be it a piece of skin or a heart.- In fact, 
some of the so-calted spontaneous abortions 
are caused precisely by such an allergic 
mechanism. 
Similarly, the mother's body constitutes a 
foreign tissue for the fetus. Were it not for the 


uterine protective barrier, the fetus would 
experience an allergic reaction against the 
mother. It would attempt to destroy and reject 
her, as it destroys and rejects any foreign 
tissue after it is born. This capacity of the fetus 
to experience an allergic reaction against its 
mother may be the most striking example of its 
biological individuality. 
Thus, the pregnant uterus is a very special 
organ. It belongs to the mother, of course, but it 
also contains another individual, the fetus. 
Moreover, this other individual is composed, in 
part, of the father's body and of his genetic 
message. Consequenlly, it belongs as much to 
him as it does to the mother. 
Three individuals therefore, seem to have 
claims on the pregm:mt uterus: the mother, the 
fetus, and the father. Why then, under the 
circumstances, should only one of them make 
the awesome decision regarding the life and 
death of the new individual? 
Would it not rather seem more 
appropriate to protect the pregnant uterus from 
such arbitrary decisions by granting it a certain 
extraterritorial status with respect to its 
mother's body and by surrounding it with the 
protection of the community? .. 


Vincent W. Adamkiewicz, professor of 
immunophysirnogy, Depanmentof 
Microbiology and Immunology. Faculty of 
Medicine, University of Montreal. 


This article also appears in the February, 
1976, issue of L'infirmiere canadienne. 


Health 
Education 
. 
In 
Copenhagen 


For: Students in Health, Education, Community Nursing, 
Teaching, Social Work, Day Care and allied fields 


Dates: August 5 - 27, 1976 


Cost: $999.00 includes air travel, room and board, tuition 


Credit: Can be taken for credit (6 credits) or non-credit 


For further Information contact: 
Gladys Lennox 
Director of Health Education 
7270 Sherbrooke St. W. 
Montreal, Ouebec H4B 1R6 


Tel: 482-0320 Local 427 


Official Notice 


Canadian Nurses' 
Association 
1976 Annual Meeting 
and 
Convention 


20-23 June 1976, 
Halifax, 
Nova Scotia 


The 1976 Annual Meeting and 
Convention of the Canadian Nurses' 
Association will be held 20-23 June 
1976 in the Commonwealth Room of 
the Hotel Nova Scotian, Hollis Street, 
Halifax, Nova Scotia. 
The opening ceremony will be held 
on Sunday evening, 20 June 1976 at 
19:30, followed by a reception for 
members, students and guests 
registered for the meeting. Business 
and interest sessions will commence 
at 08:30, Monday 21 June 1976, 
continuing daily and concluding 
Wednesday, 23 June 1976 at 19:30 
with the President's reception. 
Students enrolled in schools of 
nursing in Canada may register to 
observe the proceedings of the 
Annual Meeting and participate in 
interest sessions and social events. 




 \",e
 


 t<I",e ...--- 
'(\0''';;; 


, , 


\ 
\ 
\ 


"- , 
\ " '-.- 
'\ 
\ ....... 
... 
'. 


I
 


, 


....... 


\: 



 


, 


.--' 


'\j, )- 
\ ,,,- 
;:'....
 
\ 


f. , 
'-. 


" 
I 


. 
....""- ....
 

 ...\-.... 
>> ' 
, 
'W . 
-.".. 
. 
.
 


\' 


.
 


....................... Ik. 



 


.,' 
'#f!t' 



'I. 

 



 -:.,.; 


\ 


,,
 



 : ,) ì j", '\ 
 


"\ 
. 



 

 

o S 

 . ' C\ o1r\-L e {'L t
((\' 

ò. \'tJ O 
i,...., . C ", c. . \. 
\\\ Qt 09 .
, C\lt\IC, Ò 
V- 0'1" J >/II' \\eø' ((\((\ùt\\., e 
òòe 

 .r<\O'Cí 
lt\9 
 SC\\OO


lt\eSO\ 


O
 \B
((\
:

t. þ-s a. 
\. 0 
 ). 
 0.\' e1.\Bt\ð \,ot\ò \\\e 'l'iot\{lt\9 ,,
\\ eò\l 'iOt\ 
te 
v, . 9'0 8 ' ùtSeS, 0\ \\e Q t\et
' 
'11. 0 LaC,.b erg te
C\\lt\ 
\_,^
seò t\ " 0 \\\e to\e , 
"O\\\et g e 
",,-0 \te Q ' 'V . 01' ' 0' Q" 

O(\ Of{\e(\S\ tYt.O(\S ò 

 I'e'l'i \
e \\ea.\
\\ 
\tO
òet\e . 
te Sù \\' 
S\'ð-(\\\'ð-
 
 
'Oe\(\g SU 


, 


... 


\\ 
Þ 



30 


The CanadIan Nurse February 1976 


Reaching 
Tomorrow's 
Citizens 


:} 


. : ... 
,.- 
.. 
t , 
,
 


, 
 
r 
, 



 


"" 


t'
' 
..... 
t 
-,4t 
- 


'Z; 


. .
\ 
"'-'" 


.- .- 
.t' 
, !!!!!. 
IJII! 
,.,' 
!!!"-''!! 
. ... 
. 
I
 >> . . 
.....\ , 


j. 


. At press time, continued funding from 
federal sources was in question. 


Two nurses from the Head and Hands Clinic 
in Montreal are teaching health "where iI's at" 
to the young people In their community - at 
the local high schools and community 
colleges (CEGEPs). They are the second 
team of Head and Hands health educators to 
carry this type of program into the schools of 
Notre Dame de Grace (NDG) In west-end 
Montreal. The Clinic that serves as their home 
base was established four years ago 10 meet 
the needs of the youth community in this area 
of the city. Since then, the orientation of the 
clinic has changed from a drop-in center for 
crisis intervention and drug counseling to a 
comprehensive health center for all ages. 
Head and Hands operates on funds 
provided by the federal government through 
the Non-Medical Use of Drugs Directorate.' 
Lawyers, dentists. doctors and other 
professional volunteers donate their services 
to Head and Hands without charge, although 
doctors do benefit if patients subscribe to 
Medicare. Paid personnel include the 
administrator. medical coordinator. 
counselors, health educators, nurses and 
office staff. Clients are asked to pay a nominal 
fee for tests and some services, if they can. 
An apartment over a shop next to 
pocket-sized Echo Park on Montreal"s 
Sherbrooke Street West houses Head and 
Hands. Furniture and equipment are donated, 
as are many of the medical supplies. Muc'h of 
the literature on the waiting room-s 
information shelf is obtained free from 
government agencies, associalions, food 
producers, and insurance companies_ 
Succinctly-worded posters on the walls are 
made by the staff. A notice board has been 
posted for the convenience of clients. 
In four years of operation, the clinic has 
come to serve more and more the general 
health needs of the young, and not so young, 
of NDG. The young come for counseling on 
drug and alcohol abuse. and family planning, 
for pregnancy tests, legal counsel, dental 
advice, and nutrition tips. The older segment 
of the population look to the clinic for the last 
three services. 


Hands reaching out 
As most of those using the clinic are 
under 20, it follows that many attend school. 
Thus, when the school nurse at nearby 
Dawson College asked the clinic to present a 
program on birth control to her students some 
time ago, the invitation was welcomed as an 
opportunity to extend the climc's services. 
Then, in October, 1973, the health 
educators. (at that time Elizabeth Best and 
Jane Turner ), set up their flrSI health display 
of pamphlets, samples of contraceptives, and 
a model of female reproductive organs. They 
decided to place their display tables just 
outside the cafeteria of the Selby Campus of 
Dawson College, where they hoped students 
would drop by on their way to and from lunch 
to look, ask questions, and ask for advice. 
The response was so encouraging that now, 
two years later, the health workers of Head 
and Hands spend most of their working day 
among the students at five CEGEPs and 
several hIgh schools in NDG. They are, 


however, still on the Head and Hands clinic 
staff. 
The first year of entry on the school 
scene was devoted mainly to developing a 
worthwhile program to dovetail with the efforts 
of nurses in the CEGEPs; preparing 
brochures, displays. and posters: obtaining 
educational materials and samples from 
producers; and coordinating suggestions from 
interested students. 


High schoots 
In the beginning" it was difficult to reach 
high school students. The two 
nurse-organizers wrote letters, and 
telephoned school principals and 
administrators of NDG only to receive no 
response, or the negative ones of "no time or 
"not feasible.-- Nevertheless, they continued 
to prepare IIleir battery of materials. It took a 
party to make everyone realize the clinic 
wasnt just for drug users and to generate 
active interest! In September, 1974, Head and 
Hands decided to hold a wine and cheese 
party. Formallnvitallons to high school 
teachers, nurses and counselors, and the 
school board of NDG brought nearly 60 
visitors to the clinic tQ view the display of 
health teaching materials. tour the premises, 
and ask questions. 
Then, in 1974-75, several high schools 
asked Head and Hands for supplementary 
health education. Certain class times were 
turned over to Bess alJd Jane to allow them to 
teach human awareness, family planmng and 
preventive health in the two senior grades. 
When nutrition was the subject of discussion, 
students were encouraged to evaluate their 
own diets. Calorie counters. herbs to freshen 
the mouth, and nutritIous snacks were 
handed out to add interest and generate 
dialogue. 
In classes on family_planmng, Bess found 
working as a team with Jane to be especially 
helpful: dividing the responsibility for teaching 
and answering questions gave the sessions 
an air of informality and everyone gained 
confidence. Posters were used as a basis for 
reviewing the anatomy and physiology of 
human reproductive organs before going on 
to role playing. Bess or a student would play 
the role of a young girl and Jane that of the 
counselor. The dialogue that followed would 
cover wha
 a birth control pill can and cannot 
do, how a doctor examines a patient, the 
questions he asks, and a demonstration of 
bi rth control devices. 
Once, when demonslrating 
contraceptives, Bess inadvertently sprayed 
foam over the students in the front row! 
Laughter shattered any barriers that might 
have existed. 
Students are concerned about birth 
control methods, their side effects. and failure 
rates. Because they want to avoid peer 
reaction they usually save their questions until 
after the class. Several have asked: "My girl 
friend and I use this method. How effective is 
it ?" 
Not one hundred percenl, evidently, for 
pregnancies do occur among t'1e students 
and they usually follow a pattern, according to 



The CanadIan Nurse February 1976 


31 


Bess. Girls notice missed menstrual periods 
in September and October, after summer 
holidays or in February after the Christmas 
vacation. This has prompted scheduling of 
birth control displays to just before the 
summer vacation and the Christmas break. 
The displays are simple and practical. Some 
of the titles are: "This is what happens in the 
doctor"s office," "Questions the doctor will ask 
you," "This is a speculum." 
Bess and Jane are no longer with Head 
and Hands, buf their successors, Marg Hill 
and Marlene Fremming, are continuing to 
carry out the work they started and have built 
on the programs already established. 
Because of uncertainty about continued 
funding, they are also concerned about the 
future of their work in the community they are 
beginning to know. 
One addition to the original program is a 
session on smoking and health that was 
introduced at the request of one of the area 
high schools. It is now offered to 21 first year 
classes in two high schools. The students do 
breathing exercises as they learn the facts 
about smoking. A smoking machine is used to 
demonstrate the effect of smoking on the 
lungs. Marg and Marlene play down the 
danger of cancer, which means little to these 
13-year-olds, but do emphasize the need for 
them to ignore peer pressure. 
Nutrition, dental care, and smoking are 
the main topics covered in this grade: family 
planning and venereal diseases are 
presented only to the more senior high school 
classes. "One school wanted us to include a 
lower grade in our birth control and VD 
programs," said Marg, "but we are not ready 
for that yet. We would have to do a lot of 
research to adequately reach these 11- and 
12-year-olds and at the same time to feel 
comfortable in our own roles." 


CEGEP program 
In the CEGEPs, with up to 3,500 
students, the bi-weekly health teaching 
program has to be informal. The original 
decision to present it at the busiest spot in the 
school, near the cafeteria, has proved sound. 
During lunch break, students cannot miss 
seeing Marg and Marlene at Head and Hands 
"Healthy Rider" booth at Selby Campus or at 
their pamphlet-laden tabie at other schools. 
Judging from the responses on evaluation 
Questionnaires, students like this casual 
approach and benefit from the educational 
materials and informal discussion of their 
problems. 
Each two-hour,noonday session is 
devoted to one subject, which may be drugs, 
heart disease, nutrition (including 
vegetarianism and snacking), dental care, or 
family planning. Other topics being prepared 
are stress, exercise, and ecology (pesticides 
and the environment), 
The CEGEP health nurses work closely 
with Marg and Marlene when planning 
programs by holding workshops and securing 
speakers and films to enlarge on the subjects 
dealt with at the displays An example of 
cooperative effort is the Fitness Fair 
jJresented in the cafeteria area twice a year. 


The fair on heart disease, for example, 
involves the dietetic and athletic departments 
of the school as well as Marg and Marlene. 
Dietitians are at their display table and 
are available for individual guidance on 
weight reduction and low cholesterol diets; 
the physical education instructors conduct 
tests for fitness on students riding stationary 
bicycles: and the health educators and school 
nurse take blood pressures and test vital 
capacity of the lungs. The multidisciplinary 
program helps to get across the idea that an 
individual's state of health is the result of 
many interrelated factors over which he has 
some control. 
Experience has shown that the fitness of 
CEGEP students generally is not up to the 
level expected of this age group. For instance, 
in the bicycle test, where students pedal a 
stationary bicycle at 60 strokes per minute, 
there are few who reach the 80% mark (upper 
20% of population are considered fit) and too 
many who fall below the 40% level of fitness. 
Blood pressure is usually normal among 
the students, but when the systolic pressure 
reaches 130-140, they go to the dietitian's 
booth to be weighed and to discuss nutrition. 
They are referred to a physician for a more 
thorough checkup; many end up at the Head 
and Hands clinic for that. 
One student beamed with pride at having 
lost 15 pounds and hoped that his blood 
pressure would be down too. It was, but not 
enough to allow him to abandon his 
prescribed diet and exercise regimen. With 
encouragment and reinforcement from the 
nurses, he will probably eventually reach 
normal limits and regain a feeling of 
well-being, 


Conclusion 
The objectives that emerged during the 
first year of the program's operation are still 
applicable to the current, expanded program: 
. to help increase young people's 
awareness of health care, especially ifs 
preventive aspects 
. to encourage the young to adopt 
healthful lifestyles 
. to motivate young people to assume a 
more active role in their own continuing health 
education 
. to make health education an. enjoyable, 
relaxed nursing experience. 
Most important. informal liaison with 
school health personnel and flexibility allow 
the program to meet the changing needs of 
the young population served. In the future, it is 
hoped to increase the effectiveness of the 
program even further. by involving students in 
planning their own care program through a 
health council. .. 


Elizabeth Best (R.N., Montreal General 
Hospital school of nursing; B.A., Concordia 
University, Montreal) is now studying full time 
toward a B.Sc.N. 


Jane Turner (R. N., Montreal General Hospital 
school of nursing: B.A., Concordia University, 
Montreal) is with the federal government's 
medical services in Bntish Columbia. 


Marlene Fremming (R.N. Montreal General 
Hospital school of nursing) and Margaret Hall 
(R.N., Montreal General Hospital school of 
nursing; B.N., McGill University, Montreal), 
are the present health educators at the Head 
and Hands Clinic, 


The author is an assistant editor with The 
Canadian Nurse. 


-' 


...... 


, 


... 


\ 


-4 


I 
'\ 



.. 
.. 


. ' 
-
 


.. 


-- 


* 


--- 
-

 
- 
.I,. 
-- 


.., 


:: 


r t 


\. 


-0' 


-;. 
" " ....i 
f
. 
..... 


t 


\, \ 
... 

>


 
\L 
,.- 
 
II 


,-:d I; 1 V _I 
-'I 






 


<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 


..........................................................................................: 
: 
'.'.:.:Sý.?.':'
 . :. 
...

?-..
: : . :. :::-...

?...
:
 . :. 
.....



.c::-..;:
:
....

z.'.
.
: 
 . 7.....:-?

...:0 : 
..
..
0.
. : . f
.S0...:.;' ; I 
· ) 
 ,tv . ,'
 J; \.' I ' 
. ; \ 
 '. ".., \ 
 
'SI \ ."
'" .,-
 \. · 
. 
 , 
 I -- """ .- . _. .: -:;. ,. -" --..., 
 
II. . -- 
 
 
 ---. "'" ".' It L . 
. . #II .... #II . .... #II . 
.. #II . "". #II . ... 
. lit '. ... 
 lit' 
 'f( #II . . 
: i\'ø I()
 
V 
 1ì'('v I(
;
 1\'(-
 1(
1f iì{
 I()
 1'1(;; 
)If)ôJ' 
 
v I(
I : 
: 
 , ",.
 À ; ì. . \ .
 
.
 Á : . 
.
 . 
.,
 1 . .
. '. 
.
 1 : . 
 : 
. ' 
 A ''---^--../. _' ''---^--' ) 
 
 ,^- '
 A'" '\- .\....AJ . 
. . 
. . 
: 7777J : 
. 77766 . 
: 771;66 
 
 : 
. 70666 
 . 
· 9 . 
. 
. 
i -
l ": .... ! 
. 
 '-. 
. 
 
. 
. .
. 
. . 
. --- . 
. . 
. .. . 
. '-
 . 
. v.,- 
 . 
. . 
. . 
. A" . 
I 
 '-,:" : 
: .,,,.. : 
. . 
1-: 
: . 
! i ' 
 I 
· I ENJOY 
! I:' rnHA
l
FAX 
i \: I .1 ,. FOR WHAT I TIS 
! " t :' !"il;' AND FOR WHAT IT WAS 
! " ..1 , I ;', 
,': 
\' " . ! Ik l ' r.!
' 
 \ ' r 
 '" " 
. ,i I ... L \' \ 
 I < . \ . .... \.. , 
I . j: ' f ; I' I, 
 " ..'\ 
 ' 
 \ In;: \ " - - · 
.1 'I. . ,.<! 
,. , ---:---..
 I 
. I I . " " I 
i "':'''
;
 !Ii/I, 
';
{ \::\\'.
: 
. ../J I 
: '1, I \ \' \_"'
 --",- , / . . 
i · 
i _ fIIP .
 
-\ .
. ï i 
I I I · .,-.,.. . 
. " :.,... ..
 
: .' _ V!..
.....' )fl ' i 
! ,
'
q


- : 
. . 
. - . 
. -_.
 . 

 . 

 -'" 
 ------ 
: - - -- 
 -- --- - : 
: ., . .
_:' - .-'
 : .=;- -. I 
: 
., ..... : 
· ".. -. . ):JI' . 
: .r ;. .,' " '.I- -' . . 


" ".....-... ,. ..11' 
. - -.... . 
. . - ..--- ... ,. .,,
 - j . 
. 
 .... 
 _ ;;;
 . ..L _____ _ __ _ __ .....". 
. 
 - -- - --" "'-, - .-----. - - ,-- 
 -- .- ,..., : 
. ..-: -- - - - .. _ oÁ- _ _ -......_ - - -- _ _ .._ 
:..... ..... ....... ...... ..................................................................: 



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 
) 


- 
[- 
- -- 
. . 


-.- - 

 >:.. 



.. ,.. 
.... 
. I 


. ".
 



 


. .
 
r."
, 

J 


. 
. 
1 


.r 


Ø,..J 


- 
. 


I ...... . 


'- 



 
 


--,,-- 
 
--, 
" p 



" . 


,
' 
.. . 



 



..' 


"" 



'" 


... 


.. 

\. 
... 


..... 


shops and boutiques is wide. There s 
L Entrepot - contemporary designs in 
everything from chairs to cutlery: The Pewter 
House, handcrafted designs from the 
Maritimes. The Doll House, a delight to 
children, rich uncles and loving 
grandmothers; and Nova Pine where you II 
find reproductions and heritage crafts. quilts 
etc.. of Nova Scotia. The Duke of Granville, a 
19th century restaurant, IS here too, as well as 
the studios of the Nova Scotia College of Art 
and Design. 
Closer to the waterfront is Privateers 
Warehouse, the long, low, rough-cut gray 
stone building that forms the core of the 
waterfront resforation. It dates from the 
profitable privateering activifies of Nova 
Scotians during the Napoleonic Wars and 
now houses a pub and two seafood 
resfaurants. 


Browse through A Pær of Trmdles in the 
Old Red Store, a book shop specializing In 
Canadiana and books on Nova Scotia, The 
Merchant Adventurers. featurrng the work of 
Nova Scotia artisans. The Sea Chest On the 
Wharf, The Wooden Store and Sail/oft. Then. 
stop for a giant ice cream cone or a hearty 
sandwich at Scoops in The Carpenter Shop 
and eat it out on the wharf while you watch the 
swaYing masts of the Bluenose, last of 
the "tall schooners, the harbor traffic and 
ironwork tracery of the two harbor bridges 


There are four ways to see Halifax: 
. By car: Competent gUides can be 
obtained through the Halifax Visitors and 
Convention Bureau. Follow the Kingfisher 
Route signs throughout the city, or use your 
Metro Guide This has an excellent 
description of historical and interesting sights. 
'3 


...- 


... 

 


--'E 

... 



 

 
-.",,- 
i- 


-S;4
- 
- 


'" 
-
 


-- 


- 



 


-... 
- 


--- . 
-
- 
.

 4 


...... 
...".,.,.
 ::---........ 
..
 


- .' 
.. - 


- 
.... 



 
..
 . 


- 


- ..r- 


._- 
..:& .. 


:;y
 -" 
:-.; 

c- 


<:" 


'.- 


,.. 


-.....---.. '-.:... 


. By bus: Both the Halifax Transit 
Corporation and Gray Line have sIghtseeing 
tours. Passengers are picked up at Holiday 
Inn. Citadel Inn. Chateau Halifax. Lord Nelson 
and Hotel Nova Scotian. 
. By water: Halifax Water Tours provides 
a complete tour of the harbor and the 
Northwest Arm. Or. see Halifax from the water 
on the Dartmouth Ferry. 
. By toot: If you like walking, the 
45-minute tour of old Halifax is for you. Take 
your Metro Guide or the Walking Tour Guide 
provided by the ViSitors Bureau and start off 
from the Citadel. You II enJOY the sense of 
history all around you, catch the views of what 
has been called the finest natural' harbor in 
the world, and perhaps stop at The Five 
Fishermen, located in the oldest school 
building in Halifax and famous not-only for ItS 
food but also for its stained glass decor. The 


bUilding dates from 1818 and was at one time 
an art school under the direction Anna 
Leonowens, famed governess of the King of 
Slam. 
Halifax can also be a relaxing city with 
plenty of places to sit on a park bench and 
dream. Almost in the middle of the city is the 
Public Gardens. 17 acres of "green survival. ' 
including botanical gardens, ducks and 
swans, and wild birds nesting around a large 
pond. The Band Stand, where free band 
concerts are given on summer Sunday 
evenings, was erected In 1887 to honor 
Queef! Victoria-s Golden Jubilee. 
Point Pleasant at the extreme south end 
of the city features 186 acres of woodland, a 
free supervised swimming beach, a nature 
trail, footpaths. picnic tables, and places to 
build's fire for a barbecue, within sight of the 
sea. 


" 


,1!k 


"\. 


'- 



I
'J 


... 

c 
::1 



-J2i 

---
- I 
'*...; l1;li. 
... '
,.. . 
 
,
 ...
, 
...... 
...... . 


.:;. 


r 


Art gallenes and museums, an 
abundance of them, are also yours to enjoy in 
Halifax. The three universities in the city. 
Dalhousie. Saint Mary's, and Mount Saint 
Vincent all have art galleries with active 
exhibition programs. These are 
supplemented by the new Gallery of the Nova 
Scotia Museum of Fine Arts (soon to become 
the Art Gallery of Nova Scotia), the 
Centennial Gallery at the Citadel, and three 
commercial galleries, including Zwicker s, 
founded in 1886. The Nova Scotia Museum 
on Summer Street near the Commons, IS very 
much a part of the city's and the provinces 
cultural. scientific and historical life. This 
museum also has a History Branch on Citadel 
Hill. 'nterested in trains? The Scotian Railroad 
Museum is the depot for railroad enthusiasts. 
You'" find it on Mumford Road near the CNR 
main line. 



36 


The Canadian Nurse February 1976 


...... .. ...... ............................................................................. 
Halifax has many good eating places. Post-Convention Tours 
"One of the ten best in Canada" says the RNANS Tentative Social Program 
Toronto Star of Fat Frank's Proof of the for CNA Convention 1976 
Pudding restaurant on Spring Garden Road . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . 
It is superlative food, superlatively cooked by Sunday Night - June 20 
Fat Frank himself. Another "dinner only" spot 
is the Night Watch at the Chateau Halifax. 
Here you will find a beautiful view, excellent 
food, and lovely music for dancing. The Henry 
House and The Little Stone Jug are two 
equally good restaurants, just three minutes 
walk from the Hotel Nova Scotian, in the old 
stone house of the Hon. William A. Henry, a 
Father of Confederation, at 1222 Barrington 
Street. There's Chez Jean on South Park 
Street and L'Hermitage, and The French 
Casino. on Gottingen for really fine French 
cuisine, The Heidelburg for hearty German 
fare, Mario's and The Gondolier for pasta at 
its best, The Maharaja for curries, Zapata's 
for Greek and Mexican specialities, and many 
well-recommended Chinese restaurants, 
including China Town, which is right on the 
water at Bedford Basin. 
"Down east hospitality" is waiting for you. 
Come to the Convention in Halifax - fall in 
love with all Nova Scotia-stay for three days 
and you II become a member of the "Order of 
. AUernatlve menu available 
Good Cheer," with a certificate to prove your 
membership in this oldest social club in the 
New World. But we hope you"!1 stay much 
longer - and we know you'll have the time of 
your life. 
If you'd like more information or have 
questions, write the Nova Scotia Department 
of Tourism, Travel Services, Box 130, Halifax, 
Nova Scotia. The following publications are 
also available for the asking _ 5 
Accommodations and Campgrounds - 
Highway Maps - Events Calendar - Nova 
Scotia Holiday - Fish Nova Scotia's 
Saltwaters - Fish Nova Scotia's Freshwaters 
- Hunt Nova Scotia - Golf Nova Scolla - 
Dive Nova Scotia - Tour Nova Scotia. 


............. .................... 


An Invitation To Student Nurses 
The Student Nurses' Association of Nova 
Scotia joins with the Nova Scotia members of 
the Canadian University Nursing Students 
Association in extending a warm welcome to 
nursing students from across Canada. You 
are invited to participate in the activities 
planned especially for students during the 
Canadian Nurses' Association Convention. 
There will be an informal social evening 
on June 20th at St. Mary's University where 
accommodation at reasonable rates will be 
available for students. 
On the evening of the 22nd of June there 
will be a supper and a "Barn Dance". 
We look forward to welcoming student nurses 
with "down east hospitality." 
For information: Sister Sharon Young, 
President S.N.A.N.S. Halifax Infirmary, 
Halifax, N. S. - John Dow, National 
Chairman, C.U.N,S.A., 6829 Vaughn Avenue, 
Halifax, N. S. 


Welcome to Nova Scotia Punch Party - with 
musical entertainment to be held immediately 
after opening ceremonies, at the Hotel Nova 
Scotian. Rum punch and plain fruit punch with 
cold hors d' oeuvres will be served. 


................................. 


Monday and Tuesday Nights - June 21 
and 22 - choice of: 


Lobster with Laughter - Lobster dinner and 
Ceilidh - pronounced Kalley - a Ceilidh is a 
gaelic word meaning a get-together with 
music, singing, dancing and lots of laughter. 


Tour to Peggy's Cove ending at the Shore 
Club in Hubbards, by the sea, for a lobster 
dinner'and musical entertainment. 


Water Tour of Halifax Harbor ending at the 
Clipper Cay Restaurant on Privateers Wharf 
for a Shore Dinner. 


Dorothy Miller is the Public Relations Officer 
tor the Registered Nurses' Association of 
Nova Scotia. 


\ 


.. 


1 



 


.\ 


j 



 


.. 


... 


.1, 
" ;I I 1 " I 

 .' ,IJ
 fl.. ';;"'J 
 r: 
- ....., 
 .. '1"r

--
ß
\ \ 1\1 


....r< ..._ \
 
. Jf--- . -_.....- . , I . , ,,
,, . ' . t ( , 
i" ...."":
 , 1 
...;,)- 
.. ' , ;; -.;. \ 1 /1 I 
...:
 1.lt . \>. J. 
f;P:. -w. 
 .. 
. .2 
-L- ,,;. 

-.

 
.
.- -* 


,. 


i 



 ... 
 --:.,. 


r
 ::' 
..... 
 ..... 
. .. 


\ 

 
- 
..... 

.. 
.
 
.;. 


;r 


4-day tour of mainland Nova Scotia including 
Cape Breton where you will see the fortress of 
Louisbourg and the Alexander Graham Bell 
Museum at Baddeck. Cross romantic Cape 
Smokey to Cape Breton Highland National 
Park on the Cabot Trail and visit the Miners' 
Museum. Enjoy the spectacular scenery. 


6-day tour of Nova Scotia, Cape Breton and 
Prince Edward Island, visiting Oak Island, 
Lunenburg, Habitation at Port Royal, Grand 
Pré. Taking the ferry from Cape T ormentine to 
Prince Edward Island, visit Summerside, 
Charlottetown, Anne of Green Gables 
Museum, Cavendish Beach and then see 
Cape Breton, the Cabot Trail, Louisbourg and 
Baddeck. 


Air-conditioned motor coaches are used for 
the tours and a qualified tour director will 
accompany each one. 


For further information write: Nova Tours 
Limited, P.o. Box 1555, Halifax, N. S Tel.- 
902-429-3702 


Toronto General Hospital graduates are 
invited to gel in touch with Mrs. J. F. Rafuse, 
22 Piers Avenue, Halifax, to indicate their 
attendance at the CNA Convention in Halifax. 
The graduate nurses from this hospital who 
live in Nova Scotia will be arranging a special 
get-together. 
............................. 


E- 


"'" 


..;... 


.. 
.- 
r 


'I 


JL.. 


--., 
- 


roo. 

', 



' 


'- 


Photos courtesy Nova Scotia Communication 
and Information Centre. 



 


1 Princess Louise Fusiliers, Halifax Citadel. 
2 Aerial view Halifax Waterfront. 
3 Privateers' Wharf (restoration project) Halifax. 
4 Handicraft boutique, Halifax. 
5 Church at Grand Pré commemorating Acadian 
expulsion. 
6 Surf near Peggy's Cove. 



./ 

k'" 

 "'c., 



-g- 
i J;J 
-,' 
í, ' I \ 

 \ \ 
-1\
 'I 

 


I 
/1 


" 


l' 


I ,,
 
.... 
 '- 


Style 138 
Polyester/Nylon Corded Jersey 
Knit 
White-Blue-Pink-Ice Mint 
Sizes 4-16 .$28.00 



 
, 
 H \ 
,,
 4 


,YI' 


\, 


f 
I 


Style 131 PantSuit 
Polyester 'Ny'
n I"r-rded Jersey 
Knit-White L . Trim 
White-Blue P Yellow 
Sizes 3- $30.00 


the 
M/\GI(: 
/),.(:iICN 
sleeve 


We are proud to introduce 
another major advance in 
our endless search for 
new and improved techni- 
ques in the construction 
of our uniforms that will 
add to the comfort and 
convenience of the wearer. 
You will love the MAGIC- 
ACTION Sleeve. Be sure to 
ask for it. 
'Patent pending No. 873659 


The Career PantSuits 
shown here all feature 
The Magic-Action Sleeve. 


UNIFORMS 
REGISTERED 


718 KING ST. WEST, 
TORONTO, ONTARIO 
M5V 1 N6 
AT BETTER STORES 
THROUGHT CANADA 



 
.
 
,'-- 


.. 
j
J" I :
 I 
:;./ .:. ijjíII 
\:
:
 
:: "I 


 ,. 
f: i " :Ii 
;ß' :f:
 

(:15 
-; ;: 

,,':.f 
,..,.... 


f 


4 
Style 180 PantSuit 
Polyester/Nylon Corded Jersey 
Knit-Swiss Embroidery Trim 
White- Blue-Mi nt-Peach 
Sizes 8-20.. . . .$30.00 


Style 130 PantSuit 
Polyester/Nylon Corded Jersey 
Knit 
White-Blue-Pink-Mint 
Sizes 6-18 $26.00 



38 


The Canadian Nurse February 1976 


X.llll(>>S 


ill)(1 


Fil(-eS 


Gladys Sharpe, a former president of 
the Canadian Nurses' Association and 
of Ihe Registered Nurses' Association 
of Ontario, died in hospital November 
18. 1975 after a lengthy illness. 
After a 42-year career that 
spanned active nursing, teaching, 
administration, and military wartime 
service. Sharpe retired in 1968 as 
senior nursing consultant on operating 
standards with the Ontano Hospital 
Services Commission to work with 
kindergarten children. 
Among her career assignments 
have been those of director of nursing, 
Toronto Western Hospital; World War 
II, matron of the RCAMC Hospital at 
Camp Borden and liaison oHicer for 
the Canadian, British, and South 
African army medical services: and 
director of the school of nursing at 
McMaster University in Hamilloh. 


.... 


, . 


--, 


- 


\ 


Vivian MacDougall (R.N., Sacred 
Heart Hospital school of nursing, 
Havre, Mont.: Dipl. Teaching and 
Supervision, U. of British Columbia) 
has been appointed nurSing 
coordinator for the New Brunswick 
Association of Registered Nurses. 
She has held general staH and head 
nurse positions in Saskatchewan, 
Washington, California, and with the 
Royal Canadian Navy. She worked as 
a clinical instructor in Ontario 
before moving to New Brunswick. 
where she held similar positions at the 
Saint John General Hospital School of 
Nursing and Victoria Public Hospital 
School of Nursing in Fredericton. 
MacDougall coordinated NBARN'S 
recent reorientation course for 
inactive nurses conducted at Victoria 
Public Hospital. 


Senior nursing department 
appointments at the Lions Gate 
Hospital, North Vancouver, B.C. were 
announced a few months ago: 
Joyce M, Campbell IS nursing 
director. A graduate in nursing from 
the Vancouver General Hospital 
school of nursing, she has diplomas in 
teaching and supervision. public 
health, and business administration 
from the University of British 
Columbia. She has held various 
nursing and teaching positions at the 
Vancouver General Hospital and, in 
1967, joined the staH of the Lions Gate 
Hospital, where she has been 
supervisor," various departments, 
and nursing coordinator/director of 
nursing administration, 
Jocelyn Howden (R.N., Vancouver 
General Hospital school of nursing: 
B.S.N., University of British Columbia) 
is assistant nursing director, 
responsible to the nursing director for 
the supervision of clinical functions of 
the nursing department. Her nursing 
career has brought her to Australia 
and Ontario. Since 1961 she has been 
on staff at the Lions Gate Hospital, as 
head nurse, supervisor, and nurse 
coordinator/director of clinical 
nursing. 
Helen Graham is assistant nursing 
director, responsible to the nursing 
director for the supervision of staH 
allocation and coordination with 
clinical requirements of the nursing 
department. She earned her nursing 
diploma at the Victoria Infirmary, in 
Glasgow. Scotland, and has studied 
nursing unit administration at the 
University of British Columbia, 
Vancouver. Before joining the nursing 
staff of the lions Gate Hospital in 
1966, she was on staff at the Toronto 
Western Hospital and the Victoria 
Hospilal, London, Ontario. 


The Alumnae Association of the 
Montreal General Hospital school of 
nursing has awarded 7 bursaries for 
post-basIc education in nursing to its 
members for the year 1975-1976. 
Recipients are: Susan Collins. Ellen 
Hennessey, Karen Finestone, Anne 
Mutz, Susan Burrows, Heather 
Ayerst Tyler and Susan Lindsay. All 
are in the Bachelor of Nursing program 
at McGill University school of nursing, 
Montreal. 


Alma Leclerc (R.N., St. Paul's 
Hospital school of nursing, 
Saskatoon) has been appointed 
program director of The New 
Brunswick Tuberculosis and 
Respiratory Disease Association. Her 
nursing experience includes general 
staff and head nurse positions at the 
Saskatchewan Sanatorium, with the 
Saskatoon Anti-Tuberculosis League, 
the Central Tuberculosis Clinic in 
Winnipeg, and the Royal Ottawa 
Sanatorium. She also worked for the 
Ontario Ministry of Health in Ottawa 
where she was a clinic nurse dealing 
with TB Drevention. and the Sudburv 
and Distnct Health Unit. with 
emphasis on community work. 
Leclerc sees her new role as 
mainly educational, involving 
professionals and the public One of 
her top priorities is to establish a 
nurses' section of the Association, as 
part of the educational program for 
professionals 


or 


Judith M, Skelton (B.Sc.N., 
McMaster University, Hamilton; 
M.Sc.N., University of British 
Columbia) has been appointed 
coordinator of nursing education at 
Okanagan College, Kelowna, B.C. 
She has taught at St. Michael's School 
of Nursing, Toronto, The Vancouver 
General Hospital School of Nursing 
and the University of British Columbia. 
Most recently, she was employed as a 
public health nurse with the Central 
Okanagan Health UOIt, Kelowna. 
Okanagan College anticipates 
admitting its first class of RN students 
in September 1976. An LPN program 
is already established there. 


\. 


,.- 


Constance Swinton (R.N.. Royal 
Alexandra Hospital school of nursing 
Edmonton B.N., McGill University, 
Montreal: M.P.H., University of 
Michigan, Ann Arbor) has been 
appointed consul1ant with CARE/ 
MEDICO in Solo, Indonesia. She is on 
loån for one year from the Canadian 
International Development Agency, 
which she joined a year ago. Her major 
function will be to work with CARE's 
country director and local authorities 
to plan and evaluate rural public health 
programs with a view to expanding 
and improving them, 
Swinton has been director of 
education and projects at the national 
office of the Victorian Order of Nurses: 
public heal1h consul1ant with child and 
adult health services, Health and 
Welfare Canada: and an assistant 
professor In the population unit 
School of Hygiene, University of 
Toronto. 


Mary Dohey (R.N.. St. John's Genera 
Hospital, St. John's, Nfld.) has been 
awarded the Cross of Valor, Canada's 
highest decoration for bravery. On 
November 11 ,1971, as an Air Canada 
flight hostess she averted a major 
tragedy by spending eight hours 
pacifying a man. armed with a shotgun 
and dynamite, who had hi-jacked a 
DC-8 plane flying out of Calgary. He 
forced the crew to land the plane at 
Great Falls, Montana, where he 
obtained a ransom of $50,000. Dohey 
then persuaded him to let the plane 
land again at Great Falls to allow the 
118 passengers and some ot the crew 
to leave the plane. 
Dohey has been a part-time nurse 
at St. Joseph s Hospital in Toronto and 
recently was awarded her 10-year 
nursing pin. 
 



The CanadIan Nurse February 1976 


39 


p 


. 


FIRM 


À 


N 


E 


a true test of knowledge 


I 
I 


Rely on these new texts to help students perform 
with optimum results-optimum patient care 


\ 


.,jr 
- 
 ...... 


I- 


- edicall surgical 



 


New 6th Edition! 
MEDICAL-SURGICAL NURSING 
The first text to effectively combine medical and surgical 
nursing, the new 6th edition of this popular book con- 
tinues to lead the field. With increased emphasis on 
physiology, nursing assessment, and pathophysiology, this 
edition provides thorough and current information on 
fundamentals while adding new material, Additions in- 
clude: new chapters on ecology and health; expanded in- 
formation on cardiac disease; new guidelines for family 
planning counseling, with explanations of physiology of 
reproduction and contraception; and new chapters on 
neurologic disease, musculoskeletal disorders, and in- 
juries; and more! 
By Kathleen Newton Shafer, R.N., M.A.; Janet R. Sawyer, R.N. 
Ph.D., Audrey M. McCluskey, R.N., M.A., SC.M. Hyg., Edna 
Lifgren Beck, R.N., M.A., and Wilma J. Phipps, R.N., A.M.; with 
28 contributors. April, 1975. 1,032 pages plus FM I-XVI, 8'/2" x 
11 " , 608 illustrations. Price, $17.35. 


A New Book! 
PAIN: 
Clinical and Experimental Perspectives 
For the first time, a single volume presents the insights and 
knowledge of foremost researchers in pain. This fasci- 
nating selection of readings provides both general and 
detailed views of pain from the perspectives of various ex- 
perimental and clinical disciplines. Among the intriguing 
topics explored are: sex differences in pain tolerance and 
perception; pain reactivity and family size; conttol of pain 
motivation by cognitive dissonance; surgical treatment of 
pain; pain and cancer; pain in psychiatric patients; etc. 
Edited by Matisyohu Weisenberg, Ph. D. July, 1975 386 pages plus 
FM I-XII, 7" x 10 V. ", 86 ,IIustrations. Price, $10 00. 


New 2nd Edition! 
ESSENTIALS OF COMMUNICABLE 
DISEASE 
For a concise presentation of communicable diseases and 
appropriate nursing care, offer your students this exten- 
sively revised new edition. Including up-to-date informa- 
tion and new statistics, the text examines each specific 
disease, its etiology and stages, clinical manifestations, 
diagnosis, treatment, prevention, and control. New 
material covers: jet borne communicable diseases, rashes, 
common cold, congenital rubella, venereal disease and the 
changing role of the nurse in caring for patients with V.D, 
By Mary Elizabeth Mcinnes, R.N., B.Sc.N., M.Sc.(Ed.) July, 
1975. 402 pages plus FM I-X. 6'/2" x 9'12", 34 illustrations. Price. 
$10.45. 



40 


II 


The Canadian Nurse February 1976 


, 


undamentals/basic science 


, 


New 11 th Edition! 
MICROBIOLOGY AND PATHOLOGY 
Thoroughly updated, this popular text offers the conte?1- 
pOtary essentials of microbiology a?d patholog
. Pa
t I 10- 
cludes: basic concepts of microbIOlogy; classification of 
microorganisms; microbe anions on living cells of the 
human body, and the effects; and ptevention and control 
of disease. In Part II, pathology is explored in the tradi- 
tional two-pan manner. Review questions accompany each 
chapter. 
By Alice Lorraine Smith, A.Boo M.D., F.C.A.P., F.A.C.P. April, 
1976. Approx 720 pages, 8" x 10", 563 illustrations, 2 full page 
color plates. About $15.70. 


New 13th Edition! 
PHARMACOLOGY IN NURSING 
Now available in a new updated edition, this classic text 
presents current concepts of pharmacology in relation to 
clinical patient care. Complete discussions cover basic 
mechanisms of drug anion; contraindications for drug 
therapy; toxicity and side effects; safe therapeutic dosage 
range, ete. Expanded information is provided on drug in- 
tetactions, pharmacologic effects, nursing care, and more. 


By Betty S. Bergersen, R.N.. M.S., Ed.D., in consultation with 
Andres Goth, M.D. February, 1976. Approx. 732 pages, 8" x 10", 
143 illustrations. About $14.20. 


New 9th Edition! 
TEXTBOOK OF ANATOMY AND 
PHYSIOLOGY 
The most widely adopted anatomy and physiology text- 
book is now available in an updated new 9th edition. This 
edition featutes three new chapters on the nervous sYStem; 
26 new and modified illustrations; new information on 
brain waves, altered states of consciousness, and the" emo- 
tional brain"; biofeedback training; expanded discus- 
sions of liver functions, reproduction, physiology of cir- 
culation; and more! 
By Catherine Parker Anthony, R.N., B.A., M.S., wilh the col- 
laboration of Norma Jane KOlthoff, R_N., B.S., Ph.D. April, 1975_ 
598 pages plus FM I-X, 8" x 10", 336 figures (145 in color), in- 
cluding 239 by Ernest W. Beck, and an insert on human anatomy 
with 15 full-page plates, with 6 in transparent Trans-Vision
 by 
Ernest W. Beck. Pnce, $13.90. 


New 10th Edition! 
WORKBOOK OF SOLUTIONS AND 
DOSAGE OF DRUGS: 
Including Arithmetic 
A concise workbook, this new edition relates basic 
mathematics to common solutions and dosages, and pro- 
vides information essential to proper calculation, prepara- 
tion, and administration of drugs, Updated throughout, 
material places more emphasis on the metric. system and 
includes many new problems. The totally rewntten appen- 
dix contains drug standards and legal regulations; metric 
doses and apothecary equivalents; and more. 
By Ellen M. Anderson, R.N., B.S., M.A. and Thora M. Vervoren, 
R.Ph., B.S. January, 1976. 168 pages plus FM I-VIII, 7'A" x 
10'/2", 26 illustrations. Price. $6.55. 


A New Book! 
CLINICAL LABORATORY TESTS: 
A Manual for Nurses 
Designed for quick reference, this valuable new manu.al 
will help students transcribe physicians' orders, explam 
tests to patients, collen laboratory specimens, and under- 
stand written laboratory reports. Basic concepts of 
physiology and medical-surgical nursing are includ
d 
where relevant. Laboratory procedures appear 10 
alphabetical sequence; and abbreviations and symbols are 
explained, 
By Marcella M. Strand, B.S.N., R.N. and Lucille A. Elmer, B.S. in 
M. T., M.T.(A.S.C.P.). April, 1976. Approx. 104 pages, 5'12" x 
8'/2", About $5.75. 


New 3rd Edition! 
THE FOUNDATIONS OF NURSING: 
As Conceived, Learned, and Practiced 
in Professional Nursing 
This timely text provides students with reliable informa- 
tion on responsibilities, opportunities, and changes in 
professional nursing. This new 3rd edition discusses p
e- 
sent day nursing roles in relation to such televant topiCS 
as: abortion;- euthanasia; changes in nurse practice acts; 
transitional problems from student to practicing nurse; in- 
stitutional licensure vs. individual licensure; death and 
dying; ete. 
By Lillian DeYoung, R.N., B.S.N.E., M.S., Ph.D.; with 3 con- 
tributors. April, 1976. Approx. 336 pages, 7" x 10",14 photos, 29 
illustrations. About $10.00. 



The CanadIan Nurse February 1976 


41 


r 


J 


amily . 
I
 nurSing 


'.11 
t, 


" " 


'. 


New 2nd Edition! 
FAMILY NURSING: 
A Study Guide 
Updated discussions and new case studies help students ex- 
plore clinical application of family nursing techniques, In- 
dividual sections examine problems of beginning families, 
families with school age children, "middle years" and ag- 
ing families. 
By Evelyn G Sobol, R N., A.M. and Paulette RobisChon, R.N., 
Ph.D. June, 1975. 182 pages plus FM I-XVI. 7" x 10". Price. 
$7.90. 


ehavioral science 


A New Book! 
BEHAVIOR AND HEALTH CARE: 
A Humanistic Helping Process 
This clinically-oriented text helps students understand the 
social-emotional helping process in health care delivery, 
The authors present an advocacy model for humanistic 
helping that provides a framework for evaluation of care. 
By Jane E. Chapman, R.N.. Ph.D. and Harry H. Chapman, Ph.D. 
October. 1975. 194 pages plus FM I-XII. 7" x 10". Price, $7.90. 


i 


, 


- 


,1 


A New Book! 
BEHAVIORAL METHODS FOR CHRONIC 
PAIN AND ILLNESS 
The first book (0 discuss pain from a behavioral perspec- 
tive, this new text provides: a conceptual background of 
pain; detailed evaluation and clinical treatmem pro- 
cedures; and imponam guidelines for support nurses can 
give to patiems' families. 
By Wilbert E. Fordyce, Ph.D. February, 1976 Approx 256 pages, 
7" x 10", 25 illustrations About $10.00. 


ssues, education, 
administration 


[, 


New 6th Edition! 
RIGHT AND REASON: 
Ethics in Theory and Practice 
In this new edition, thought-provoking material examines 
contemporary ideas on women's roles; education; en- 
vironmemal responsibilities; death; and trade. 
By Austin Fagothey, S.J. April, 1976. Approx. 488 pages, 7" x 
10", 1 illustration About $13. 15. 


New 3rd Edition! 
CREATIVE TEACHING IN 
CLINICAL NURSING 
This new edition explores the role of creativity in clinical 
teaching. It includes teaching approaches, technology, and 
educational communication media 
By Jean E. Schweer, R N., B.S., M.S. and Kristine M. Gebbie, 
R N., M.N. February, 1976. 216 pages plus FM I-VIII" 7" x 10", 
3 illustrations. Price, $8.35. 


A New Book! 
MANAGEMENT FOR NURSES: 
A Multidisciplinary Approach 
This excellem new (ext presents readings from various 
disciplines (business, behavioral sciences, ete.) - all 
designed to acquaim studems with leadership/manage- 
ment concepts, 
By Sandra Stone. M.S.; Marie Streng Berger, M.S., Dorothy 
Elhart, M S., Sharon Cannell Firsich, M.S.; and Shelley Baney 
Jordan, M.N. December, 1975. 280 pages plus FM I-XII, 6 3 A" x 
9 3 /.".24 illustrations. Price, $8.65 



1.,.. 


ritical care 


New 2nd Edition! 
DECISION MAKING IN THE 
CORONARY CARE UNIT 
Here, simulated crisis situations provide students with 
clinical experience in making decisions in the CCU, Each 
case includes an EKG tracing and adequate information to 
determine treatment goals, actions, and evaluation. A new 
chapter on patient education is included. 
By William P. Hamilton, M.D. and Mary Ann Lavin, R.N., B.S.N., 
M.S.N. April, 1976. Approx. 184 pages. 7" x 10", 126 illustra- 
tions About $6.85. 


k 


\ 



 


A New Book! 
SPATIAL ANALYSIS OF THE 
ELECTROCARDIOGRAM: 
A Program 
This new programmed text develops a method for spatial 
analysis of any electrocardiogram. Using a question-and- 
answer format, the book covers: orientation of frontal 
plane leads; mean frontal QRS vector; and mean horizon- 
tal QRS vector, 
By Irwin Hoffman, M.D.; Julien H. Isaacs, M.D.; James V. 
Dooley, M.D., Phil R. Manning, M.D.; and Donald A Dennis, 
Ph.D. May, 1975. 150 pages plus FM I-X, 7" x 10",199 illustra- 
tions Price, $7.65. 


New 2nd Edition! 
A COMMONSENSE APPROACH TO 
CORONARY CARE: 
A Program 
Students can learn all the major problems associated with 
acute myocardial infarction with this programmed book. 
This new 2nd edition includes new information on drug 
therapy of shock and heart failure; hemodynamic moni- 
toring; and more, Background material is included. 
By Marielle Ortiz Vinsant, R.N., B.S.; Martha I. Spence, R.N., 
8.S., M.N., and Dianne Chapell Hagen, R.N.. B. S. October, 
1975.228 pages plus FM I-XVI, 7" x 10" 439 illustrations. Price, 
$7.65. 


ractical nursing 
New 6th Edition! 
SIMPLIFIED DRUGS AND SOLUTIONS 
FOR NURSES, INCLUDING 
ARITHMETIC 
Updated throughout, this text helps students acquire the 
practical understanding needed to solve problems of 
dosage, solution, and interpretation of drug orders, In 
three sections, the book reviews basic arithmetic, systems 
of weights and measures, and dosages and solutions, 
By Norma Dison, R.N., B.A., M.A. March, 1976. Approx. 120 
pages, 5V2" x 8'/2",18 illustrations. About $5.00. 


New 3rd Edition! 
BASIC MATERNITY NURSING 
This family-centered approach to obstetrical nursing 
emphasizes principles of care and nursing roles for all 
situations. Topics cover: reproductive anatomy and physi- 
ology; embryonic development of the child; complica- 
tions; effects of pregnancy on both parents; and more, 
By Persis Mary Hamilton, R.N., P.H.N., B.S., M.S. May, 1975. 
248 pages plus FM I-X, 7" x 10", 159 illustrations. Price, $7.30. 


New 2nd Edition! 
CARE OF PATIENTS WITH 
EMOTIONAL PROBLEMS: 
A Textbook for Practical Nurses 
Designed to help nursing students identify and meet the 
emotional needs of patients, this new 2nd edition provides 
essential background information on personality develop- 
ment, dynamics of behavior, and manifestations of anxie- 
ty and defense mechanisms. 
By Dolores F. Saxton, R.N.. B.S., M.A., Ed.D. and Phyllis W. Har- 
ing, R.N., B.S., M.S., M.Ed. May, 1975. 110 pages plus FM I-VIII, 
6" x 9".8 illustrations. Price. $5.00. 


IVIDSBV 


TIMES MIRROR 


THE C V MOS8Y COMPANY L TO 
86 NORTHLINE ROAD 
TORONTO ONTARIO 
M48 3E5 



The CanadIan Nurse February 1976 


43 


X
tlll(tH 
tll(1 F
I(.(>>H 


Recent appointments to the faculty of 
he University of Alberta school of 
ursing include: 
Joan Affleck (R.N.. Royal 
Alexandra Hospital school of nursing, 
Edmonton: B.Sc.N.. University of 
Alberta) lecturer, who was formerly 
with the Victorian Order of Nurses in 
Peterborough, Ontario; 
Rene Day (R.N., B.Sc.N.. 
University of Alberta school of nursing: 
M.S., University of Hawaii) assistant 
professor, who has been a public 
health nurse with the City of Calgary 
health department and a lecturer at the 
U. of Alberta school of nursing, 
Edmonton; 
Sylvia King-Farlow B.Sc.N., 
University of Alberta; M.Ed.. 
University of Ottawa) lecturer, who 
has had extensive nurSing, 
supervisory, and teaching experience 
in hospitals in Edmonton, Los 
Angeles, Culver City, and Guelph: 
Jane Ligowski (B.Sc.N., 
I University of Toronto school of 
I nursing), visiting lecturer. who has 
been a public health nurse in Midland, 
Ontario and staff nurse at the 
University of Alberta Hospital. 
Edmonton: and 
Reita Markovich R. N.. Victoria 
Hospital, school 01 nursing, London: 
B.Sc.N. University of Alberta) clinical 
supervisor, who has been engaged in 
general duty and public health nursing 
in London, Peace River, Port Alberni, 
Calgary, and Edmonton. 


Claire Kane (R.N.. St. Martha s 
school of nursing, Antigonish: B.Sc.N.. 
University of Ottawa) has been 
appOinted executive director of 
Planned Parenthood Ottawa, 
succeeding Mary Mills who has 
become executive director of the 
Planned Parenthood Federation of 
Canada in Toronto. 


þ 


Marjorie Hewitt (R.N., Vancouver 
General Hospital school of nursing: 
BASe., University of British 
Columbia) has been appOinted 
nursing consultant with the 
Saskatchewan Registered Nurses 
Association. Formerly assistant 
director of the Regina Grey Nuns 
(Pasqua) Hospital school of nursing 


she has also had extensive clinical 
and teaching experience with the 
Royal Inland Hospital in Kamloops, 
B.C., and the Regina General 
Hospital. 


Nurses appointed during 1975 to the 
faculty of nursing at Dalhousie 
university. Halifax, include: 
Shirley Halliday (R.N., Victoria 
Genera' Hospital school of nursing, 
Halifax, B.N.. Dalhousie University), 
lecturer. She was formerly instructor 
and curriculum coordinator at the 
Victoria General Hospital school of 
nursing, Halifax. 
Judy Harwood (R.N.. Toronto 
General Hospital school of nursing: 
Dip!. Public Health and Outpost 
Nursing, Dalhousie University), 
lecturer In outpost nursing. She has 
worked in the emergency department. 
Toronto General Hospital. and with the 
medical services branch of Health and 
Welfare Canada at Aklavik, N.W.T. 
Ruth C. MacKay (BA, McMaster 
University, Hamilton: M.N.. MA, 
Emory University. Atlanta, Ga.: Ph.D. 
University of Kentucky, Lexinglon, 
Ky.), associate professor. Since 
returning to Canada In 1969, Dr. 
MacKay has been associate professor 
a1 Queen s University, Kingston, and 
at McMaster University, Hamilton, 
Ontario. She has had articles 
published in several professional 
journals 


Hattie Lee Shea (R N., Dallas 
Methodist Hospital school of nurSing: 
B.S N.Ed.. M.S.N., University of 
Texas, Austin), associate professor. 
Her previous appointment was that of 
assistant professor, University of 
Western Onlario, London and, prior to 
coming to Canada In 1970, she 
worked In various centers in Texas. 
Marilyn Walper (B Sc.N.. University 
of Saskatchewan, Saskatoon), 
lecturer. During her nursing career as 
staff nurse and instructor she has 
worked In Saskatoon and Moose Jaw 
Saskatchewan; Barne, Ontario; 
Portage-La-Prairie, Manitoba; and 
Dartmouth. N.S 
Leslie White (R.N., Montreal General 
Hospital school of nursing: B.N., 
University of New Brunswick, 
Fredericton: M.Sc.N., University of 
Western Ontario, London), lecturer. 
She has been on the nursing staff of 
the Sensenbrenner Hospital, 
Kapuskaslng, Ontario; Montreal 
General Hospital, Montreal: Hotel 
Dieu Hospital. Perth. New Brunswick: 
a"d Victoria Hospital, London, 
Ontario. 
Ardythe Wildsmith (R.N.. 
Nightingale SChool of Nursing, 
Toronto; B.N.. Dipl. Public Health, 
Dalhousie University), lecturer. She 
was formerly an Instructor at the 
Victoria General Hospital school of 
nursing, Halifax. 


(

11(t11(1
11. 


February 28 - 29, 1976 
Post-Anesthetic Recovery - A 
Conference for Nurses, to be held at 
University of British Columbia, 
Vancouver, B.C. Formformation write: 
Continuing Education in Health 
Sciences, Woodward Instructional 
Resources Centre, University of 
British Columbia, Vancouver. B.C. 
V6T 1 W5. 


April 2 - 4,1976 
Biennial meeting of the Northwest 
Territories Registered Nurses 
Association to be held in Yellowknife, 
NW.T. 


March 24. May 12, 1976 
Course: 'Recent Advances In the 
Nursing Care of Ihe High Risk 
Pregnancy Patient and the Newborn 
Infant," Wednesday evenings at the 
McLennan PhysIcs Building, 
University of Toronto. For information 
contact: Dorothy Brooks, Continuing 
Education, Faculty of Nursing, 
University of Toronto, 50 Sf. George 
St., Toronto, Ont., M5S lAl. 
April 5-9, 1976 
Rehabilitation nursing workshop to be 
held in Edmonton. For Information, 
write: Nursing Education Coordinator 
Glenrose Hospital, 10230-111 
Avenue, Edmonton,Alta. 


April 29 - May 1, 1976 
Annual Meeting of the Registered 
Nurses Association of Ontano to be 
held at the Royal York Hotel, Toronto, 
Ontario. 


April 23 - 24, 1976 
Interdisaplinary Respiratory Disease 
Workshop sponsored by the New 
Brunswick Tuberculosis and 
Respiratory Disease Assoaation will 
be held at the University of New 
Brunswick in Fredericton, N.B. For 
further information write: Alma T. 
Leclerc, Program Director, New 
Brunswick TB and A.D. AssocIation, 
123 York Street, Fredericton. N.B. 
E3B 5E3. 


April 19 - 23, 1976 
Advanced refresher course for 
obstetrical nurses to be held at the 
School of Nursing, University of 
Alberta, Edmonton. For informatIon, 
wflte: Continumg Education for 
Nurses, 12-103 Clinical Sciences 
Building, University of Alberta. 
Edmonton, Albena T6G 2G3. 


May 17 - 19, 1976 
General Foods National Nutrition 
Seminar at the Toronto Hyatt Regency 
Hotel, a multi-disciplinary approach to 
nutrition For information, contact: 
Una Abrahamson, Co-ordinator, 
Genera) Foods Nutrition Service, 
Suite 400, 4th floor. 2 Bloor Street 
West. Toronto, Ont.. M4W 3K1. 



44 


The CanadIan Nurse February 1976 


I \\11 at 
s Ne\y 


· 4 
.: 4 
. . 


----- ". 


.... 



 


J 


'\ 


--- 


-'- 


II. 


J 


. ""
: 
 .-= 
1'J 
 
..... 


J 


IV Feeding Pump 
The IV AC 600 IV Pump 
infuses IV fluids and drugs 
precisely and dependably in cc's 
per hour, using its own sterile 
disposable infusion set. Its 
infusion rates are from I to 999 cc's 
per hour. The prescribed infusion 
rate In cc's per hour is obtained by 
setting a dial. Weighing less than 
9 Ibs., the Model 600 has 
selfcontained battery Power for 
portability, or operates on 
standard line voltage. 
Forinformation, contact: IVAC 
Corporation, 11353 Sorrento 
Valley Road, San Diego, 
California 92121, U.S.A. 


New Disposable X-Ray 
Cassette Cover 
A heavy-duty plastic x-ray 
Cassette Cover has been added 
to the Convertors line of 
disposable operating room 
safeguards. The cover is 
economical because no 
laundering, restenlization, folding 
or packaging is required. 
Made of heavy lint-free clear 
plastic, the cassette cover is 


impervious to blood and fluids. 
After the laminated package and 
sterile wrap are opened, the scrub 
nurse inserts her hands into the 
deep cuff where indicated. The 
circulating nurse then drops the 
x-ray cassette into the cover and 
th fold-over cuff Isolates 
contamination. One size fits all 
cassettes. 
For further information, write: 
Convertors Division of American 
Hospital Supply Corp., 1633 
Central St., Evanston, III. 60201, 
U.S.A. 


Service Tray 
Vollrath s new tray is available 
in Mint Green or Gold. Made of 
strong polystyrene, and 
tear-drop-shaped, it holds a 
carafe and tumbler. 


The tray has feet to prevent it 
from sticking to bedside stand or 
table. It measures 8 7 / 8 " X 5 5 / 8 ", 
and is available in bulk, or as part 
of Vollrath's customized kit 
program for individual use. 
For information, write: The 
Vollrath Company, 1236 North 
18th Street, Sheboygan, 
Wisconsin 53081. 


...... 


--'L 


. 


. 


. - 
. 


_. 
 


. 


La Belle Pia-Malic 
Controller 
The Pla-Matic Controller 
introduced by La Belle Industries 
facilitates presentation of visual 
programs using existing 
remote-controlled slide or 
film-strip projectors. The 
Controller commands the 
projector to advance the visual 
presentation so that It is 
synchronized with the taped 
audio. It is useful when presenting 
audio/visual programs for in-plant 
or office training, on-the-road 
selling, or dissemination of 
important knowledge. 
The Controller can 
synchronize the audio with other 
switch-operated devices, such as 
animated displays or 
programmed lighting effects. 
The Controller weighs nine 
pounds and measures 9" x 6" x 
6". A handle is furnished for easy 
carrying. Programs can be 18 or 
36 minutes long. Slides or filmstrip 
frames can be rapidly changed for 
animated motion effects. 
For information write: LaBelle 
Industries, Box 128, 
Oconomowoc, WI 53066. 


C.R. Shoe Covers 
Shield disposable shoe covers 
from Convertors are designed to 
cover the shoe completely. They 
come in 3 styles, all of strong and 
lightweight nonwoven fabrics that 
create impermeable fluid barriers 
and prevent excessive heat 
build-up. The covers are durable, 
nonskid and noise-free. 
The "Perfect Fit" style 
(illustrated here) fits all sizes, 
Elastic instep insures snug, 
comfortable fit. Available with or 
without conductive strip, they are 
supplied in space-saving 
dispenser cartons. The elastic top 
shoe cover has a comfortable 
elastic closure and is color-coded 
for easy inventory by size. 
Available in 4 sizes, conductive 
only. 


"' 



 
tilt 


At 


",I ) 
--

 ) 



.


 
-' 4f' j 


... 


" 
" 


The Rubber Band Closure 
style, especially designed for 
men's and women's high-top 
shoes. assures a comfortable fit 
without binding at the ankle. 
Available in 3 sizes, conductive 
only. 
For information write: 
Convertors Division of American 
Hospital Supply Corp., 1633 
Central Street, Evanston, IL 
60201. 



PROTECT 
SKIN "- 
from contact with 
 
Irntatmg exudate 
with a Karaya 
Blankel around the 
wound site 


- 


ç- 


INSPECT 
WOUND 
through transparent 
Access Cap without 
trauma of dres-mg 
removal to treat 
wound or advance 
dram tube remove 
Just the Cap 



 


-COLLECT 
EXUDATE 
m a Dramage 
Collector that keeps 
flUid away from 
wound and odor 
away from patient 


Hollisters 




 


uu 


I 
sheds new light on draining wounds 


If only someone made a dressing you could see through. 


A dressing that lets you see hemorrhaging or other un- 
welcome conditions developing at the wound site A 
dressing that keeps dram age away from the wound and 
protects the skin A dressing that lets you easily assess 
and measure exudate 


Now someone makes such a dressrng The HOllister. 
Dralnmg-Wound Management System makes it easy for 
you to see what s happening at the wound site. No more 
guesswork. no more need for traumatic time-consuming 
and costly dressing changes 


Everything IS supplied sterile for quick application in the 
a.R. recovery. I.C.U. or patient's room. No messy wet 
dressmgs to handle or change so post-operative care will 
be simpler. . and generally less expenSive. 
If you want to see what s going on at the wound site. you' II 
want to see the. transparent dressing ,. Write for complete 
information. 


Hollisler Dr.ining-WOUn



I;;

 G 


>JOLLISTER LlMITEO 332 CONSUMERS ROAO WILLOWOALE ONTARIO M2J IPS 


COPYRIG.....T 1975 HOlUSTEFt INCORPORATED ALL RIGHTS RESERVED 



46 


11()oJtS 


The Canadian Nurse February 1976 


Nursing the Dying Patient by 
Charlotte Epstein. 210 pages. 
Virginia, Reston Publishing Co.. 
1975. 
Reviewed by Betty Johnson, 
Lecturer in Nursing, The 
University of British Columbia, 
Vancouver. B.C. 


I 
I 
I 
II 

 


In the past ten years, the literature 
concerning the care of the dying 
patient has gone from next-to-nothing 
to remarkable in quantity (and, 
usually, in quality). The hard work and 
compassionate attitude of Elisabeth 
Kübler-Ross is an outstanding 
example of bringing to our awareness 
the personal needs we all have in 
facing death - our own and our 
patients'. Western society has 
encouraged us to deny death. In order 
to avoid running from our dying 
patients we have to face our fears 
about death. 
The literature GrIes out against 
abandoning the patient, but we are still 
left with the task of how to actually get 
ourselves into the real situation with 
our patients and their families. 
Charlotte Epstein's book Nursing the 
Dying Patient tries to help student and 
teacher (and in the author's approach 
these roles are always 
interchangeable) bridge the gap 
between theory and practice. Her 
objectives are to have us learn to face 
our own dying and learn to interact 
with dying people. 
The strength of the book rests in the 
way Epstein has provided the reader 
with a rich variety of exercises, 
role-play situations, practice 
interactions, and thought-provoking 
questions. This book is not to browse 
through. rather it is a book to be 
worked through in a small and 
supportive group. It contains a gold 
mine of activities outlined in specific 
detail and with a firm theoretical base. 
A group working with this book will get 
in touch with the myriad of emotions 
encountered when facing death and 
will also have the practice needed to 
confidently enter nurturing 
relationships with dying patients. 


Clinical Nursing 3ed., by Irene 
Beland and Joyce Y. Passos. 
1120 pages. New York, 
Macmillan, 1975. 
Reviewed by Basu Majumdar, 
Assistant Professor, School of 
Nursing, McMaster University, 
Hamilton, Ont. 


This book is an improvement over 
the first and second editions. 
The authors have used 
patient-centered and problem-solving 
approaches. The book deals with the 
basic sciences necessary to 
understand "pathology." 
Most of the 19 chapters are 
comprehensive and include anatomy, 
physiology, biochemistry and family 
oriented patient care including the 
acute, chronic, and rehabilitative 
stages. The "psychosocial Impact of 
illness on a patient" and the spiritual 
needs of a patient are emphasized by 
the authors. 
In the preface. the authors 
explained that they have reorganized 
and updated the cc.ltent of the book. 
They have attempted to demonstrate 
the importance of nursing intervention 
in the clinical setting and also the 
importance of applying basic science 
principles to a variety of nursing 
situations. 
Focus is placed on the promotion 
of health, Ihe prevention of disease, 
the medical treatment and nursing 
care of people with illness, and the 
differences between health and 
illness. The case studies are very 
helpful and they provide opportunities 
to discuss and understand the 
dynamics of various 
biopsychopathologies. The book is 
organized and begins with physiology, 
injurious agents, and responses of the 
body to injury. The major focus is then 
given to specific problems in clinical 
settings. The illustrations and 
diagrams are helpful and the 
reference materials that are included 
at the end of each chapter are current 
. and comprehensive. Most of the 
common and current clinical 
conditions are treated by the authors. 
The discussion on 'Pain' is given 
in detail and the Important points are 
highlighted. The chapter "Summary of 
Some Responses to Injury" is well 
explained and organized 


"Nursing the Patient Having a 
Problem with Some Aspect of 
Transporting Material To and From 
Cells" IS an excellent and 
comprehensive chapter. Anatomy; 
physiology; assessment of the patient 
with different conditions, e.g., anemia, 
venous and arterial problems during 
therapy; diagnostic tests: surgery: and 
nursing interventions are included. 
Illustrations on page 672, are very 
helpful in understanding fluid retention 
in congestive heart failure. 
"Nursing the Patient in Shock," 
another excellent chapter, includes 
the effects of shock on each body 
syste,ll and the responses by the 
systems. Causes Qf shock and "how 
may the degree of cardiovascular 
responses be determined" are 
explained well. 
This reviewer believes that the 
book could not be used as a quick 
reference. The printing in this book is 
still distracting and the method of 
marking important points could be 
improved. However, it is a 
comprehensive text for the graduate 
nurse and an excellent basic text for 
baccalaureate nursing students. 


Designing Hospital Training 
Programs by Reba D. Grubb and 
Carolyn J. Mueller. 199 pages. 
Springfield, III., Charles C. 
Thomas, 1975. 
Reviewed by Sharon Richardson, 
Nursing Instructor, Selkirk 
Community College, Castlegar, 
B.C. 


Essentially a handbook on "how 
to"; Designing Hospital Training 
Programs IS rooted in the philosophy 
that a hospital-wide educational 
service is preferable to multiple, 
Independently organized. and 
administered inservice programs 
offered by separate departments 
within the institution. The rationale 
presented by the authors states that 
"hospital-wide programs should be 
designed to improve patient care, 
thereby, reaching the individuals 
involved, regardless of the department 
in which they work." 
Guidelines for evolving a 
hospital-wide educational program, 
including a basic overview of learning 
theory, are presented in the first half of 
the book. Included, are suggestions 


for the use of instructional material, a 
description of selected teaching 
methods and teaching aids. A 
diScussion of the formal organizational 
component required by a 
hospital-wide educational program, is 
Introduced in the first chapter. 
However, this aspect is not developed. 
The second half of the book is 
devoted to sample program outlines, 
or "modules." These modules are 
presented In some depth since "the 
authors hope that they may act as a 
guide to establishing and expanding 
training programs on a hospital-wide 
basis." 
At intervals throughout the first 
half of the book, the authors indicate 
that they perceive the role of a hospital 
education program as being 
considerably broader in scope than 
simply to serve hospital needs. For 
example, mention is made, on pp. 15 
- 16, of hospital sponsored classes 
that "eliminate basic educational 
deficiencies and lead to a high school 
diploma." In light of existing 
educational resources for upgrading, 
e.g.. high school, adult learner 
classes, and college preparatory 
programs, duplication of services by 
the hospital seems unjustified. 
Essentially, the authors appear to 
have achieved their stated goal of 
presenting in a single volume the 
synthesized elements of a 
hospital-wide educational program. 
Unless one is employed as an 
educational coordinator in an 
institution that uses this approach to 
inservice, the most informative 
aspects of the book would probably be 
chapters 2-4. The steps that are 
involved in planning and implementing 
a particular in service program are 
discussed here. 
This book cannol take the place of 
existing texts that deal with theories of 
learning or methods of instruction. 
However, it could serve as an adjunct 
In the development of specific, 
instructional programs. Nursing 
coordinators, in particular, might find it 
a useful guide to supplement other 
standard texts and articles. .. 



b
N
tCUU;) N
YV btCUUt" UI;)\,UUN I;) on all 
Items shown. for eroup purchases. 8I'aduatlon t . favors, etc. 
6,11 Same Items, Deduct 10%; 12-24 Same Items, Deduct 15% 
25 or More Same Items, Deduct 20% E 


, 
Me 


, 
/1M 'If 


Choose style you want. shown rlpt Pnnt ßlme (and 2nd 
line If desired) on dotted lines below. Chtd other Into In 
bol" on chart, tllJI I!uI S<<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, 
__ 10 .... .. I.... 


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 

 :




:
$;.

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
:' l

'. 

:. 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 

RË

;;
:=

eb:r
I


::
:n
th couþuot,. .. 
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 


I 
I 
. 
\ Ple..e add 50<< handlinll/Postagt I 
I enclose $ I on orders totallinl under $5.00 
No COD's or bill.ng to indi.,duals. Mass resldenls add 3% S. 1 I 
Send to . . 


I 
. 
I 
I 
I 
. 
Streel 
I City 
I... 


Use extra sheet lor addit.onal items or orders 
INITIALS as desired: _ _ _ 
TO ORDER NAME PINS, fill oul all information in box, lop 
left, clip ou1 and attach 10 this coupon 


State 
..-.. 


'1 
I 
.Zlp. .. 
.._1 



48 


The CanadIan Nurse February 1976 


... \11(1 i.Þ,-iHlllll 


\ 
) 


- 
\ 


- 


 


\ 


\\' 


- 
"""' 


-.) 


. First Aid 
Help Is,.. 
A 15-minute demonstration of first 
aid at the roadside-what to do in the 
critical minutes before police and 
ambulance arrive. A comprehensive 
treatment that includes not only 
on-the-spot assistance but also the 
individual responsibility of every 
motorist in today's traffic picture. 
Produced in co-operation with federal 
and provincial medical and traffic 
authorities. Commissioned to 
Chetwynd Films Limited for Health 
and Welfare Canada and available 
from any of the regional offices of 
National Film Board. 


. Sex Education 


VD - Fact Or Fantasy 
This is a 15-mlnute, color 
videotape describing what VD is, what 
symptoms to watch for and how to get 
treatment. Produced by the Division of 
Instructional Media Services, 
University of Toronto, this videotape 
can be purchased from: 
Media-Science, 728 Bay Street, 
Toronto, Ontario, M5G IN5. 


Purposes of Family Planning 
This is a 18 min. color film of the 
positive purposes of family planning- 
health, emotional stability, a child s 
need for individual love and attention 
- presented simply for all ages and 
income levels. To request this film 
contact the Canadian Film Institute, 
303 Richmond Rd.. Ottawa, Ontario 


4\00 


About Conception 
and Contraception 
This is a 12 min. color film 
illustrating reproductive physiology, 
sexual intercourse, conception, and 
methods of contraception. To request 
this film contact the Canadian Film 
Institute, 303 Richmond, Rd., Ottawa, 
Ontario. 


. Obstetrics 


Becoming 
In Super 8mm, 30 min. long, this 
describes the Lamaze method of 
natural childbirth. It deals with the 
physical and psychological factors of 
nonmedicated birth, and stresses the 
roles played by physician, nurse, and 
husband in creating and sustaining 
confidence within the family. 
The film is designed for nursing 
education and inservice training, 
childbirth educational classes, and 
classes dealing with family dynamics 
and human relationships. It may be 
purchased from: Hospital Audio Visual 
Education, 606 Halstead Ave., 
Mamoroneck. N.Y., 19543, U.S.A. 


Hello World 
This is a 35-minute, 16mm film 
designed to answer the questions that 
prospective mothers and fathers have 
about the birth of their child. The film 
was made by the Ottawa-Carleton 
Regional Health Unit in cooperation 
with the University of Ottawa and the 
Ottawa General Hospital's Obstetrics 
and Gynecology Department. The film 
is available from the Ottawa-Carleton 
Regional Health Unit, 1827 Woodward 
Drive, Ottawa, Ontario, K2C OR5. 


. Pamphtets 
Easy Eating with Canada's 
Food Guide 
This is a nutrition publication 
containing suggestions on what to eat 
for weight control, convenience, 
snacks, and how to cut food costs. The 
pamphlet is available in quantity from: 
Communications Branch, Ontario 
Ministry of Health, Hepburn Block, 
Toronto, Ontario. M7A 1S2. 


. Catalogues 


Films on the Health Sciences is a 
recent catalogue of films researched 
and edited by Margaret Britt. Included 
in the catalogue are films in the 
following areas: addictions, 
adolescent development, adoption, 
anatomy, child care and development, 
dental health, diseases, first aid and 
safety, hospitals, marriage and family 
life, mental health, nursing and patient 
care, and mental illness. For your copy 
of the Films on the Health Sciences 
Catalogue, write to the Information 
Officer. Canadian Film Institute, 303 
Richmond Road, Ottawa. .. 


IJlu-u.-U ['ltdUh- 


Publications recently received in the 
Canadian Nurses' Association Library 
are available on loan - with the 
exception of items marked R - to 
CNA members, schools of nursing. 
and other institutions Items marked R 
include reference and archive material 
that does not go out on loan. Theses, 
also R. are on Reserve and go out on 
Interlibrary Loan only. 
Requests for loans, maximum 3 
at a time, should be made on a 
standard Interlibrary Loan form or on 
the "Request Form for Accession List" 
printed in this issue. 
If you wish to purchase a book, 
contact your local bookstore or the 
publisher. 


BOOKS AND DOCUMENTS 
1. Allied health material, a list to 
support an ongoing display sponsored 
by the Medical and Health Sciences 
Division, Canadian Book Publishers 
Council. Don Mills, Ont.. College 
Bibliocentre, 1974. 98p. (Its Current 
awareness lists) R 
2. American Hospital Association. 
Career goals of hospital school of 
nursing seniors: report of a survey. 
Chicago, c1975. 67p. 
3. Bailey, June J. Decision making in 
nursing: tools for change, by . . . and 
Karen E. Claus. St. Louis, Mosby, 
c1975. 167p. 
4. Bonnemaison, M. Pediatne, par 
et C. Joly. 3ed. Paris, MalOlne, 1975. 
411 p. (Diplôme d'état d'infirmiere) 


5. Brooks, Shirley M. 1939- 
Fundamentals of operating room 
nursing St Louis, Mosby. c1975. 
184p. 
6. BUisseret Irene de. Deux Langues, 
six idiomes. Manuel pratique de 
traduction de /'anglais au français. 
Ottawa, Carlton-Green Pub., 1975. 
480p. 
7. C.M.A. Conference on Negotiations 
and Physician Remuneration. Ottawa, 
Oct. 17 and 18, 1974. Proceedings. 
Ottawa, Canadian Medical 
Association, 1974. tv. (various 
pagings) 
8. Canadian National Conference for 
World Population Year, Ottawa. May 
10-11,1974. Report. Ottawa, 
Canadian Council for International 
Cooperation. 1974. 68p. 
9. Canadian Public Health 
Association. Annual meeting, 18-21 
June 1974, Sf. John's, Nfld. Patterns 
of health delivery rural and urban. 
Proceedmgs. Edited by Andrew 
Sherrington and Lowell W. Gerson 
Ottawa, Canadian Public Health 
Association, 1975 407p 
10. Canadian Red Cross Society. The 
healthy elderly 1ed Toronto, c1974 
69p. 
11. -. Healthy living. 1 ed. Toronto 
c1974 64p. 
12. Caribbean Nurses Organization. 
Biennial Conference, Ninth. Curaçao, 
July 27 - Aug. 2, 1974 Report. 
Kingston, 1975. 100p. 
13 Cintract. Maurice. Enseignement 
de techniques manuelles et 
electrotherapie en rècuperation 
fonctionnelle' T.MR. Paris, Maloine. 
1975. 157p. 
14. Curtin, Leah. The mask of 
euthanasIa. Cincinnati. Nurses 
Concerned for Life Inc., c1975 53p. 
15 Elliot, James R. Living m hospital: 
the social needs of people in 
long-term care. London, King 
Edward's Hospital Fund, 1975. 84p. 
16 Evans Richard Isadore, t922- 
Carl Rogers: the man and his ideas. 
New York, Dutton, c1975. 195p. (His 
dialogues with notable contributions to 
personality theory; v.8) 
17. Feller, Irving. 1925- Nursing the 
burned patient. by. . and Claudella 
Archambeaull Jones. Ann Arbor, 
Institute for Burn Medicine c 1973. 
407p. 



The CanadIan Nurse February 1976 


49 


I.lst I.IP- · atE 


t 


, 
. 


CURRENT 
DRUG 
HANDßOOK 


.,.,.. 
>' 
..<<"
 


Whatever your question on drugs in nursing care, you'll find the 
most recent clinical information in Current Drug Handbook 1976- 
1978 . . . and you'll find it quickly, too. 


Over 1,500 drugs are included in this softcover reference- 
grouped by usage and fully indexed by both proprietary and generic 
names. The tabular format lets you grasp pertinent facts at a glance: 
. name, source, synonyms and preparations (including the Canadian 
name if it is different than that used in the U.S.A.); 
. dosage and administration; 
. uses. both primary and secondary; 
. action and fate; 
. side effects and contraindications; 
. pertinent remarks. 


The drugs are grouped under 16 categories, such as Antiseptics 
and Disinfectants, Anti-infectives, Biologicals, Antihistimines, etc. This 
latest Handbook has added a separate category for Chemotherapy of 
Neoplastic Diseases. There's also vital new data on potentially fatal hyper- 
sensitivity reactions to penicillin therapy. All listings in the book have been 
checked and carefully up-dated to reflect today's most accurate phar- 
macologic information. 


By Mary W. Falconer, RN, MA. formerly Instructor of Pharmacology, 
O'Connor Hospital School of Nursing, San Jose; H. Robert Patterson. 
PharmD, Prof. of Bacteriology and Biology, San Jose State Univ.; and 
Edward A. Gustafson. PharmD, Pharmacist, Valley Medical Center. 
About 275 pp. Soft cover. About $6.90. Ready March 1976, 
Order #3567-9. 


BrinQs YOU 
thE latEst 
uSEful data 
on morE than 
1,500 druQs 
in common USE. 


Among the drugs added 
to the 1976-1978 volume, you'll find: 
Poloxamer -iodine (Prepodyne) used as an antiseptic. 
Miconazole nitrate (Monistat) in the treatment of can- 
d i d iasis. Silver sulfadiazine (Silvadene) for prevention 
and treatment of wound sepsis in patients with second 
and third degree bums. AmoxiciUin (Amoxil) in the 
treatment of susceptible strains of gram - H. influen- 
me, E. coli, P. mirabi/is, N. gonon'hoeae. gram + Strep- 
tococci (including S. faecalis). D. pneumoniae. 
nonpenicillinase-producing staphylococci. Cefazolin 
sodium (Ancef, Kefzol) for treatment of respiratory. 
genitouri nary, skin, soft tissue, bone and blood infec- 
tions - Cephapirin sodium (CefadyI) for the same uses 
as Cefazolin sodium . Cephradin (Velosef) for treat- 
ment of respiratory, urinary, skin and soft tissue infec- 
tions. and many other new agents. 


:tï' 
.o

r
s


o



t




NY CANADA LTD. Pncessubiecttochange_ 
r--------------------p,;;e
,;_---------------c
761 
I I 
I 0 Yes, send me a copy of Falconer et al.: Current I 
I Drug Handbook 1976-1978 (3567-9) just as FULL NAME I 
I soon as it is published. About $6.90, Examination I 
I on 30-dayapproval. POSITION a AFFILIATION (IF APPLICABLE) I 
I HOME ADDRESS I 
I I 
L [ check enclosed-Seunders pays postage [send C.O.D. . btll me CITY PROVINCE ZONE 
-----------------------------------------
 



50 


The Canadian N ur5e February 1976 


IJh.ou.oU 1
I.duh. 



I 


18. Goerzen, Janice L 1943- Review 
of maternal and child nursing, by. . 
and Peggy L Chinn. St. LOUIS, Mosby, 
CI975.210p. 
19. Grant, John Charles Boileau. 
Grant's Method of anatomy; by 
regIOns, descnptlVe and deductive. 
ged. Edited by John V. Basmajian. 
Baltimore, Williams & Wilkins, 1975 
654p. 
20. Harmon, Vera M. Nursing care of 
the skin: a developmental approach. 
by . . . and Shirley M. Steele. New 
York, Appleton-Century-Crofts. 
c1975. 133p. 
21. Jakobi, William. The 
cardiovascular system as it relates to 
heart pacing' a learning and 
reference guide for Medtronic 
employees and others concerned 
with pacemakers. Minneapolis, Minn., 
Medtronlc, c1975. 482p. 
22. Kientz, Albert. Pour analyser les 
media: ranalyse de contenu. 2ed. 
Paris, Mame, c1 971. 175p. (Collection 
Médium) 
23. Leininger, Madeleine M. Health 
care Issues, 1974. Philadelphia, Pa., 
Davis, 1974. 163p. (Health care 
dimensions. Fall 1974) 
24. Levine, Harry D. Factors affecting 
staffing levels and patterns of nursing 
personnel, by. and P. Joseph 
Phillip. Bethesda, Md.. U.S. Division of 
Nursing, 1975. 110p. (U.S. DHEW 
Publication no. (HRA) 75-76) 
25. Messel, Meer Abramovich. Urban 
emergency medical service of the city 
of Leningrad. Bethesda, Md., National 
Institutes of Health, 1975. 287p. (U.S. 
DHEW Publication no. (NIH) 75-671) 
26. Mousseau-Gershman, Yolande. 
Manuel de travaux pratiques en sante 
communautaire; perspective 
internationale. Montréal. Les Editions 
HRW, c1975. 155p. 
27. National League for Nursing. 
Division of Research. State-approved 
schools of nursing - R.N.; meeting 
minimum requirements set by law and 
board rules in the various jurisdictions 
1975. New York, 1975. 137p. 
28. Nurse ' by Giles. London, 
Beaverbrook Newspapers, c1975. 1v. 
29. PaedIatrics and the environment. 
Scientific proceedings of the 2nd 
unigate Paediatric Workshop held 
at . . . London, June 1974. Edited by 
Donald Barltrop. London, Fellowship 
of Postgraduate Medicine, c1975. 
106p. 


30. ProfessIonal nurse gUIde, 1975. 
Richmond, Va., Health Publications, 
Inc , c1975. 64p. 
31. Reilly, Dorothy E. Behavioral 
objectives in nursing: evaluation of 
learner attainment. New York, 
Appleton-Century-Crofts, c1975. 
178p. 
32. Richard, Robert N. Venereal 
diseases and their avoidance. New 
York, HolI, Rinehart and Winston, 
c1974 187p. 
33. Robert, Paul. Le petit Robert 2. 
Dictionnaire universel des noms 
propres. Paris, S.E.P.R.E T., 1974. 
1992p. 
34. Robertson, Elizabeth Chant. The 
nght combination: a guide to food and 
nutntion. Toronto, Gage Educational 
Pub. 1974, c1975. 32p. 
35. St. Mary's Hospital Medical 
Center, Madison, Wis. Clinical 
laboratory manual. St. Louis, Catholic 
Hospital Association, c1975. 474p. 
36. Secourisme. 3ed. canadienne. 
Ottawa, L ambulance St-Jean. c1 974. 
264p. 
37. Shannon, Gary W. Health care 
delivery: spatial perspectives, 
by . and G.E. Alan Dever. New 
York, McGraw-Hili, c1974. 141p. 
(McGraw-Hili problem series in 
geography) 
38. Sparrow, Christopher J. An 
annotated bibliography of Canadian 
air pollution literature, compiled 
by . . . and Leslie T. Foster. Ottawa, 
Environmental Protection Service, 
EnVIronment Canada, 1975. 270p. 
39. Stevens, Barbara J. The nurse as 
executive. Wakefield, Mass., 
Contemporary Publishing, c1975. 
260p. 
40. Tichy, Monique K. Health care 
teams an annotated biblIography. 
New York, Praeger, c1974. 177p. 
(Praeger special studies in U.S. 
economic, social, and political 
issues.) 
41. Villet. Barbara. Head nurse New 
York, Doubleday, 1975. 201p. 
42. Wandell, Mabel A. 1917- Quality 
patient care scale, by . . . and Joel W. 
Ager. New York, 
Appleton-Century-Crofts, c1974. 82p. 
43. -. The Slater nursing 
competencies rating scale, 
by , . . and Doris Slater Stewart. New 
York, Appleton-Century-Crofts, 
c1975. 101 P 


44. World Health Organization. Fifth 
report on the World Health situation 
1969-1972 Geneva, 1975. 322p. 


PAMPHLETS 
45. Aaron, Dorothy. About face; 
towards a positive image of women in 
advertising. Toronto, Ontario Status of 
Women Council, 1975. 30p. 
46. Association of Registered Nurses 
of Newfoundland. Personnel Service. 
Rational for the service. St. John's, 
Feb 1975. 4p. 
47. Brown, Muriel. The joint social 
information unit. An 
interorganizational approach to the 
provision of information for the health 
and social servicés. London, King s 
Fund College, 1974. 16p. (King's Fund 
Project paper, no. 6) 
48. Bush, William L The directory of 
audio-visual aids for hospital safety 
programs, by . . . and Ronald J. 
Cogan. Diamond Bar, Calif., Quest, 
1974. 15p. 
49. C.C.H Canadian Limited. Your 
Canada pension plan 1975. Don Mills 
Ont., c1975. 38p. 
50. Canadian Conference on the 
World Food CrisIs. Ottawa, Oct. 8, 
1974. Report. Ottawa, Canadian 
Council for International Cooperation, 
1975. 30p. 
51. Canadian Red Cross Society. 
Alberta - N.WI. Division. Family 
Health Department. Operation alert; 
security guide for senior citizens. 
Calgary, Alberta, 197? 28p. 
52. Canadian Tuberculosis and 
Respiratory Disease Association. 
Report 1974-75. Ottawa, 1975. 11p. 
53. Consultation on wider issues in 
nursing education, Birmingham, 4-6 
Jan. 1974. Some of the papers given. 
London, Institute of Religion and 
Medicine, 1974. 28p. 
54. Dutra de Oliveira, J.V. Food and 
nutrition. Toronto, General Foods, n.d. 
18p. 
55. Gardner, Robin. Nursing 
diagnosis. Toronto, 1972. 28p. 
56. Hollingsworth, Dorothy. NutritIOnal 
problems in an affluent socIety. 
Toronto, General Foods, n.d. 12p. 
(General Foods Ltd. Distinguished 
international lectures on nutrition) 
57. Irwin, Theodore. Male 
"menopause" crisis in the middle 
years. New York, Public Affairs 
Committee, c1975. 28p. (public 
Affairs pamphlet no. 526) 


58. Katzell, Mildred E. Productivity, 
the measure and the myth. New York 
Amacon, c1975. 38p. (AMA survey 
report) 
59. Levenson. Goldie. Type, length, 
and cost of care for home health 
patients. A report of the discharge 
summary feasibility study. New York 
National League for Nursing, CounCI 
of Home Health Agencies and 
Community Health Services, c1975 
15p. (NLN Pub. no. 21-1589) 
60. Montag, Mildred L Where is 
nursing going? The Ruth V. Mathene) 
Memorial lecture presented at the 
1975 N.LN. convention, New 
Orleans, Louisiana. New York. 
National League for Nursing, 
Department of Associate Degree 
Programs. 1975. 9p. 
61. National Conference on Employel 
Physical Fitness, Ottawa, Dec. 2, 3, 
and 4, 1974. RecommendatIons 
Ottawa, Health and Welfare Canada 
1975. 7p. 
62. National League for Nursing. 
Statement of purpose. . . approved 
by the Board of Directors,. . May, 
1975. New York, 1975. 1p. 
63. -. Council of Diploma Programs 
Characteristics of diploma education 
In nursing. New York, 1975. 5p (NLN 
Pub. no. 16-1588) 
64. -. Dept. of Diploma Programs. 
Criteria for the evaluation of diploma 
programs in nursing. 4ed. New 'York 
c1969, 1975. 19p. 
65. -. Division of CommuOily 
Planning. Outdate 
 update 
continuing education. who, what 
where, when, how. Papers presentee 
at the Conference of the Northeast 
Regional Assembly of Constituent 
Leagues, New York. 1975. 37p. 
66. New Brunswick Association of 
Registered Nurses. Folio of reports, 
June 10-12, 1975. Fredericton, 1975 
14p. 
67. Newcombe, H.B. A method of 
monitonng nationally for possIble 
delayed effects of various 
occupational environments. Ottawa. 
National Research Council of Canada 
1974. 42p. 
68. Ontario Hospital Association. 
Guidelines for emergency 
departments. Toronto, Ontario 
Hospital Association, 1975. 16p. 



The Canadian Nurse February 1976 


51 


69. Ozimek, Dorothy. The future of 
nursing education. New York, 
Nallonal League for Nursing, Dept. of 
Baccalaureate and Higher Degree 
Programs, c1975. 20p. (NlN Pub. no 
15-1581) 
70 Registered Nurses' Association of 
British Columbia Basic nursing 
education programs m British 
ColumbIa. Vancouver, Registered 
Nurses' Association of British 
Columbia, 1975. 27p. 
71. -. Studying' a learnmg package 
to assist candidates who are 
preparing to write registration 
exammations. Vancouver, 1975. 11p. 
72. Royal College of Nursing of United 
Kingdom Report 1974-75. London. 
1975 16p. (RCN Nurs Standard no. 
46, supplement, Sep.lOct. 1975) 


73. Rozovsky, Lorne Elkin The 
hospital's responsibility for quality of 
care under English common law 
Presented on Se;>. 24. 1975 at The 
National Conference on Health and 
the Law. Ottawa, 1975. 11p. 
74 Séminaire national sur Ie thème 
nutntlon: controverses et prlontes. 
Ottawa, 7 mal. 1975. Programme 
Ottawa, Conseil des Sciences du 
Canada, 1975. 19p. 
75. Stein, Morris I. The physiognomIc 
cue test: a measure of a cognitive 
control principle. Manual for PCT. 
New York, Behavioral Publications. 
c1975. 30p. 
76. Spector, Audrey F Regional 
planning for nursing education in the 
South, 1972-1975: a study in 
transition. Atlanta, Ga., Southern 
Regional Education Board. 1975. 42p 


77. Symposium on Primary Care to 
the Elderly Patients, Sept. 10. 1974 
Ottawa Proceedings. Ottawa. 
Council on Medical Services, 1974 
Iv (various paglngs) (Council on 
Medical Services. Minutes of meeting, 
Sept. 9-10. 1974, appendix 1) 
78. Victorian Order of Nurses of 
Canada. Report 1974. Statistical 
supplement. Ottawa, 1974. 44p. 
79. Wandelt. Mabel A 1917- 
Definitions of words germane to 
evaluatIOn of health care. New York, 
National League for Nursing. Council 
01 Baccalaureate and Higher Degree 
Programs, 1975. 4p 
80. Wini.::k, Myron. Nutrition and 
mental development. Toronto, 
General Foods. n.d. 8p. 
81 Yale University. School 01 
Nursing. StudIes in nursing. Abstracts 


of reports submItted m partial 
fulfillment of the requirements for the 
degree of Master of Science m 
Nursmg. Sertes XVII. 1975. New 
Haven, Conn.. 1975. n.p. 


GOVERNMENT DOCUMENTS 
Canada 
82. Advisory Council on the Status of 
Women. Report 1974/75 Ottawa, 
1975 n.p. 
83. Blbllothèque national du Canada. 
Format de communication du MARC 
canadien; monographies 2éd. 
Ottawa Bureau MARC canadien, 
Direction de la recherche et de la 
planification. 1974. 92p. 
84. -. Inventa"e des publications en 
serie dans les domaines de 
I'educatlon et de la soclologle 
disponibles dans les bibliotheques 
canadiennes. Ottawa, 1975. 221 p. 


Are International Horizons for You? 
They can be yours when you read the 
International Nursing Review 


The InternatIonal Nursmg RevIew, official journal of the International Council of Nurses. is one of the nursing profession s most prestigious 
publications, read regularly by nurses In more than 100 countries around the world. Through its extensive coverage of nurSing affairs worldwide 
readers of the InternatIOnal Nursing RevIew can 
.. follow international trends In nursing 
.. follow activities of their colleagues in othe' countries 
.. keep up to date on international meetings and seminars 
e Increase then professional awareness outside their own country. 
SIX Information-packed issues per year will be yours when you fill out the coupon below and mail Don't miss the highhghls of the commg year in 
International nursing. Send your order now - and send a gift subscription to a friend at the same time. 
tnternational Council of Nurses 
P.O. Box 42 
CH - 1211 Geneva 20 Switzerland 
Please enter my subscription to the InternatIonal Nursing RevIew 
I enclose SWISS francs 34.00 (or US$12.00 or Enghsh E4.50) for one year (Please bill me for) 
Please print 
Name 


Street 
City 
Province 


Position 
Institution 
Country 


Signature 


Please enter a subscription to the International Nursing Review as a g,ft trom me for the person named below: 
1 enclose Swiss francs 3400 (or US$12 00 or English E4.50) for one year (Please bill me for) 
Name Position 


Street 


City 
Province 


Institution 


Country 



S2 


The Canadian Nurse February 1976 


l..i In-i"-!) ['I)(ht ft>> 


85. Commission royale d'enquête sur 
la situation de la femme au Canada. 
Rapport. Ottawa, Information 
Canada, 1970. 540p. 
86. Conseil national de recherches du 
Canada. Comité associé sur les 
critères scientifiques concernant I'ètat 
de I'environnement. Rapport 
d'activité, fevrier 1975. Ottawa, 19 7 5. 
63p. 
87. Dept. of Fif'lance The tax 
treatment of charities. Ottawa, 1975. 
14p. (Discussion paper) 
88. Dept. of Labour. Legislation 
Branch. Human rights in Canada 
1975. Ottawa. Information Canada. 
1974.70p. 
89. Health and Welfare Canada. 
Canada's mental health, v.23, no. 5, 
supplemenl1975. Ottawa, 1975. 20p. 


Tropical 
and 
Parasitic 
Diseases 


90. -. Fitness and Amateur Sport 
Branch. Revised Terms and 
conditions for contributions. Ottawa, 
Health and Welfare Canada, 1975. 
10p. 
91. -. Non-medical Use of Drugs and 
Directorate. Research on drug abuse 
1973. Ottawa, Health and Welfare 
Canada, 1973. 1 portfolio. 
92. Information Canada. Photos 
Canada v. 1-5. Ottawa, Information 
Canada, c1964-1974. 4v. 
93. Labour Canada. Legislation 
Research Branch. Labour standards 
in Canada, 1964-1974. Ottawa, 
Information Canada, 1975. 11 v. 
94. Law Reform Commission. Study 
papers prepared for the 
Administrative Law Project. Ottawa, 
1974. 1v. 


Seneca College is offering short courses at the post- 
diploma level in Tropical and Parasitic Diseases. Courses 
start in February and September: 
International Health Course-One Semester 
Preparation to function intelligently in an environment 
where such diseases pose a health problem. 
International Health-Short Course 40 hours 
Incorporated in Ihe one semester course. Emphasis on: 
Incidence of tropical and parasitic disease in Canada, 
detection and referral, prevention and control. 
For further information, contact the Admissions office 
at the address ÍJelow, or telephone (416) 494.8900. 


j "W SENECA COLLEGE 
OF APPLIED ARTS AND TECHNOLOGY 
"'" 11>> SHEPPARD AVENUE EASI WllIOWDALE ONTARIO Mlk IEl 


95. -. Section de la formation et du 
perfectionnement du personnel. 
Comment préparer un 
organigramme: un manuel 
d'enseignement séquentlel. Rédigé 
par Louise Newton. Ottawa, 
Information Canada, 1975. 1 v. 
(various pagings) 
96. Manpower and Immigration. 
Canadian glossary of training terms. 
Ottawa, Information Canada, c1975. 
30p. 
97. Medical Research Council. Grants 
and awards guide 1975. Ottawa, 
Information Canada, 1975. 76p. 
98. National Library of Canada. 
Research collectloRs m Canadian 
Libraries, /I Special studies, 2 Federal 
government libraries. Ottawa, 1974. 
231p. 


Ontario 
99. Council of Health. Health 
information and statistics. Toronto, 
1975. 61p. 
100. -. The nurse practitioner in 
primary care. Toronto, 1975. 41 p. 
101. Laws, statutes, etc. The 
environmental protection act, 1971. 
Statutes of Ontario, 1971, chapter 86. 
Toronto, Queen's Printer and 
Publisher, 1971. 36p. 
102. Ministry of Health. Report, 
reaction, response; the health care 
system in Ontario. A review of the 
reaction to the Report of the Health 
Planning Task Force and a summary 
of common ground on which health 
care strategy can be advanced. 
Toronto, 197? 16p. 
103. Ministry of Labour. Research 
Branch. Major medical, prescription 
drug and dental plans in Ontario 
collective agreements. Toronto, 1975. 
18p. 
104. -. Selected cost-of-living 
provisions in Ontario collective 
agreements. Toronto, 1975. 13p. 
(Bargaining information series, no. 7) 
105. -. Sick leave plans and weekly 
sickness and accident indemnity 
insurance plans in Ontario collective 
agreements. Toronto,. 1975. 18p. 
(Bargaining information series, no. 5) 


Quebec 
106. Ministère des affalres soclales. 
Enquête alimentaire en milieu scola ire 
au Quebec (niveau secondaire) 
Québec, Mimstère des affaires 
sociales, 1972. 67p. 


STUDIES DEPOSITED IN CNA REPOSITORY 
COLLECTION 
107. Anderson, Joan Madge. The 
concerns and coping behaviours of 
the single mother with a child aged SIX 
months to eight years. Montreal, 1973. 
130p. Thesis (M.Sc. (Appl.))-McGill. 
R 
108. Bajnok, Irmajean. A comparison 
of the quality of care provided by 
registered nurses working the 
twelve-hour shift and those working 
the eight-hour shift in a large general 
hospital. London, 1975. 251 p. (Thesis 
(M.Sc.N.) - Western Ontario. R 
109. Desjean, Georgette. The 
problem of leadership in French 
Canadian nursing. Detroit, Mich.. 
1975. 308p. Thesis Wayne State. R 
110. Gousse, Claude. Les 
préoccupations des infirmiéres. 
Rapport final. Etude préparé pour 
I'AIIPQ par. . . en collaborations avec 
André Gagnon de Cadres 
Professionnels Inc. Montréal, C.R. 
OPP. Inc., 1970. 1v. R 
111. Ingenito, Françoise. Memoire sur 
la penurie d'infirmiéres présenté 
par. . . et Suzanne Rollin-Lepage et 
patronné par I'Université du Québec, 
direction des études Universitaires 
dans I'Ouest québecois. Hull, P.Q., 
Conseil de la Santé et des Services 
sociaux de I'Outaouais, 1975. 150p. R 
112. Kotaska, Janelyn Gail. The effect 
of guidance on learning in 
independent study. Vancouver, 1973. 
87p. (Thesis (M.Sc.N.) - U.B.C.) R 
113. McEwan, Ada E. Report of World 
Health Organization study tour of 
Sweden, Denmark, the Netherlands 
and Great Britain. Ottawa, Victorian 
Order of Nurses for Canada, 1975. 
25p. R 
114. Paquette, Claire. Personal 
history of persons complaining of 
back pam: a psychosocial approach. 
Seattle, 1972. 163p. (Thesis (M.A.)- 
Washington) R 
115. Pope, Alice Marion. Canadian 
Health Services used by Korean 
immigrants and their perceptIOns of 
the helpfulness of those services. 
Toronto, c1975. 132p. (Thesis 
(M.Sc.N.) - Toronto) R 
116. Service de dépistage des 
problèmes auditifs pour les comtés de 
Prescott et Russell, Ontario. Project 
décibel. Rapport final. Hawkesbury, 
Ontario, 1975. 21p. R 



The CanadIan Nurse February 1976 


S3 


"The more you 
want from nursing, the 
more reason 
you should be 
Medox:' 


Virginia Flintoft, R.N., Staff Supervisor 


\ 


"" 


,'! ..... 


" 


Do y ou want to: 
. increase the variety of your work and gain 
experience to help you specialize? 


Work in a hospital, a nursing home or a doctor's office. Enjoy as- 
signments in a private residence, hotel or summer camp. Perhaps 
you want specialized experience in CC.. IC or another field. Medox 
can give you more variety. 


. work for a company that takes special care 
of its nurses in every way, including pay? 


Medox employs the best people at the best rates of pay in the 
temporary nursing field. You owe it to yourself to contact Medox. 


. free yourself from too many mandatory 
shifts and shift rotation? 


Medox nurses get the best of both worlds: the assignments they 
want and the shift work they prefer, Because there are more as- 
signments available. 


. to take advantage of free-lance nursing 
without the paperwork? 


When you work with Medox, we look after all paperwork. We pay you 
weekly and make normal deductions. Medox is your employer: the 
times, shifts and assignments are yours to choose. 


trade the rigid schedules of full-time nurs- 
. ing for the flexibility of temporary or part- 
time work? 


. choose to work only one or two days a 
week? 


As a Medox nurse, you can ease off the strict schedules of full-time 
nursing. Cut down to a few shifts or split shifts a week: the choice is 
yours. 
As a Medox nurse, you can pick the days you want to work; you're 
automatically on call forthe time you want. Medox nurses have more 
time to themselves, they can arrange as many "free" days as they 
want. 


. work shifts that tie in wIth your husband's 
work schedule? 


Wouldn't it be nice to work the same shifts as your husband: both 
home together and both earning good incomes? If his shifts change, 
Medox will arrange to change yours too. 


. retire from nursing, but not completely? 


If the idea of retirement appeals to you, yet not the thought of forced 
inactively, becomes a Medox nurse, Be retired on the days you want. 


.. As a registered nurse 
with more years experi- 
ence behind me than I 
care to think about, I 
know how important il 
is to keep growing in your job-to 
avoid that awful feeling of being 
stuck in the same rut. Certainly 
what you're doing is tremendously 
worth-while, and heaven knows 
there is a desparate shortage of 
nurses, But your job must be 
worthwhile to you, or else youïl 
eventually want to drop out". 
"That's why Medox has so much 
to offer a nurse today". "You see, 


at Medox. we supply quality nurs- 
ing staff on a temporary assignment 
basis to hospitals, clinics, doctors' 
offices, nursing homes and private 
residences. We're a part of the 
world-wide Drake International 
group of companies and we operate 
in major cities across Canada. the 
U.S. U.K. and Australia" 
"As far as you're concerned. 
however, the key phrase is "Tem- 
porary Assignments". Because, as 
you can see by the chart above, you 
can choose just about any working 
condition, or shift, or professional 
discipline you want". "It come
 


down to this: if you want more from 
nursing than you're getting now, 
talk to Medox". 
"Write to me, Virginia Flintoft, 
R.N" Staff Supervisor, Medox, 55 
Bloor St. W., Toronto, Ontario, or 
call the local Medox office". 


lM:EDoXJ 


a DRAKE INTERNATIONAL comp.nt' 


If you care for people, 
you're Medox. 



54 


Advertising 
rates 


For All 
Classified Advertising 


$15.00 for 6 lines or less 
$2.50 for each additional line 
Rates for display 
advertisements on request 


Closing date for copy and 
cancellation is 6 weeks prior to 1 st 
day of publication month. 
The Canadian Nurses Association 
does not review the personnel 
policies of the hospitals and agencies 
advertising in the Journal. For 
authentic information, prospective 
applicants should apply to the 
Registered Nurses' Association of 
the Province in which they are 
interested in working. 


Address correspondence to: 


The Canadian Nurse 


50 The Driveway 
Ottawa, Ontario 
K2P 1 E2 



 



, 
-"" 


H4'" 
OFF 
'4CE 


I 
1 
I 


, 



 

 

m\ H.\PPY! I 
h,.d ugl
 ,upertluou, hair. . W." 
unloved _ di'>C,'uraged. Iried man\ 
Ih1llg
. . e\en ra"o;
. "Jolhing \\oa', 
'ali
faclOr
. J hen I dnd"ped a 'illl- 
pie. painle". ine....pl.'n,i\e. nondeclric 
Illelhod_ II ha, helped Iholl,.lIld, \\0 in 
beaUI}. Ime, h.tppine',. \J
 I'RFF 
boo". 'Whal I Did Ah"UI SlIpcr- 
fllll'u
 
hllr" e....plain' melh"d. I\Jailed 
in plain elnel,'pe. AI", Iri.11 Olfer. 
\VI ill.' \Jme Annellc 1.IIlLelle. P.O. 
80\ 610. Depl. C-flJ2. Adelaide SI. 
P.O.. Toronlo 210. Onl. 


LOVE IIUIIsf.' 


I 


The Canadian Nurse 


('Ialssi 11(>>(1 
.6. \(I
(>>I.' is(>>III(>>II'H 


Alberta 


Reglst
red Nurses required for lO-bed accredlled aC1lve treatment 
Hospital Full lime and summer relIef All AARN personnel polloes. 
Apply In writing to the Director of Nursing, Drumheller General Hospi- 
tal Drumhe1ler. Alberta 


British Columbia 


Expenenced General Du1y Nurses required for small hospital North 
Vancouver Island area Salary and personnel policies as per RNABC 
contrad Residence accommodatIOn $30.00 pel monlh Transporta 
lion paid from Vancouver Applylo Director of NurSing. Sf. George S 
Hosprtal. Box 223 Alert Bav. BnllSh ColumbIa VON lAG 


Experienced Nurses (eligible for B C reglstrahon, required 10..... 
409-bed acute care. teach,ng hospl1al localed In Fraser Valley 20 
minutes by freeway from Vancouver. and wllhln easy aCceSS of vaned 
recreahonal facllttles Excellent Onenlallon and ContinUing Educallon 
programmes. Salary S 1 049 00 to S 1.239.00. Clinical areaS Include: 
Medicine, General and Specialized Surgery Obstelncs PedlalncS. 
Coronary Care. HemodialysIs Rehabilitation. Operallng Room. Inlen- 
slve Care. Emergency Practical Nurses (eligible for B C license) 
also reqUired Apply 10 AdmIOlstratlve Asslstan1. Nursing Personnel. 
Royal Columbian Hospllal. New Westminster. Bntlsh Columbia. 
V3L 3W7 


General Duly Nurses lor modern 41.bed hosprtal localed ón Ihe 
Alaska H'ghway Salary and personnel pohcles In accordance wl1h 
RNABC Accommodallon available In residence Apply Director of 
Nursing. Fori Nelson General Hospl1al. FOr1 Nelson. British C
umbla 


General Duly Nurses lor modern 35-bed hosprtallocated In south- 
:
 B





f{o
e
n w



c:


t
,
re


nB



i


 
Nurse s home. Apply Director 01 NurSIng, Boundary Hospital Grand 
Forks British Coiumbla. VOH IHO. 


Nova Scotia 


F8culty Positions - Posl1lons available for all cllnlcar nurSing areas 
In an Integrated four-year baccalaureate program offered In coopera- 
tion with DalhOusie Umverslly School of Nursing Master S degree In 
clinical speciality areas. and/or cUrriculum development. educahon 
required. POSlhons Inv
ve responsibility for theory and cllmcal teach- 
Ing In local hosprtals Candidates should be avaIlable July 1, 1976 
Appllcahons. wl1h curricula vllae. should be directed 10 Dr Waher 
Shelton. AcedemlC Dean Mount Saint Vincent UniverSity Halifax. 
Nova Scolla B3M 2J6 Caneda 


Ontario 


Registered Nurses lor 34.bed Genera' Hospllal Salary $945 00 to 
$1 14500 per monlh. pluS expenence allowance Excellent personnel 
pol'cles Apply 10 Director of Nursing Englehart & Dlstnct Hospital 
Inc.. Englehart. Onlano. POJ IHO 


Registered Nurses and Registered Nursing AssIstants tor 45-beo 
Hospl1al Salary ranges ,nclude generous expenence allowances 
R N s salary $1 045 10 $1 245 and R N A s salary $735. to $810 
Nurses residence - pnvate rooms with bath 
 $60. per monlh Apply 
to The Dlreclor of Nursing Geraldton Dlslnct Hospital Gerald10n 
Onlano, POT 1 MO 


Registered Nurses required for our uhramodern accredlled 79-beo 
General HospItal In bilingual community of NOr1hern Ontano. French 
language an assel but nol compulsory Salary is $1 115 to$I,315. 
monthly with allowance for pasl expenence and 4 weeks vacation 
aher 1 year Hosprtal pays 100 0 001 0 H I.P , Llle Insurance (10.0001 
Salary Insurance (75 0 .0 of wages to the age 0165 wilh U tC carveout). 
a 35c drug plan and a dental care plan. Master rotation In effect 
Furnished bachelor apartments available nearby and reserved 
through the Personnel Department Excellent personnel poliCies. 
Apply 10 Personnel Dtrector Noire-Dame Hospllal. POBox 8000. 
Hearst. Ontaflo. POL 1 NO 


Quebec 


Nurses for Chlldren's Summer Camps in Quebec. Our member 
camps are located In the laurentlan Mountains and Eastern Town- 
ships within 100 mile racbus of Montreal. All camps are accredited 
members of the Quebec Camping Assooatlon Apply to Quebec 
CampIng Association. 2233 Belgrave Avenue Montreal. Quebec. 
H4A 2L9. or phone 489 1541 


February 1976 


Quebec 


Registered Nurses and Nurses Aides wanled for summer camps 
end of June toendof August MUS1 be qualified to wortlln Quebec. Will 
consider one month Or two month baSIS. Apply JewlSt'l Community 
CampS, 5151 Cote Sle. Catherine Road Montreal Quebec H3W 
IM6 Telephone (514) 735.3669 


One RegIstered Nurse lor ChIldren s Co-Ed Camp End 01 June to 
August 201h. Prefer season $700 plus Iravel laurenftan Region. 
Doctor on staff. excellent facilities Wn1e. Joseph A Ffledman. Dlrec- 
lor YM-YWHA & NHS ot Monlreal 5500 Weslbury Avenue Montreal 
H3W 2W8 Quebec 


Saskatchewan 


Director of Nursing required for acllve rural hospItal In Southern 
Saskatchewan Duties 10 commence Immediately Salary according 
10 schedule and expeltence Fm furthØf Informalion please conlad 
Clifford Day. Chairman. or G.P Williamson. Secretary-Treasurer. 
Kincaid Union Hospllal. Kincaid Saskalchewan 


Director 01 Nursing: Immediate applicattons are Inv..ed for the POSI- 
hon of Director of NurSing In the 43-bed Wadena Umon Hospl1a1. 
Fnnge beneflls Inelude Registered PenSIOn Plan. Group life Insur- 
ance and Income Replacemenl Plan ThiS IS a seven year old wen- 
eqUipped hOspl1alln a town of 1500 populahon serving a large rural 
population Wadena IS centrally toealed 130 miles from each of two 
major Saskalchewan centres SupervIsory experience IS eSsenllal 
Nursing Admlnislratlon COurse desirable Attradlve salary scale 

:


 AJ
I
;t
;;'sgp

rlj


loB
=nc;
xW


: to S





:

: 
SOA 4JO 


Registered Nurses are required immedl
tely for the 43-bed Wadena 
Union Hospital This IS a modern, altraChve acute care hospital 
situated in the lown of Wadena. Saskatchewan. a friendly parkland 
community wdh a population of 1500 At1raChve salary and fTinge 
benefits are provided under the Saskatchewan Umon of Nurses ag- 
reemenl In effect Please direct applications to Admlnls1rator. 
Wadena Union Hospital. POBox 10. Wadena. Saskatchewan 


United States 


Landed Immigrant Nurses - If you are looking for an exciting 
change then contact uS We are offenng SRNs the opportunity to work 
In the USA for SIX months or longer Choice locations available. We 
w.1I pay your fare and arrange accommodations for you Free Health 
Insurance and Visa Sponsorship Write Fllst Gill International. 333 
North MlchlQan Avenue Chicago. illinOIs. 60601 


R.N.'s -Iowa Methodist Medical Center invites you to explore nurs- 
Ing opporlumlreS In orthOpediCs. rehablhlallon ICU and CCU. 
medIcal-surgical and pedlatncs 700-bed general teaching hospl1al 
wllh expansion plan Well organized and directed nursing program 
::

 b

:c.l
r
:
t




1:1

:

r:rÝ
%
cimE



I






:1 
Will asslsl wl1h vISa for Immigration tf Inleresled In further details 
please contact Personnel Director. Iowa Melhochsl Medtcal Center. 
1200 Pleasant Streel Des Mornes. Iowa, 50308 or phone (5151 
283-6313 


1exas wants you! If you are an RN. expenenced or a recent 
graduale. come to Corpus Christ, Sparkling City by the Sea a city 
bUilding for a beller fulure. where your opportumhes lor recreation and 
slucbes are limitless MemOrial Medical Center 500-bed. general. 
teaching hospital encourages career ad\fancement and provides In- 
servIce orientation Salary from $78520 to $1 052 13 per month 
commensurate wtlh educahon and expenence Dlfferen1'al for Ø\fen- 
'ng shifts available. Benefits Include holidays. sick leave. vacations. 
pad hOspitalization heallh life Insurance. pension program Become 
a vllal pert 01 a modern. up-Io-dale hospital wnte or call John W 
Gover Jr. Director of Personnel. Memonal Medical Cenler. P.O. Box 
5280. CorpuS Chnsli' Texas 78405 


R .N_'s needed Immediately for a 31-bed acute care hospital Rotahng 
shifts. We will assist In making arrangements to come to beautiful 
WYOming Call CoIlecI: Director 01 Nurses. Cheryl 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 


" 
, '! .1 


 
 '
 V 
'.
.. 
. 
 "'<J'
 


, 


1\ 4
. 



" 
" 


I. Health and Welfare Canacb S..nte el 8.en-elre .0<:1..1 Cana
 


I
" ... 


NAME 


ADDRESS 


CITY 


'" 
"-- 


PROVINCE 


POSTAL CDDE _ 


PHDNE 



58 



u
 
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... 


,.-- -' 
. '9 


- 
\.;'" 


Saint John 
General 
GJIoÆPital 
SaintG}ohn,NB, 
CANADA 


.J 


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 


-
! 
,. ô?- ....._.. r--"'
....._ 
;r

;

 
:!::::
!!)
':',..7 
:--.F -.
 ....,
 

/7 ,;;/-. . t ""'
":1'-
"_'" . 
-
 
 



... 
 
-; ..< :


.
:'-";
J... --
. ..- ø 
.


:

,. ()' '
?
 . __J.. ';.-'
' 



:-
"'_.u. - 
 If' - 
_-:, .i'r'"
' 'J ::, 
.....
 .;,
' "'::. ..
::;:;
 - 
. 
. --,



;. ..:""".... 


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. 



f 
 

. 
,,

 
.11'
 
-.., j' 


. ' 


... 

 
J 
o 
() 
I: 

 
'I- 
o 

 

 
.- 
o 


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 


, 
,.. 


" 


::;. 


.. 


j 


" 


.... 


, 


II 
... 
, \ 

 . 

 \ I 
- Å"i< -- - , l 
- 

 ...... 
... 
 ;; ,
- 
\ ..... 
-. ............ -- 
 - ---... \ 
+- 
. 

. n. 
th t 
'''! ,'_ 
 
......... " tenge! 
, 
" . 


\ 
I 
I 


of providing health 
care for the 
Indian peopl
,

:\ 
of Canada f.\> "" 
,
' :", 
-;.;; ... . ,.... / 
I , : \ ..... "'. - 


. "(:í; \ Yi; 
1,'1 
 , 
/
" / 
-< 7%: J'N ' 
1 \ 
 
4í 
I + Health Sanlé et 
 
 
and Welfare B'en-ëtre socIal \ \ 
Canada Canada I. . 
,-------------"""-. 
 
I Medical Services Branch I 
I Department of National Health and Welfare I 
I Ottawa, Ontario K 1 A OK9 I 
I I 
I Please send me more information on career I 
I opportunities in Indian Health Services. I 
I Name: I 
I Address: I 
City: Prov: _ 

_______________J 


The CanadIan Nurse February 1976 


Index to 
Advertisers 
February 1976 


The Canada Starch Company Limited 7 
The Clinic Shoemakers 2 
f'\esigner's Choice 5 
Encyclopaedia Britannica Publications Limited 1 
Hampton Manufacturing (1966) Limited 10, 11 
Health Care Services Upjohn Limited 55 
Hollister Limited 45 
International Council of Nurses 51 
Lanzette Laboratories 54 
J.B. Lippincott Company of Canada Limited 32,33 
MedoX 53 
The C.V. Mosby Company Limited 39,40,41,42 
Procter & Gamble 12 
Reeves Company 47 
Roussel (Canada) Limited 55, Cover 4 
W.B, Saunders Company Canada Limited 49 
Seneca College of Applied Arts and Technology 52 
Uniforms Registered 37 
Uniform Specialty Cover 3 
White Sister Uniform Inc. Cover 2 


Advertising Manager 
Georgina Clarke 
The Canadian Nurse 
50 The Dnvewa
 
Ottawa K2P 1 E2 (Ontario) 


Advertising Representatives 
Richard P. Wilson 
219 East Lancaster Avenue 
Ardmore. Penna. 19003 
Telephone: (215) 649-1497 


Gordon Tiffin 
2 Tremont Crescent 
Don Mills, O. ,tario 
Telephone; (416) 444-4731 


Member of Canadian 
Circulations Audit Board Inc. 


mn:J 



76 


The Canadian Nurse 


F0003'57 Ù 
P I s-s J:: -STcrr 
60B-ilL 

KTc
8U
G 
CTTAhA 2 CNT 


... 



--- 

' 
/' A 


t 
,II 


, I 


A) Style No. 6482 
Sizes 8-16 
Royale Corded Tricot 
White, Cantaloupe 
About $29.00 


\ 


B & C) Style No. 46548 
Sizes 3-15 
Pristine Royale, 100% 
Polyester Textured Warp Knit 
White, Cantaloupe 
About $35.00 


\)
 
!J;)B
J 
C 
See our new line of Whites and!J..r Colours at fine stores across Canada 


I
 I ""HITE 
Hè) SISTER 
CAREER APPAREL 



For a clearer perspective on nursing care... 


Gillies & Alyn: PATIENT ASSESSMENT AND 
MANAGEMENT BY THE NURSE 
PRACTITIONER 


The brand new text by these respected nursing authors is ideal for 
developing your skills in interviewing and physical examination. It 
focuses on interviewing techniques. physical examination proce- 
dures, laboratory test interpretation, and protocol in the manage- 
ment of patients with chronic illnesses such as hypertension, 
diabetes, osteoarthritis. arteriosclerotic heart disease, obesity. 
alcoholism, and chronic obstructive lung disease. 
By Dee Ann Gillies. RN. EdD, Asst. Director of the Dept of Education, 
Health and Hospitals Governing Commission of Cook County, Dlinois; and 
Irene B. Alyn. RN, PhD. Assoc. Prof. of Medical Surgical Nursing, Univ. 
of III. College of Nursing. About 320 pp. II\ustd. About $11.30. Ready April 
1976. Order #4133-4, 
Falconer. Patterson & Gustafson: CURRENT 
DRUG HANDBOOK 1976-78 


Whatever your question on drugs in nursing care. you'll find the 
most recent clinical information on about 1.500 drugs in common 
use in the Current Drug Handbook. Its tabular format lets you 
grasp pertinent facts at a glance. and iI's fully indexed by both 
proprietary and generic names The drugs are grouped under 16 
categories, such as Antiseptics and Disinfectives, Antihistimines, 
and-new to the 1976-78 handbook-Chemotherapy of Neo- 
plastic Diseases. 
By Mary W, Falconer. RN, MA, formerly of the O'Connor Hospital 
School of Nursing; H, Robert Patterson. PharmD. Prof. of Bacteriology 
and Biology, San Jose State Univ.: and Edward A. Gustafson. PharmD. 
Pharmacist, Valley Medical Center. About 275 pp. Soft cover. About 
$6.70. Ready March 1976. Order #3567-9. 
Howe: BASIC NUTRITION IN HEALTH AND 
DISEASE. New 6th Edition 
From explanation of how food is chemically converted mto human 
tissue-to the modern principles involved in diet planning. pur- 
chasing and storage-this text covers all the material necessary for 
a better understanding of basic nutrition. There's plenty of infor- 
mation on diet therapy, common misconceptions about food, and 
weight control; and the appendix includes an alphabetical listing of 
modified diets. 
By Phyllis S. Howe. RD. BS. ME, Nutritional Insl7uctor. Contra Costa 
and Diablo Valley Community Colleges. California. About 465 pp. /lJustd. 
Soft cover. About $7.75. Ready April 1976. Order #4788-X. 
Mayes: NURSE'S AIDE STUDY MANUAl. 
New 3rd Edition 


Designed to equip the student aide with a working knowledge of 
good patient care, this book teaches principles that are applicable 
in any hospital or nursing home situation. It covers: basic nursing 
arts procedures, her ethical and legal responsibilities and limita- 
tions, what to do in emergencies, and basic anatomy and physiol- 
ogy. (An InstTuctor's Guide is available.) 
By Mary E. Mayes. RN. formerly Supervisor. Emergency Room. Ventura 
General Hospital. California. About 285 pp.. 130 ill Soft cover. About 
$6.20. Ready April 1976 Order #6191-2. 


Kron: THE MANAGEMENT OF PATIENT 
CARE: Putting Leadership Skills to Work, New 4th 
Edition 
Here's a modern look at the challenges of nursing leadership in the 
rapidly changing health care field. It examines the responsibilities 
of the professional nurse. the legal aspects of practice. ways to 
improve communication and understanding. the administTative 
and managerial responsibilities of nurses. methods of work im- 
provement. and leadership skills. Particular attention is paid to 
defining the role of each member of the nursing team, their interac- 
tion with other hospital personnel, and the use of the problem- 
oriented record system. 
By Thora Kron. RN. BS About 290 pp. Jl]ustd Soft cover. About $5.15 
Ready April 1976. Order #5528-9. 


Simmons: THE NURSE-PATIENT 
RELATIONSHIP IN PSYCHIATRIC NURSING: 
Workbook Guides to Understanding and 
Management, New 2nd Edition 
This practical workbook shows you how to establish a therapeutic 
relationship with the mentally ill patient Each of 19 guides presents 
a specific aspect of the process-from orientation and communica- 
tion to final evaluation. This revised edition includes new guides on 
observation of anxiety. assessing the milieu, theoretical approach. 
crisis intervention. descriptive data, assessment of the client's learn- 
ing, and assessing of the nurse's learning. 
By Janet A. Simmons. RN, MS, School of Nursing, Univ. of Mas- 
sachusetts. About 240 pp. Soft cover About $7.00. Ready April 1976. 
Order #8286-3. 


Anderson: CLINICAL ANATOMY AND 
PHYSIOLOGY FOR ALLIED HEALTH 
SCIENCES 


Ideal for community college nursing curricula or for para-medical 
courses. this eloquent. beautifully illustrated book effectively in- 
tegrates clinical considerations with the study of basic anatomy and 
physiology. 
By Paul D, Anderson. MS, Assoc. Prof. of Anatomy and Physiology, 
Massachusetts Bay Community College. About 480 pp.. 315 ill. About 
$10.25. Just Ready. Order #1234-2, 


Anderson: lABORATORY MANUAL AND 
STUDY GUIDE FOR CLINICAL ANATOMY 
AND PHYSIOLOGY FOR ALLIED HEALTH 
SCIENCES 


This valuable manual is designed to be used with the author's 
textbook. It gives your students detailed laboratory directions. 
useful background information about the tissues examined. and 
challenging questions that lead thern to a broader understanding of 
the material. 
By Paul D. Anderson. MS About 225 pp.. 140 ill. Soft cover About 
$6.70. Ready April 1976. Order #1236-9, 



 W. B. SAUNDERS COMPANY CANADA L YD. 
'---'_ 833 Oxford Street, Toronto, Ontario M8Z ST9 PncessublecttoChange 
,- T-;;'-;;; title s-;;' 3D-day appr o-;;'.

'
 
ber ana author: - - - - ---;'
 e Pri ;;; - - - - - - - - - - - - - - -
;;;;;-I 
I I I I I I I I 
I AU: AU: AU: I 
FULL NAME 
I I 
I POSITION & AFFILIATION (IF APPLICABLE) I 
I HOME ADDRESS I 
I I 
L 
 heck 
 Io..d- 
n

 
.la 
 _ 
ndC . O.D ._ -"'II m 
 _ 
 ITY __ _ _ _ _ _ _ _PROVINCE =- _ _ _ ZON ':.......--=-_I 



. """'" 
\ 


C L IN/( I 


. - 


o 


I --\. 

" 


o 


at 
shoe do 
most 
n es 
prefer? 


THE 

LINIC 


TRADl.IMIUIta NO. \J.&. PAT CWP I CAHAØA. 
 .. U.I-A 


SHOE 
p.k

Wkai,@ 


For a complimentery pair 01 white shoeleces, folder showing all the amert Clinic styles, and list 01 stores selUng them, write: 
THE CLINIC SHOEMAKERS · Dept. CN-3 7912 Bonhomme Ave. . St. Louis, Mo. 63105 




 
3 76 


The Canadian Nurse March 1976 


3 


Input 
News 
Calendar 
Names and Faces 
What's New 
Books 


Audiovisual 
LIbrary Update 


The Canadian Nurse 


The official journal of the CanadIan 
Nurses' Association published 
monthly in French and English 
editions. 


6 
8 
16 
44 
46 
48 
46 
54 Frankly Speaking 
Physical Assessment 
of the Newborn 
A Practical Guide 
to Successful Breast-feeding 
Freezing Breast Milk 
at Home 
The Treatment of Mastitis 
in Nursing Mothers 
Babies At Risk? 
Matthew My Son 
Shaping a New Future 
Plenty of Room 
for You and Your Family 


Volume 72 Number 3 


F. Harrison 19 
V. Marcil 20 
M.E. Taggart 25 
D. Théberge-Rousselet 31 
D. Théberge-Rousselet 32 
D. Théberge-Rousselet 34 
B MacLellan 36 
B. Ratsoy 40 
D. Miller 42 



 

 


L--. 


- 


New approaches to childbirth and the 
care of the newborn give nurses the 
opportunity to take an active role in 
promoting a healthy mother and child. 
That's why the focus, this month, IS on 
that very important character, the 
neonate. The photo of the one on the 
cover was provided by Information 
Canada, Ottawa. 


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


ISSN 0008-4581 


Indexed in International Nursing 
Index, Cumulative Index to Nursing 
Literature, Abstracts of Hospital 
Management Studies, Hospital 
Literature Index, Hospital Abstracts, 
Index Medicus. The Canadian Nurse 
is available in microform from Xerox 
University Microfilms, Ann Arbor, 
Michigan, 48106. 


The Canadian Nurse welcomes 
suggestions for articles or unsolicited 
manuscripts. Authors may submit 
finished articles or a summary of the 
proposed content. Manuscripts should 
be typed double-space. Send original 
and carbon. All articles must be 
submitted for the exclusive use of The 
Canadian Nurse. A biographical 
statement and return address should 
accompany all manuscripts. 


A Canadian Nurses' Association, 
':::( 50 The Driveway, Ottawa, Canada, 
K2P 1 E2. 


Subscription Rates: Canada: one 
year, $8.00; two years, $15.00. 
Foreign: one year, $9.00: two years, 
$17.00. Single copies: $1.00 each. 
Make cheques or money orders 
payable to the Canadian Nurses' 
Association. 


Change of Address: Notice should be 
given in advance. Include previous 
address as well as new, along with 
registration number, in a provincial 
nurses' association where applicable. 
Not responsible for journals lost in mail 
due to errors in address. 


Postage paid in cash at third class rate 
Montreal, P.Q. Permit No. 10.001. 
CCanadian Nurses Association 
1976. 



4 


The Canadian Nurse March 1976 


Save 20 0 00n all 
Professional 
Shoes 


.Bøtø 
CßEAUTY' 
ON'ÐUrY 


NORTH 
z;:smA 
Reg. $18.99 
$15.19 


--':<I 
.
....- 


Offer Ends 
Saturday, March 27! 


These are just three of the great 
styles that working feet deserve. 
Leather uppers are white, washable 
and supple. Unit soles are soft and 
flexible to cushion every step. 
Padded arch support; cushioned 
insole. More styles available at 
varying prices-all at 20% off. 



! 
I 


. 
"'\ 
,. 



.

- ...--....<' 
'- 
..
 


Reg. $23.99 
$19.19 


, 


, 


A world of comfort at your feet 


--- 
CHARCD. 

 
11111111111111111111111111111 



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 


lit.>> I-t.>> ill 
-
 
'... 

 --A' 
L " 
, \ 
-- 
yo , 


- ....: 
----- - 
- .... 

 
 -;....- " 


Bernadel Ratsoy was the driving force 
behind the setting up, in 1971, of a new 
postpartum program at St. Paul's 
Hospital In Vancouver. The program, 
aimed at encouraging parents to make 
decisions and adopt a positive, 
independent role in the care of their 
newborn babies, is described in The 
Canadian Nurse, April 1974. 
In this month s issue, she relates 
her experience at St. Paul's to the 


broader field of health care planning 
and outlines a strategy that any nurse 
can use to launch her own ideas. 
The article is based on a paper 
prepared for the 63rd anniversary 
meeting of the RNABC when 
members examined the potential role 
of the nurse in health care planning 


Next month, Barbara Geyer 
a nurse at the Charles Camsell 
Hospital in Edmonton, describes the 
nursing care involved in the 
replantation of a severed limb in a 
young patient. 
Two-year old Theresa was 
brought 10 the hospital with her left 
arm completely severed. Today, she 
has close to normal function in that 
limb. 



6 


The Canadian Nurse March 1976 


Ill))11t 


Nightingale debunked 
As a student of Florence 
Nightingale for 25 years, I wish to take 
exception to the image projected by 
Simpson and Green in the December 
issue of The Canadian Nurse. 
Florence Nightingale is what is wrong 
with the nursing profession. 
She most certainly had 
organizing ability but did not 
personally assemble a staff in less 
than a week. She spent most of the 
time in her rooms in Pall Mall while four 
friends interviewed the applicants who 
were few in number. 
It would have been impossible for 
anyone to impose order in Scutari, 
even Florence Nightingale. Efficient it 
never became! 
Florence Nightingale warm and 
sympathetic? Never! She was a cold 
fish, her personal relationships were 
unsatisfactory and she remained 
emotionally immature throughout her 
life. 
She spent less than three of her 
90 years practising nursing and never 
set foot in a hospital, except as a 
visitor, after 1856. Founded a school 
of nursing reluctantly and visited it for 
the first lime, 22 years later. Opposed 
the registration of nurses and the 
enfranchisement of women. Despised 
women. Liked men. Was a martyr, 
fanatic, mystic and hypochondriac. 
Her influence has done more 
harm to the nursing profession than 
any other single factor. Florence 
Nightingale was not the founder of 
nursing, but because her "clout" was 
greater than anyone else's. her 
attitudes prevailed, giving rise to the 
apprentice system and a militaristic 
structure with a chain of command, 
hierarchical form and unquestioning 
obedience. 
She has descended through the 
last 120 years as a myth. Sweet, 
gentle, perfect, noble, self-sacrificing 
lady. Florence Nightingale is the 
epitome of the perfect nurse. Ergo, 
every nurse must be sweet, gentle, 
perfect, noble, self-sacrificing and a 
lady. 
The nursing profession has been 
led by pale imitations of the myth of 
Florence Nightingale since 1885 or 
thereabouts, ladies every one of 
them. "Ladies"nursing did not 
need, but tough, assertive women. 
Because of the legend of 
Florence Nightingale, there is no room 


in the nursing profession for the 
iconoclast, the intellectual, the rebel or 
the maverick. Every nurse has to fit the 
mold, drab, dull, conditioned and 
brainwashed. Yet, in every field of 
human activity, progress and 
innovation has been brought about by 
individuals or groups who have been 
rebels, iconoclasts, intellectuals or 
mavericks. 
Name five statesmen whose 
names are in the public domain. Name 
five wnters. Name five politicians 
known throughout the English 
speaking world. Name five nurses. 
Well, there is Florence Night- 
ingale. And Florence Nightingale. 
And Florence Nightingale. And 
Florence Nightingale. Maybe, 
Edith Cavell because she got shot. 
Who else? 
- Pat Barr, Carstairs, A1ta. 


Heart of the matter 
I am writing to comment on what 
has to be the best article ever 
published in The Canadian Nurse - 
Colleen McElroy's "Caring for the 
Untreated Infant" (December 1975). 
The author sees clearly through the 
maze of confusion that is the downfall 
of so many of us - rigid, blanket 
policies, legal red tape, satisfaction of 
curiosity (as opposed to legitimate 
research) - to the heart of the matter, 
this one patient's welfare and best 
interests. 
A humanist philosophy is the only 
one that has any place in the care of 
the untreatable patient: with it, one can 
always be sure of doing the right thing. 
That will mean to treat one patient, not 
treat another, or change approaches 
with a third, without hesitation. 
We have generally applied 
"rules" of care for the living, with 
intensity of application measured 
appropriately to each situation. Why 
are we so afraid to develop 
appropriate care for the dying? 
Appropriate care would mean the 
positive promoting of comfort 
measures, as actively as is necessary 
for the patient's comfort, rather than 
just negatively withholding life 
support. Care of the dying (or 
untreatable) still means caring, and as 
such resolves concern over questions 
of feeding such a patient, or providing 
stress-relieving oxygen therapy, 
thereby "prolonging his suffering." 


McElroy touches a crucial point 
when she mentions these patients 
have no awareness of time: rather the 
problem is one of our projecting our 
own feelings and fears onto them. 
This is definitely an area that cries 
out for further discussion and debate. 
Any institution that cares for the ill 
would do well to organize a workshop 
or study session to face the question. 
- Lucille Pakalnis, R.N., Sudbury, 
Ontario. 


Cutting corners 
Being a graduate of the 2-year 
program and having worked three 
years in a hospital setting, I have a 
poor regard for this course. At the 
present time in Ontario, especially 
since budget cuts have reduced the 
staff drastically, new graduates are 
placed alone on wards on afternoons 
and nights and are often in charge. 
They are usually young (18 and 19) 
and many of them have little practical 
experience. I feel this is placing 
extreme pressure on young grads and 
also placing the life of the patient in 
jeopardy. 
Recently I have come across 
young grads who 1) gave 1,000 ml of IV 
with pitocln in it in a very short time and 
didn't know of the dangers of this,2) 
one new grad who catheterized a 
postpartum patient for 1100 ml straight 
and had no concept of the fact this 
procedure could set a patient into 
shock as the bladder collapses, 3) 
another grad was to give a preop 
enema. The ward was very busy and 
she had never performed this 
procedure. No one was available to 
assist her. 
I realize these are only three 
instances of poorly prepared grads but 
I must state the patients in the care of 
these girls were clearly not in the 
safest hands. 
Another very serious problem is 
the system of admissions to 
community colleges. The quality of 
applicants is not well assessed and 
often colleges are more concerned 
with filling their enrolment quotas than 
pruning the group and having those 
suited to nursing placed in the 
program. It seems to me we have 
lowered our standards now that 
hospitals are no longer competing for 
the best students. 
- Margaret, Davidson, Chatham, 
Ontario. 


Psychiatric Journals 
As the national nursing library we 
try to achieve complete runs of 
Canadian nursing journals. At the 
moment we are trying to find back 
issues of the Canadian Journal of 
Psychiatric Nursing to complete our 
holdings, and to fill an outside request. 
The issues we seek are volumes 1 to 
7, number 7 inclusive, that is from 
1960 to August 1966. If any readers 
can assist us, we shall be most 
grateful. 
- M. Parkin, Librarian. CNA House, 
50 The Driveway, Ottawa. 


Pension Benefits Amended 
The December 1975 issue of The 
Canadian Nurse contained an 
article "Is There Sex Discrimination in 
Health Care?", which stated that 
Ontario Community Colleges 
discriminate against female 
employees for pension purposes. This 
is not the case, and has not been so 
since November 1974. In that 
amendment, the word "Spouse" was 
submitted to include either the widow 
or the widower of an employee. There 
is no longer any need for a widower s 
previous dependence on a female 
employee to entitle him to the pension 
death benefit. 
I trust that this will clear up any 
misunderstanding of our pension plan 
that you may have reæived. As you 
know, all colleges are under the same 
plan. 
- E Karen Sendall, Employment and 
Benefits Officer, Conestoga College 
of Applied Arts and Technology, 
Kitchener, Ontario. 


The editor replies: Thank you for 
pointing out this inadvertent error on 
our part. The example of perceived 
discrimination you refer to was cited 
by a teacher in a community college. It 
was incorporated in the article in good 
faith since it was impossible to verify 
all of the comments contained in the 
many questIonnaires returned by 
readers. Perhaps thIs error on our part 
will serve some purpose if it alerts 
other faculty members to the 
amendment you refer to. The 
Canadian Nurse apologizes for any 
Inconvenience you may have 
suffered. 




 



 


\' 


" 


'" 


- 


\ 


\ 


-.... 
............... 
-r--...... 


. 


ì 


. 

 


(\ 
f 
'- 1 


/ 
'"' 


. 


I " ./ 
, '-- ..-/ 



 


The 'Littmann' Series Portfolio of 
Ä. Y. Jackson drawings 
Free with your order 


Reproduction of 
A. y. Jackson 
drawings by 
special permission 
of the McMichael 
collection. 



 


Littmann 
STETHOSCOPES 
. . . tru Iy the fi nest 
stethoscope a 
nurse can own 
The Medallion 
Combination Stethoscope 
The highest quality bell and diaphragm 
chest piece, the stethoscope for nurses who 
practice in critical care areas. Choice of five 
tubing colours - goldtone, silver tone, blue, 
green and pink. 
The Medallion Nursescope 
Colour co-ordinated in five jewel like 
colours. This stethoscope was especially 
designed for the nurse. Weighs only 2 oz. 
and fits neatly into uniform pocket. 


Group Purchase Package 
Your local selected surgical supply dealer 
handles the complete line of'Littmann' 
stethoscopes and will offer discounts on 
group purchases of five or more. 


Write us today! 
for complete details on: 
D The 'Littmann' stethoscope line 
D The Group Purchase Package 
D The 'Littmann' Series portfolio 
D A list of selected 'Littmann' 
dealers 


MEDICAL PRODUCTS 
m 
3m CANADA LImITED 
 .,.I. 


POST OFFICE BOX 5757 LONOON ONT'ARIO N6A 4T1 



6 


The Canadian Nurse March 1976 


Ne".s 


t 
(.w 
) 
"'" 
...\ 
, 
/ 
"" 


\' 


). 
NBARN members Arlyn McGee (far 
left) and Evelyn Matthieu (center) 
meet Dr. William Forster, N. B. Director 
of Mental Health Services during a 


1 
I 

 


New Brunswick nurses with a special 
interest in providing more effective 
care and better understanding of the 
suicidal patient received some expert 
assistance recently at a two-day 
workshop on "Suicide and 
Self-destructive Behavior." 
Dorothy Burwell, associate 
professor, faculty of nursing, 
University of Toronto, and Patricia 
Delbridge, founder and former 
executive director of the Ottawa 
Distress Centre, a telephone service 
for crisis intervention, were resource 
persons for the two-day meeting. 
"After the initial response to the 
suicidal act, it is important that a total 
care package be devised for each 
patient," Delbridge told her audienæ. 
"By total care I don't mean 
round-the-clock company and 
custody, but a care package that 
recognizes that in 60 percent of 
attempts, we are dealing with an 
at-risk period that may be for the 
duration of the crisis but may also 
return at each crisis or indeed become 
a way of life." 
The speaker, who is presently 
director of Help the Aged, a British 


" 


\...7 



 



- 



. 
" 
 
 
f:.:.-. i . 


 -' 
 

 


.-r 


"'- 



 , 



 



. 


...:. , 


I 
recent workshop on crisis 
intervention. Resource persons were 
Patricia Delbridge (far right) and 
Dorothy Burwell. 


agency now extending its operations 
to Canada, stressed the importance of 
"Caring." "About the only thing 
experts agree on," she said, "is that 
when a nurse, counselor or friend 
thinks someone is suicidal, the best 
thing he or she can do is listen and 
sympathize." Burwell, who was 
formerly director of nursing education 
at the Clarke Institute of Psychiatry in 
Toronto, reminded her audience that 
"modern science has uncovered only 
the tip of the iceberg when it comes to 
communication between humans." 
She described Crisis Centre 
volunteers as more advanced than the 
professions at breaking down barriers 
between people. 
Panel participants included Ryllys 
Cutler, associate professor, faculty of 
nursing, and Kenneth Fuller, director 
of counseling services, UNB. The 
workshop was sponsored by The New 
Brunswick Association of Registered 
Nurses and the N.B. Department of 
Health, in cooperation with the UNB 
Department of Extension Serviæs. 


.. 


MARN members 
Support PCWM 
Brief on rape 
The Board of Directors of the Manitoba 
Association of Registered Nurses has 
given its support to a Brief on Rape 
prepared by the Provincial Council of 
Women of Manitoba. The Brief, which 
was unanimously approved by the 
Manitoba Council 01 Women,has been 
submitted to the National Council of 
Women and is being considered for 
inclusion in its annual presentation to 
the Canadian government in 
November. 
MARN representatives have 
requested Directors of the Canadian 
Nurses' Association to consider 
endorsing the Brief at their meeting in 
February. 
In the Briel, the PCWM 
emphasizes the need to recognize 
rape as a "crime of violence" rather 
than simply a sexual offence. "The 
Criminal Code presently attaches 
significantly greater importance to the 
sexual act than to other aspects of the 
attack," the Brief points out. "Women 
who are raped are indeed assaulted, 
although the law does not emphasize 
this aspect." 
The PCWM recommends 
legislative amendments to recognize 
rape as sexual assault under the 
general heading of assault, with 
specifications of various forms and 
degrees of assault. Making the length 
of sentence correspond to the degree 
of assault, would help to place the 
offence of rape in its proper 
perspective according to the Council. 
The Brief contains a summary of the 
Council's reaction to recent proposals 
by the federal Minister of Justice to 
amend the Criminal Code respecting 
rape, as well as related 
recommendations. 
The 10 recommendations include 
one suggesting changes in courtroom 
procedure "to spare the rape victim as 
much embarassment and indignity as 
possible, for example in the display of 
intimate apparel and questioning as to 
previous behavior." The Council 
stresses the need for liaison between 
the medical, legal and police 
professions and recommends 
expansion and strengthening of 
counseling services, review of 
methods of interrogation, and medical 
procedure. 


The Council also notes the need 
to "prepare girls to be less submissive 
so as to begin to eliminate their 
vulnerability to attack." 
"The school physical education 
curriculum should provide female 
students with courses in basic 
self-defense skills at an appropriate 
time in their development. 
Self-defense may n.ot be sufficient to 
repel an attack, but il would make 
girls/women more familiar with 
situations they should avoid; it would 
also teach girls/women how to think 
their way out of a difficult situation, be 
a physical conditioner, and a form of 
self-discipline. Recent studies indicate 
that the difference between the 
physical potential of women and that 
of men could be greatly lessened by 
early physical training for girls on a 
basis comparable to that received by 
boys. This would encourage girls to 
reach their full physical potential." 


National survey studies 
Community nurses 
If you are one of the roughly 14,000 
registered nurses working in 
community-based settings in Canada, 
chances are that you will soon be 
called upon 10 help describe this 
aspect of nursing practice. 
The Canadian Nurses' 
Association is presently conducting a 
national postal survey of nurses to 
determine the responSibilities, 
practice setting, education, 
remuneration and legal 
protection/status of nurses working in 
the various public health agencies, 
occupational health agencies, visiting 
care agencies, community health 
centers, physicians' offices, private 
and commercial nursing agencies, 
and treatment centers across Canada 
A random sample 01 8,000 of the 
estimated 14,000 nurses working in 
these settings will soon be receiving 
questionnaires from CNA. Names of 
the recipients were chosen by 
computer on a random basis and 
anonymity is assured by the principal 
Investigator. 
CNA requests the cooperation 
and assistance of all nurses who 
receive questionnaires. 


- 




 
l!t 

I 
I -_.:. 
I ' 
'-
 , 


f 




. 
\ '\.1 
\' 


\' 


/
 
/ 
(
lr'! iIi/) 
I \, 
 
 
 
 J.
 
J -\ 
 
) C' 
 ..\ \', \ 
I .. --
 
 ì\ 
,;"-<t r-- 
i:i,\f]l b 
,\I, 
\ 1!! . I 

 
--- 


...... 


" 


Style No. 46299 
Sizes 5-13 
Royale Wicker 
100% Polyester Textured Warp Knit 
White, Blue · 
About 130.00 


AT YOUR FAVOURITE STORE 


. 


Vl 


I 
M 


/ 
. 



esi[(nçr's 


:
: choIce 
A PROUD CANADIAN NAME 
I . 
 _A...a . 



NEW FROM 
EGGS@ 
Nurse White Pantyhose. 


Available only through the mail. 


- 


....... 


Here's something especially for you. 
Famous L'eggs pantyhose in Nurse White. 
And they're available in Sheer Energy' 
pantyhose, to give your legs all-day 
support; or regular L'eggs with their 
super-stretch, super-fit. 
Our Nurse White pantyhose are made 
from "yellowing-resistant" fibres, and 
they're dyed to a Snow White color. 
As this pantyhose is made specially for 
nurses, it's available only through a mail 
order program. And we pay the postage. 
It's economical, prompt, and convenient. 
And on larger quantities, we offer bonus 
savings-six pair for the price of five; 12 
pair for the price of 10. 


.". "" 
" 


....1. I FaI. 


-- 


Sheer Energy -. for all-day support. 
If you want all-day support from Nurse 
White pantyhose, choose Sheer Energy. f 
They're made from a special springy yarn, 
so they hug the shape of your legs. This 
springy hugging action of our yarn, 
together with the movement of your legs, 
supports and refreshes your legs. Sheer 
Energy' come at our regular price of 
$3.99, and they're available in three 
sizes-A, Band Queensize. Just look at 
the height-weight chart to find your size. 


. 
- 


Our L'eggs fit your legs. 
L'eggs Regular and Queensize pantyhose 
hug you, hold you, and never let you go. 
No matter what your size, these super- 
stretching, super-fitting pantyhose are for 
you. They come at our regular price.of 
$1.49 for Regular L'eggs, $1.59 for 
Queensize. Just look at the height-weight 
chart to find your size. 


... 


You can't lose. 
L'eggs are guaranteed! 
When you order our Nurse White panty- 
hose, you can't be disappointed. Because 
if any L'eggs product doesn't fit exactly 
the way you like, if it doesn't last long 
enough, or if you're unhappy with it for 
any reason-we'll refund your money or 
replace the product, 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, fill in the order form, 
enclose a cheque or money order and mail to L'eggs Nurse White. 


Determine the price for your order. 


Available Styles and Sues 3 pairs 6 pairs ler 12 pairs for 
price of 5 price of 10 
re
s-Re
ular $ 4.47 $ 7.45 $14.90 
l e
s - Oueenslze $ 4.77 $ 7.95 $15.90 
Sheer Ener
y' -SizeA $11.97 $19.95 $39.90 
Sheer Enem' -Size B $1197 $19.95 $39.90 
Sheer Ener2V' - Oueenslze $1197 $19.95 $39.90 


Ontario resIdents add 7" sales lax 
If the coupoo at the nght has been used, please prepare your order using the 
above chart. 
Please do not send cash. Make cheque or money order payable to: 
l'eggs Nurse While Madlo: 


l eggs Nurse White 
PO. Box 8116 
Toronto. Ontano M5W 1S8 


For best fll.lind your height and weight below and choose the appropnate size 
R etU lar Pan ty hose Sheer Enern 
Heigh! Average Size Queenslze Size A SizeB Oueenslze 
4'10" 1I0.\30Ibs. 
4'W 105. I35lbs. 
5'0" 100.130Ibs. I31.180 Ibs. 100.140Ibs. 145.180 Ibs. 
5'1" 95. I35lbs. 136.185Ibs. 95.145Ibs. 150.185Ibs. 
5'2" 90.140 Ibs. 141.190Ibs. 90.140 Ibs. 141.150Ibs. 155. 190 Ibs. 
5'3" 90.145Ibs. 146.195Ibs. 90. I35lbs. \36 1551bs. 160.195 Ibs. 
5'4" 90.145Ibs. 146.200 Ibs 95. \30 Ibs. 131.160Ibs. 165.195Ibs. 
5'5" 90. 145 Ibs. 146.200Ibs. 100 1251bs. 126.165Ibs. 170.195Ibs. 
5'6" 90.145Ibs. 146 2001bs. 105.120Ibs. 121.165Ibs. 170.190 Ibs. 
5'7" 95.145Ibs. 146.195Ibs. 1I0.115lbs. 116.165Ibs. 170.185Ibs. 
5'8" 100. 145 Ibs. 146.190 Ibs. 115.160Ibs. 165.180 Ibs. 
5'9" 105.140Ibs. 141.185Ibs. 120.150 Ibs. 155.175Ibs. 
5'10" 115.135Ibs. 136.180Ibs. 125.145Ibs. 150.170Ibs. 
5'W \30 140 Ibs. 145.170Ibs. 
6'0" 145.160Ibs. 


L'eggs Nurse White Order Form 
r-----------------------, 


Mail to: 
L'eggs Nurse White 
P.O. Box 8116, 
Toronto, Onl MSW 158 
Once you order pantyhose, you are not obligated in any 
way, and will not be sent any further panty hose unless you 
order them directly. 
Nurse White only color available-See size chart 


Available Styles and Sizes 3 pairs 6 pairs lor IZ pairs for TOTAL 
price of 5 price 0110 
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. 


- 



Your patients 
will amaze 
you . . . 


\ 


(J 


" 


'" 


------ 
 


.... 


- 


. \ 


, 


o 


-. 
I ..... - . 
- 


'.. 


, \\, \' t t 
r 
 .\' \ I
' 
so will retelast I
. 

 "
 
) 
.'\\
 
 
\. 
f, 
Your patients will be back to normal in no 
 .>\V6 '- 
': ' 
nothmg happened. , . 
 
 
NOT SURPRISING. . ..' t1 
RETELAST is so comfortable and g ives . , 
'".-jJt 
such fast relief. Moreover, RETELAST 
. . 
costs up to 40% less than any other 1 i ' 
dressing or traditional bandage. ' I 


. 
.\, 
-.. 



 @ 
 @) 0 @ PHARMACEUTIQUES LTEE 
PHARMACEUTICALS LTD 
Laval, Que. Canada 


DEMONSTRA TION 
AND FOLDERS 
UPON REQUEST 



14 


The Canadian Nurse March 1976 


XP\'-S 


Good health 
The yoga way 


Recipe for health: Start with exercise, 
a few simple postures to stretch the 
muscles and keep the body in tune. 
Add lots of fresh air, sports, a dash of 
country living. Eat healthy food. Calm 
yourself. Breathe deeply. Reach 
inside yourself for inner happiness. 
Sound promising? This was the 
message of Suzanne Piuze, a yoga 
teacher from Montreal, who has done 
much to adapt these classical 
teachings to the North American way 
of life. While in Ottawa recently to 
promote her method of teaching yoga, 
she visited CNA house to talk to 
journal staff about yoga and its 
relationship to the medical profession. 
"T 0 me, yoga IS an art of better 
living, and also a school of happiness. 
It's a way to find peace of mind, to 
control your body as well as your mind, 
instead of being a slave all your life to 
your environment, to your work, to 
sadness, to whatever comes from the 
outside. Yoga helps you to get inside, 
deep inside and find happiness where 
it really is:' she said. To help people 
find their way, she teaches a 
combination of the many forms of 
yoga, including Hatha Yoga (yoga of 
postures) and Raja Yoga (yoga of the 
mind) at her studio in Montreal and a 
live-in Yoga Centre In the Laurentian 
Mountains. 



 
I' 1
 
. .. 
\1 
 "- 
-'" 


! 
'.':I! : 
t ' 


"uQo 


--"").- 


"You have to start with your body, 
but at the same time something 
happens while you are so aware of 
your muscles, of your health, of 
movement, you also control your mind 
because you have to think only of what 
you are doing." The exercises 
themselves, she says, are only one 


.ft 4 t, . If I(AU 11 iiA '.....I.,niJ 
. I: -:( I I .11 .... I I , 5r: :1:1 . 
2 . 
It- 
J. j 
 
t
- 
,\ 
 co.o..JfO" :IIOo,Oc:P- 
Oo,,,,...!!! 
J , A

 - 
-4
 
" '- ó
 
_. .." .. 


" 


Two CNA journal staff members, 
Viviane Marcil (assistant editor, 
L'infirmiére canadienne) and Carol 
way to cleanse the mind. She also 
teaches transcendental meditation. a 
technique to calm the mind and stop 
the inner "movie camera" from 
producing its constant flow of images 
To facilitate this type of relaxation 
students repeat a mantra, usually a 
Sanskrit word, over and over as they 
follow their breath. Because the word 
has no meaning for them, it doesn't 
bring to mind any particular thoughts 
or worries, but does help to push out 
other thoughts that seem to control the 
mind. 
Nutrition is also an important part 
of her teachings. She does not smoke, 
nor drink coffee and avoids eating 
sweet foods like cakes and pies. She 
does drink tea, however, and serves 
her students at the Yoga Centre a 
variety of herbal teas, specially mixed 
to take advantage of their medicinal 
effects. 
Far from regarding it as quackery, 
Piuze says that more and more 
doctors are recognizing the beneficial 
effects of yoga, particularly for 
psychosomatic diseases and cases 
where relaxation is important, e.g. 
heart conditions. and many are 
sending pallents 10 her. She stresses 
that yoga is basically preventive and 
should complement medical advice 
rather than being used as a substitute 
for it. To this end she has studied 
anatomy, physiology and 
acupuncture, and is committed to a 
personalized form of yoga where 
postures are adapted for the individual 
and his physical capabilities. She also 
adapts the postures for other groups, 
including expectant mothers who can 
take advantage of her prenatal yoga 
classes to learn to breathe properly 
and relax. In fact, she says, many of 
the breathing exercises taught in 


Thiessen, right, (The Canadian Nurse) 
interview Canadian yoga expert, 
Suzanne Piuze. 


community prenatal 
Iasses have their 
origin in yoga. 
Among her clientele are many 
nurses who come for personal 
reasons and "sometimes because 
they want to get away from pills, just 
the sight of them." Asked how nurses 
can apply wnat they learn to their jobs, 
she replied: "The best way to teach is 
by example. Instead of telling 
someone to do this or that, if you apply 
it to yourself, it reflects. Also, if they are 
more aware of their patients, if they are 
100 percent with them, it helps too. 
With yoga, when you are present, you 
are really present." She also 
suggested that nurses can encourage 
good health "by telling patients that 
when they get out of the hospital they 
should go near the sun as much as 
they can and eat better. They should 
walk, they should practice sports, they 
should drink lots of water between 
meals, they should go to the country 
as much as possible, they should not 
drink too much coffee." 
In her own way, SuzannePiuzeis 
trying to spread the message of "yoga 
for health." She has published three 
books, La Santé par Ie Yoga, Hatha 
Yoga, and Yoga Sex; she teaches 
yoga in a studio in Montreal; she gives 
one half hour a week of yoga on 
community television; and she 
teaches adolescent girls in jail one 
night a week. In addition she publishes 
brochures encouraging those who are 
interested to come to her Yoga Centre 
in Eastman for intensive weeks or 
weekends of yoga, seminars on 
physiology, stress, etc., fresh air, 
sports and healthy surroundings. 


AARN celebrates 
Diamond jubilee 
The Alberta Association has 
announced that the theme of its 
Diamond Jubilee Celebrations will be 
"Co-ordination of Health Care 
Services." In the 60 years since it was 
established, the AARN has grown 
from the initial nucleus of 12 members 
to a total of more than 35.000 
registered nurses at the beginning of 
1976_ 
Looking back on the history of the 
association's preliminary steps 
towards organization, a spokesman 
for the AARN, recalls: 
In 1909, the embryonic Canadian 
Nurses' Association set out to 
encourage nurses to organize at the 
provincial level. Before this, nurses in 
the various provinces were not 
organized as a provincial body but as 
alumnae within the provinces. In 
Alberta, prior to 1916. local nurses' 
groups existed in four major Cities. 
Local registries of qualified nurses for 
private duty nursing were also kept. 
The main reason behind the 
development of provincial Graduate 
Nurse Associations was that trained 
nurses found themselves competing 
for status and wages with 'nurses' who 
had little or no training. No legal 
controls to curb this situation existed. 
Trained nurses in each province 
therefore united to lobby for ProvinCial 
Registration Acts that would establish 
uniform standards for preparation and 
graduation and give qualified nurses 
legal status. 
When the Alberta (Act) developed 
bytheAARN, was passed in 1916, the 
province became the third in Canada 
to enact nursing legislation. Nova 
Scotia (1910) and Manitoba (1913) 
had passed acts incorporating 
registration procedures shortly before 
this time. 
The AARN 1976 annual 
convention takes place May 11-14 in 
Edmonton. 


Think piece - A full 90 percent of the 
wort< done In this country is done by 
people who don't feel weli...People 
who write the most interesting and 
effective letters never answer letters... 
they answer people ....And, when you 
come to the end of a perfect day... 
check back carefully. 



I 


trav 


I 


- 


I 
- 
II 


f\l\&Lo\U 



ARIFJf 


seru h Recentl 
M" m c olesterol y, a dieta ry 
mnesot I' was re ted progra 
fish, lean a
 t Included s
':; "from the IT to reduce 
Result: seru:
' and Mawla "li:' poultry, 

:e,:ity of 
average of 17% holesterol level % pure com oil eggs, 
. F . s were reduced . 
1m or a an 
I .portant stud complete r 
nformation B y, please wr. t eport on th. 
Star h C ,est Food "' e to Nt"" 's 
Stat" ompany P 0 s DIvision Th u 2tlOnai 
H3C o l n C A , Mont;eaÎ Q . Box 129,' e anada 
1 ' uebec 
Mazol C ' 
54% a lorn Oil cont . 
14
 po yunsaturated 
ms: 
l! saturated fats. lats and 









 
ct




 

\.

. 


B
st Foods 
Llving up t 
o our name. 


'\ ttazol S 
CORN O.a.. 

OO% plJtt" 
'...... 1J



f5 
....... 
..._.,_
" 


........ 


-- 



16 


The Canadian Nurse March 1976 


Ca:tlendal- 


March 23 - May 11, 1976 
Course: "Conserving and Promoting 
Health for the Mentally Retarded," 
Tuesday evenings at the McLennan 
Physics Building, Umversity of 
Toronto. For information contact: 
Dorothy Brooks, Continuing 
Education, Faculty of Nursing, 
University of Toronto, 50 St. George 
St., Toronto, Ont.. M5S IAI. 


March 31 - April 1, 1976 
National Nephrology Forum: A 
Conceptual Approach to Patient Care 
at Hyatt on Union Square, San 
Francisco, CA For information write 
to: American Association of 
Nephrology Nurses and Technicians, 
Two Talcott Road, Suite 8, Park 
Ridge, Illinois 60068. 


March 30 - April 1, 1976 
21st annual convention of the 
American College of Nurse-Midwives 
to be held at Stouffer's Riverfront 
Towers, St. Louis, Missouri. On March 
29, a workshop on Adolescent Health 
Care; April 2 workshop on Attitude 
Reassessment for the Sexual 
Counselor. For information, write: 
American College of Nurse- 
Midwives, 1000 Vermont Avenue, 
N. W.. Washington, D. C. 20005. 
March 24-27, 1976 
Association for the Care of Children in 
Hospitals conference to be held in 
Denver, Colorado. For 
pre-registration information, write: 
Lynn Moulthrop, ACCH Colorado 
Affiliate, P.O. Box 613, Aurora, 
Colorado 80010. 


Moving, being married? 
Be sure to notify us in advance. 


. 


Attach label from 
your last issue or 
copy address and 
code number from it here 


New (Name)/Address 


Street 


City 


Prov./State 


Please complete appropriate category 


Postal Code/Zip 


o I hold active membership in provincial nurses' assoc. 


reg. nO./Pl?rm. cert./lic, no. 


o I am a personal subscriber 


Mail to: The Canadian Nurse, 50 The Dnveway, Ot1awa K2P 1 E2 


April 1 - 3, 1976 
Workshop: Current Concepts In the 
Care of the Diabetic to be held at 
Jasper Park Lodge, Jasper Alberta. 
Information from: Continuing Nursing 
Education Division of Continuing 
Medical Education, Clinical SCiences 
Bldg., University of Alberta, 
Edmonton, Alia. TOO 2G3. 


April 2 - 4,1976 
Biennial meeting of the Northwest 
Territories Registered Nurses 
Association to be held in Yellowknife, 
N.WT. 


April 3 - 4, 1976 
"Nursing Today in Émergency Care" 
to be held in Vancouver. Apply to: 
Continuing Education in the Health 
Sciences. P.A Woodward 
Instructional Resources Centre, 
University of British Columbia, 
Vancouver, B.C. V6T 1W5. 


April 9 - 10, 1976 
"Practical Application of 
Psychosomatic Obstetrics and 
Gynecologic Concepts to Patient 
Care" - conference to be held in 
Chicago, sponsored by the Canadian 
and U.S. sections of the International 
Society of Psychosomatic Obstetrics 
and Gynecology. For information, 
wf/le: Toby Hofslund, 1307 East 60th 
Street, Chicago, Ill. 60637, U.S.A 
April 21 - 24, 1976 
Symposium on fetal monitoring to be 
held at Chateau Frontenac, Quebec 
City. In English and French, with 
simultaneous translation, information 
from: Dr. Adrien Bastide, Hôpltal 
Saint-François d'Assise, 10 de 
I'Espinay, Quebec, Quebec, G 1 L 2H 1 . 
(Tel: 418-688-8710) 


April 23 - 24, 1976 
Interdisciplinary Respiratory Disease 
Conference sponsored by the New 
Brunswick Tuberculosis and 
Respiratory Disease Association will 
be held at the University of New 
Brunswick in Fredericton, N.B. For 
further information write: Alma T. 
Leclerc, Program Director, New 
Brunswick TB and A.D. Association, 
123 York Street, Fredericton, N.B. 
E3B 5E3. 


April 26 - 30, 1976 
National conference of Operating 
Room Nurses and Biennial Institute of 
the British Columbia Operating Room 
Nurses Group to be held at the 
Vancouver Hotel. Information from: 
Ellen Schodt, Chairman, Registration 
Committee BCORNG, 103-930 
Glenacres Drive, Richmond, B.C. 


April 29 - 30, 1976 
Session: Current Nursing Methods 
and Resources in Coronary Care to be 
held at School of Nursing, University of 
Alberta. Information from: Continuing 
Nursing Education Division of 
Continuing Medical Education, 
Clinical Sciences Bldg., University of 
Alberta, Edmonton, Alta. T6G 2G3. 


April 29 - May 1, 1976 
Annual Meeting of the Registered 
Nurses' Association of Ontario to ba 
held at the Royal York Hotel, Toronto, 
May 11 - 14,1976 
Alberta Association of Registered 
Nurses convention to be held at the 
Edmonton Plaza Hotel. Theme: 
Coordination of Health Care Services 


May 12 - 14, 1976 
Annual meeting of the Registered 
Nurses' Association of British 
Columbia to be held at the Vancouver 
Hotel, Vancouver. 


May 16 - 18, 1976 
Manitoba Association of Registered 
Nurses annual meeting to be held at 
the North Star Inn, Winmpeg. 


May 17 - 19, 1976 
Cardiology 76: third annual 
conference on cardiac care for doctors 
and nurses, to be held at Humber 
College, Toronto. Information from: 
Conferences and Seminars Office, 
Humber College, P.O. Box 1900, 
Rexdale, Ontario. 


May 28, 1976 
Annual meeting of the Registered 
Nurses' Association of Nova Scotia IS 
to be held at the Hotel Nova Scotian, 
Halifax, Nova Scotia. 


June 8 - 10, 1976 
Annual meeting of the New Brunswick 
Association of Registered Nurses to 
be held at the Playhouse, Fredericton. 



The Canadian Nur.. March 1976 


17 


en you are 


CONVENIENT 
STERILE 
. INEXPENSIVE 
OB DISPOSABLE PRODUCTS FROM HOLLISTER 
Nothing to get ready, nothing to clean up when 
you're through. With every Hollister disposable 
you use. you are ridding yourself of the cross-con- 
tamination hazards of reusable instruments, What's 
more, our disposables don't crimp your budget. It's 
possible to perform amniotomy, clamp the baby's 
umbilical cord, footprint him and circumcise him 
for as little as 93
. 


FOR 
AMNIOTOMV 


FOR 
CIRCUMCISION 


the Double-Grip' UmbIlical 
Cord-Clamp maintains a 
constant pressure on the 
cord until it dries. 
Designed for easy, one-hand 
application. 


the Plastibell
 circumcision 
device permits clean, fast- 
healing circumcisions 10 as 
few as three minutes. 
(Now available also 
in the Hollister 
Circumcision Tray) 


FOR 
NEWBORN 
IDENTIFICATION 


the AmniHook amniotic 
membrane perforator reduces 
the chances of injury to 
mother and fetus because of 
its protected pOint 


FOR 
UMBiliCAL 
CORD 
LIGATION 


the Disposable FootPnnter 
consistently delivers 
high-quality, permanent 
prints on Hollister Newborn 
Identification Forms. 


h, 


4 
, 


"""1\ 


TRVTHEM... 
AT OUR EXPENSE 


D AMNIHOOK" 
amniotic membrane perforator 


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" 
Umbilical Cord-Clamp 


D PLASTIBELL'- 
cIrcumcIsIon devIce 


D DISPOSABLE 
FOOTPRINTER 


name (please pnnt) 


"lie 


hospItal 


telephone 


MAIL TO 
HOLLISTER LIMITED 
332 CONSUMERS RD. 
WlllOWDAlE. ONT. M2J 1 PB 


HOLLISTEÅ 
 
cIty 


street address 


province 


zone 


. COPYRIGHT 1975 HOLLISTER INCORPORATED ALL RIGHTS RESERVEO. 



AVAILABLE 
AT YOUR FAVOURITE STORE 


/ 


/ 
}: 

 
// 
1/ 
II 


H.S. 752 
< FINE CORD JERSEY 
60% Polyester 
40% Nylon 
Colours; 
Pink, Blue, Mint, 
Canary, Sherbet. 
Sizes: 3 - 15 
Suggested Retail: 
$29.00 each 


H.S. 753 > 
FINE CORD JERSEY 
60% Polyester 
40% Nylon 
Colours: 
Pink, Blue, Mint, 
Canary, Sherbet 
Sizes: 14
 - 24
 
Suggested Retail: 
$30.00 each 


,\ \. 
'
 


ð
 


;\ 


H.S. 748 
FINE CORD JERSEY 
60% POlyester 
40% Nylon 
Colours: 
Pink, Blue, Mint, 
Canary, Sherbet 
Sizes: 4 - 16 
Suggested Retail: 
$33.00 each 


from 


: \ 


o White Cross 


For additional information: 
HAMPTON MFG. (1966) L TO. 
125 Elmira 
Tal.: (514) 842-2906 



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.... 



20 


/ 


'- 'r 
, 



 


II 

I '" 
" 
I '" 
c: 
'" 
u 
I .. 

 
I ãi 
3: 
T) 
" 
OJ 
I 
Õ 
LC 
Q. 


The Canadian Nurse March 1976 


........ 


'. 


, 



The CanadIan Nurse March 1976 


21 


PHYSICAL 
AS)ESSMENT 
OF IF-iE 
NEWBORN 


. If( ... 
r . .
:. 
.. ,
..ç 
;.

. 
.
 ft{;
 
' 


 - 
.. .
 
... 


Bibliography 
1 Clausen, Joy Pnnceton. Maternity nursing 
today, by... et al. Toronto, McGraw-Hili 1973. p. 
638-700. 
2 Ingalls, A. Joy. Maternal and child health 
nursing, by...and M. Constance Salerno. Saint 
Louis, Mosby, 1975. p. 186-250 
3 Keay, A.J. Craig's care of the newly born 
infant, by...and D.M. Morgan. 5th ed. Edinburgh, 
Churchill Livingstone, 1974. p. 89-297. 
4 Lerch, Constance. Maternity nursing. 2nd ed. 
Saint Louis, Mosby, 1974. p. 279-343. 
5 Moore, MaryLou. The newborn and the nurse. 
Toronto, Saunders, 1972. p. 87-182. 


-........- 
i 


Viviane Marcil 



 


Birth is a most traumatic experience and negotiating 
successfully from intrauterine to extrauterine life is a 
major challenge to the neonate. In fact, statistics 
reveal that the largest percenta'ge of infant deaths 
occur during the first 24 hours after birth and the 
great majority of these occur in the first hour of life. 
In the light of this, the nurse has the important 
function of assuming responsibility for immediate, 
careful, and constant observation of the newbom; she 
is the one most likely to detect the first clue that all is 
not well with the infant. Not only must she be 
thoroughly familiar with the physical mechanisms of 
the neonate in order to provide optimum supportive 
care in the stabilization of respiration and 
temperature, but she must also have broad and 
specific knowledge of the range of usual physical and 
behavioral findings of the normal infant in order to 
recognize those that indicate pathology and require 
immediate medical attention. One of the best means 
of detecting any abnormality is to proceed with 
careful. thorough, and systematic physical 
examination of the newborn. 
Before the nurse proceeds with the actual 
examination of the infant, she should review the 
antenatal history (health of the mother during 
pregnancy, Rh typing, complications of pregnancy, 
and drugs taken) and the birth history (kind and 
duration of labor, type of delivery, sedation or 
anesthesIa, resuscitation required, Apgar score, 
birth weight and length, and gestational age) as they 
may reveal pertinent information as to where 
abnormality Or pathology may exist. The infant's 
body temperature. respiratory rate, pulse rate, cry 
and color are also evaluated. Careful observation of 
the state of consciousness and general activity also 
provide valuable general impressions that can be 
confirmed or modified later. 
Although the sequence of the examination 
should normally be standardized, the nurse may 
adapt the system of examination to the particular 
infant and situation For example, it may be best to 
examine the chest and abdomen first if the baby is 
sleeping or to examine the mouth, palate, gums and 
facial contractions if the newborn is crying. Whatever 
the approach, the nurse should make sure that no 
part of the examination has been missed. 
Afterwards, a detailed recording of the 
examination IS made in order to provide valuable 
base-line data for the physician who will later 
examine the child himself, and for other nursery staff 
who will subsequently be responsible for the care of 
the infant. A standardized system of recording 
makes it easier for others to identify specific 
information more efficiently. 



22 


The Canadian Nurse March 1976 


Normal variations Abnormalities 


Usual findings 


Head 


Face 


Eyes 


Ears 


Size 


Shape 


Symmetry 


35 
 2.5 cm circumference 


Molded, if vaginal delivery, round If 
cesarian section 


Palpable anterior and posterior 
fontanels and sutures 
Anterior fontanel flush with neighbor- 
Ing parts (can be expected to be 
slightly depressed when child is in 
sitting position) 


Sutures are normally felt as ridges 
immediately after birth or as 
depressions within a day 
Symmetry between left and right side 
of face 


Symmetrical contractions of face when 
infant cries or grimaces 


Color 


Red 


<33 cm - microcephaly 
(eg. anencephaly) 
>38 cm - macrocephaly 
(eg. hydrocephalus) 


Asymmetry due to molding, hematomas 
or edema (eg. caput succedaneum, 
cephalhematoma) 
Posterior fontanel may be closed 


Tension of the anterior fontanel 
(to be determined when child is in 
sitting position) 
depressed (eg. dehydration) 
bulging (eg. intracranial 
pressure) 
Notify physician immediately 
There may be overriding of the sutures Hemorrhage (intracranial) 
Observe and notify physician Depressed skull fracture 
Notify physician immedIately 
Asymmetry between left and right 
side of face (eg. congenital 
malformation, hemiplegia) 
Movement of only one side of face when 
infant cries (eg. facial nerve palsy) 
Pallor, gray color 
Persistant cyanosis (eg. congenital 
cardiac malformations) 
Centered or deviated to right 
or left 
Marked edema or inflammation 


Discharge 


Moderate discharge from irritation 
by silver nitrate 


Drooping 
Setting-sun sign 
Purulent 


Cornea 
PupilS 


Iris 


Correct placement on face in relation 10 
each other 
Edema due to instillation of silver 
nitrate 
Blink reflex present 


None 


Bright and shiny 
Round shape 


Equal and reacting to light 
Dark or slate blue 


Reaction to light discernible 


Hazy or dull 
Oval or irregular shape 
Constricted (eg. cerebral paralysis) 
Fixed and dilated 


Symmetry 


Eyelids 


Hemorrhage 
Jaundice 


Sclera 


Bluish-white 


Retina 
Coordination 


Shape 


Hearing 


Nystagmus usually present when Occasional uncoordinated 
child rotated laterally. Does not persist movements 
when replaced in crib 
Well-formed 


Red reflex 


Cartilage present 


Upper part of ear should be on same 
plane as angle of eye 
Blinking of the eyes, momentary 
cessation of activity or startling 
indicate positive reaction to sound 
Moro reflex 


Opacity of lens 
Persistent uncoordinated 
movements 


Malformations 
(eg. branchial clefts) 


Preauncular papillomas may be 
present 
Amount of cartilage varies (lessened 
amount is usually a sign of prematurity) 
May be folded or creased Malformations 
(eg. low placement) 


No response to sound 


Nose 


No response to Moro 
reflex (eg. intracranial hemorrhage 


Symmetry 
Shape 


Patency 


In midline of face 


Appears flattened 


Infant should breathe easily through 
nose when mouth closed 


Some mucus present in nares may 
Interfere with free breathing 


Deviated to right or left 
Malformation 
Unusual flattening 
Flaring of nares 
(eg. obstructed airway, atelectasIs) 
Check for other signs of 
respiratory distress 



The CanadIan Nurse March 1976 


23 


Usual findings 


Normal variations 


Abnormalities 


Mouth Lips 


Malformation (eg. cleft lip) 


Tongue 


Palata 


Gums 


Pink 
Rooting reflex 
Pink 
Inside mouth 


Normal volume 


Pink and well-formed 


Pink 


May have transient circumoral 
cyanosis 


Short frenulum linguae 
(insignificant) 


Epstein's pearlS 
Inclusion cysts 
Rear gums may be whitish 
May appear quite jagged 
Teeth may be present 
Inclusion cysts 


Thrush 
ProtruSion 
Frenulum linguae extending to tip 
of tongue (may interfere with 
sucking) 
Large and thick (eg. Down's syndrom e) 
Malformation (eg. cleft palate 
or unusually high) 


Salivation 


Reflexes 


Neck 


Appearance 


Motion 


Scant 


Sucking reflex initiated when lips 
touched 
Extrusion reflex 
Gag reflex initiated by tongue blade 
Short. straight 


Head moves freely from side to side 
and from flexion to extension 


Excessive and frothy (eg. tracheo- 
esophageal fistula) 
Loss of sucking reflex 
(eg. physiologic jaundice) 


Masses 
Distended veins or edema 
Webbing 
Restriction of motion 
Congenital torticollis 
Opisthotonus 


Chest Size 


Averages 30 to 37.5 cm 


<30 cm - prematunty 


Shape 


Expansion 


Respirations 


Breath sounds 


Almost circular 


Symmetry of movement with 
respirations 
Rate - 40/m;n. 


Vesicular 


May range from 30 to 60/min. 


Gross abnormalities 
Bulging 
Depressed sternum 
Asymmetrical movements 
(eg. diaphragmatic hernia) 
Labored breathing 
Grunting on expiration 
Retractions with respirations 
Rales 
Rhonchi 
Wheezes 


Breast Tissue 


Nipples 


Present in both sexes 
Symmetrical placement of 
nipples 


Excessive amount of breast tissue 


Milky secretion may be evident 


Asymmetrical placement of nipples 
(eg. fracture of clavìcle) 
Signs of infection 
Presence of supernumerary 
nipples below nipple line or In axillary 
region 


Heart sounds 


Abdomen 


Shape 


Rate ' 120 to 150/ min. 
Rhythm-irrpgular following physical 
or emotional stimulus 
Quality - first sound (closure 
of mitral valve and Iricuspide valve) 
and second sound (closure of aortic 
and pulmonary valve should be 
sharp and clear 


Contour cylindrical and relatively 
prominent 


Sounds of poor quality 
Extra sounds 
Heard on right side (sign of 
dextrocardia) 
Murmurs accompanying heartbeats 
Asymmetry 
DIstensIon 
Localized bulging (eg. hernia) 
Scaphoid abdomen (eg. 
diaphragmatic hernia) 
Check for other signs of respiratory 
distress 


Femoral pulses Present 
Umbilical stump Bluish-white Umbilical hernia may be present and 
Dry within several hours after birth is usually insignificant 


Abnormal redness, bleeding 
or infection 
Odor 



24 The Canadian Nurse March 1976 
Usual findings Normal variations Abnormalities 
Genitalia Size In both sexes, tend to appear Edema present in breech 
large in relation to rest of body delivery 
Size of penis and scrotum varies 
widely 
Color Red May have increased pigmentation 
in dark-skinned races 
Appearance Female: labia minora are quite Smegma 
prominent and prof rude over labia 
majora Vaginal discharge - mucoid or Excessive vaginal bleeding 
Male: prepuce usually adherent blood-tinged Malformations (eg. epispadias, 
to the glans hYpOspadias, phimosis) 
Testicles usually in scrotum Cryptorchidism 
Scrotum small and firm or fairly Hydrocele 
loose, relaxed and pendulous 
Meatal opening should appear as a slit Meatal o p enin g appears round 
Extremities Generally flexed but can be put in May retain in utero position when Limitation of movement in any 
Appearance full range of motion passively sleeping joint (eg. fractures, paralysis) 
Alignment of parts and presence of Absence or defects of parts or all 
all limbs and extremities of extremities 
Color Cyanosis may last for several hours Difference of color or temperature 
after birth between the extremities 
Hands Fists clenched Malformations (eg. webbing or 
Flexion of hand at wrist is approximately presence of extra digits, clubbing 
1100; extension is 80 0 of fingers, unusual shortness 
Grasp reflex or curvature of little finger, simian 
crease on palm of hand) 
Arms Shoulders abduct from trunk Limitation of motion (eg. fracture, 
about 120 0 paralysis) 
Range of motion at the elbow 
Feet Plantar fat makes feet appear flat Malformations (eg. club feet. 
Grasp reflex absence of toes, abnormal 
Babinski reflex spacing between first and 
Usually held in varus or valgus May turn in but can be passively second toe) 
attitude but can be straightened turned out 
without forceful manual stretching 
Flexion and extension of ankle about 
130 0 
Legs Mild degree of bowing or medial Extra folds or asymmetry 
rotation (eg. hip dislocation) 
Symmetry of medial skin folds on 
anterior and posterior thigh 
Hip Range of motion should be about Limited abduction of one or both 
160' to 170 0 in flexion and extension hips (eg. dysplasia, hip dislocation) 
ThlQhs flexed at hip should abduct to 
an angle of 160 0 between thighs 
Skin General Red in color Pallor; jaundice in first 
Appearance Varies with race and ethnic origin 24 hours of life 
Cyanosis of lips, fingernails, toenails, Harlequin Sign Generalized cyanosis (eg. 
hands and feet Erythema toxicum neonatorum cardiac, neurologic or respiratory 
Capillary hemangiomas malformations) 
Lanugo 
Vernix caseosa Tinted vernix caseosa 
\ Tendency to be dry Desquamation (eg if post-maturity) 
Turgor Skin of back of lower leg or thigh or Fold of skin perSists for 
I of abdomen returns to its former several seconds after release 
position after release of grasp between 
B ac k thumb and index finger of examiner 
General Shoulders, scapulae, iliac crests on Malformations (eg. spina 
Appearance same plane with each other bifida) 
Abnormal curvature of spine 
Spine straight and easily flexed Pilonidal dimple over coccygeal area Pilonidal cyst or sinus 
Hair over shoulders and back, Tufts of hair anywhere over the spine, 
especially in premature infants especially over sacrum (eg. spina 
bifida) 
Anus Patency Proven by adherence of meconium Anus may be irritated by frequent Imperforated anus 
on rectal thermometer rectal temperatures Fissures, bleeding 



The CanadIan Nurse March 1976 


25 


A PRACT CAL GU DE 
TO SUCCES3FUL 
BRFAST-FEEDING 


Although lactation is a normal human 
function, most mothers need some 
assistance in establishing a satisfactory 
routine. The information in this guide is 
provided 10 nurses who undertake to offer 
this important support and understanding. 


.. 

. 


'. 


" 



 


.. 



26 


The Canadian Nurse March 1976 


Marie-Elizabeth Taggart 


Mothers who choose to nurse their babies 
need to understand, not only the anatomy and 
physiology involved, but also the proper 
procedure for breast-feeding. It is not unusual 
in obstetrical units, to find nursing mothers with 
a variety of physical complaints, including 
dorso-Iumbar fatigue after feeding, sore 
nipples and painful engorgement of the 
breasts. Unfortunately, these discomforts 
have not always been predicted, explained or 
alleviated by the nurse involved and many 
mothers as soon as they return home, give up 
their attempts to breast-feed. 
Inadequate instruction by medical or 
nursing personnel is not the only reason that 
these setbacks occur. Success or failure in 
breast-feeding depends upon many factors, 
including contemporary social and cultural 
attitudes. To illustrate, nursinq mothers are 


. 


1 
\ 
I 


, 


, 


(" 


- 


often anxious about their ability to maintain an 
adequate milk supply, even though it has been 
established that the vast majority of women 
(85 percent) are physically capable of lactating 
for six months or longer. Usually, the failure of 
physiological mechanisms involved in milk 
secretion and ejection can be traced to 
psychological barriers that are the result of 
stress and anxiety. 
Evidence also indicates that social 
attitudes play an important role In determining 
the success or failure of breast-feeding. 
Urbanization and industrialization have been 
accompanied by new social values. Iii fact, it 
could be said that industrialization has 
transformed breast-feeding into an outdated, 
archaic practice, at the same time that it has 
elevated artificial feeding into a positive 
symbol of economic slatus. In today's society, 
the breast is too otten perceived as primarily a 
sexual symbol. Some mothers have 
developed a negative body image concerning 
breast-feeding; for them, this procedure is a 
disgusting or degrading act. 
The attitude of members of the immediate 
family and close friends also affects the 
success or failure of the program. Recently, 
there have been indications of a trend towards 
renewed interest and enthusiasm about 
breast-feeding College or university 
-educated women, along with advocates of 
"natural foods," are among the strongest 
advocates of a return to this method of 
nourishing the baby. Some of these supporters 
have been influenced by publicity surrounding 
possible long-term harmful effects of artificial 
feeding on the baby's metabolism. Studies 
have been released suggesting that these 
include: neonatal hypocalcemia; overtaxing of 
the baby's kidneys with electrolytes as a result 
of the too early introduction of semi-solid and 
salty preparations; and the early appearance 
of a taste for sugar and consequently a 
long-range risk of tooth decay. 
In view of this renewed interest, it is the 
responsibility of today's nurses to equip 
themselves to provide new mothers with 
understanding, support and education. 
Although lactation is a normal human function, 
most mothers need some assistance in 
learning how to breast-feed successfully. The 
aim of this article is to help nurses and, 
indirectly, mothers become more 
knowledgeable in this area by describing the 
main stages of an educational program on 
breast-feeding. This includes a brief 
discussion of the advantages of 
breast-feeding and suggested educational 
approaches appropriate for each stage in the 
maternity cycle: I) prenatal, II) in-hospital, and 
III) at-home 


Advantages 
Breast-feeding offers certain advantages 
over artifical feeding that should be explained 
to the mother. For example: 
. The beginning of lactation triggers a 
hypophysial reflex that induces an ocytocic 
hormonal action on the uterus. This causes 
contractions that.in turn, facilitate its involution 
and help to effect a return to its normal state. 
. The mother's milk contains various 
anti-infective properties that ensure the baby's 
protection against intestinal infections causing 
diarrhea, especially those caused by 
Escherichia Coli. Moreover, the mother's milk 
seems to provide a degree of protection 
against pathogenic agents such as poliovirus 
and enterovirus. In addition, epidemiological 
studies conducted in developed countries 
Show that the Incidence of upper respiratory 
infections is lower among breast-fed babies. 
. Pottenger and Krohn (Ashley MontaQu 
1971) found that breast-feeding facilitated 
adequate development of the peri-buccal 
muscles and the dental arch so as to help 
prevent the protrusion of teeth that would 
eventually require orthodontic repair. 
. It has been proven that the incidence of 
colic, food allergies and eczema is lower 
among breast-fed babies. 
. Psychologists agree that breast-feeding 
provides the baby with maximum oral 
gratification and establishes irreplaceable 
bonds of affection between mother and child. 


Pre-Natal Instruction 
About the middle of the second trimester, 
or at the beginning of the third, the nurse 
responsible for prenatal teaching may begin to 
provide some general advice, a brief 
theoretical explanation and some illustration of 
the procedures involved In breast-feeding. 


Some helpful suggestions 
The mother contemplating breast-feeding 
needs to know, for example, that during 
pregnancy, the size of the breasts will 
gradually increase and that this will 
necessitate buying progressively larger 
brassiere sizes. These bras should have wide 
shoulder straps for adequate support; should 
be washable and have properly fitting cups. 
They should not be rubber-lined, strapless or I 
boned. 
Brief air or sunbathing may be 
recommended to strengthen and toughen the 
nipples. A terrycloth facecloth or towel may be 
used to rub the breasts vigorously night and 
morning. 
During her daily bath the prospective 
mother should wash her breasts first using 
plain water and avoiding soaps or perfume that 



The Canadian Nurse March 1976 


27 


II 


nay dry out the aerola and eventually cause 
I 'happed nipples. A body oil. containing 
I ,molin, cold cream or baby oil, or one 
)rescribed by the doctor may be applied to 
.eep the nipples and aerola flexible. 
Mothers who have chosen to breast-feed 
heir babies should have their breasts 
'xamined by either the nurse or doctor in order 
10 ensure that the nipples are tractile. since 
';uccessful breast-feeding depends to a large 

xtent on the baby being able to draw the 
lipples against his hard palate when sucking. 


Postpartum is hardly the time for a mother to 
discover, to her painful surprise, that her 
breasts are not suited to breast-feeding Most 
nipples are tractile when held between the 
thumb and index finger. This means that the 
Ilipple begins to harden and swell when 
subjected to stimulation with the fingers. Some 
women, however. have retractible nipples that 
contract rather than swell when stimulated. In 
such cases, the exercises that will be 
described later may be useful. The mother wIth 
retractible nipples can be helped by wearing 
Woolwlch cups (available from the La Leche 
League) for at least eight hours a day These 
cups follow the shape of the breasts very 
closely and force the nipples to protrude. 
Mothers hoping to breast-feed their 
babies may wish to join the La Leche League 
Association to obtain free advice and 
encouragement 


Physiology of Breast-feeding 
In order to successfully breast-feed her 
baby, the mother must grasp the basic 
concepts involved in the anatomy and internal 
functioning of the breasts. If this explanation is 
provided in straightforward and simple form, 
the mother will understand the lactation 
process and will be less anxious about her 
ability to nurse her baby. 
Patient teaching should include: 
. Examination of the outer aspects of the 
breast (figure 1). This description should 


I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
/ 


Fig. 1 - external view of breast 
A Papilla 
B openings for milk to flow (nipple) 
C Montgomery s glands (glandulae areolares) 


include an explanatiOn of Montgomery's 
Tubercles. the small fleshy globules on the 
aerola that secrete a substance to keep the 
nipple and aerola tractile. Mothers should be 
warned of the possibility of infection if these 
globules are squeezed or handled roughly. 
The 15 to 20 openings at the tip of the 
nipple through whiCMìnilk eventually flows 
should be pointed out tothe mother. Invariably, 
this information relieves the mother who had 
been under the impression that there was only 
one opening for the milk. 
. An explanation of the internal functioning 
of the breast This serves to reassure mothers 
of their capacity to produce milk. Figure 2 
provides a simple explanation of the "reservoir 


B. 


A .,,1 
Â: 
-g 

 
.. 


D 


Fig. 2 - cross-section of breast 
A lactiferous ducts leading to milk reservoirs 
B openings of lactiferous tubules 
C ampullae (milk reservoirs) 
D alveoli (where milk forms) 


aspect" of the milk supply and establishes that 
the breasts are always full and ready to feed 
the baby. 


Preparatory Exercises 
During the third trimester of the 
pregnancy. the nurse may suggest the 
following exercises to assist the mother. 
Nipple Protrusion Exercises: roll the nipple 
between the thumb and the index finger; or 
stimulate the nipple between the two thumbs in 
a vertical or horizontal direction, with some 
stretching action on the areola (figure 3). 


Fig. 3 - nipple protrusion exercises 
A stimulation of nipple between thumb and 
index finger 
B stimulation of nipple between two thumbs on 
an even plane 
C pressing areola toward base of the nipple 



28 


The Canadian Nurse March 1976 



 .. 
. -. 
.. 
... 


These exercises are to be done, beginmng in 
the sixth month of pregnancy, at least twice 
daily. 
Massage: The breasts should be massaged 
and pressed for one or two min utes twice daily, 
six to eight weeks before delivery (figure 4). 


Fig. 4 - breast massage 
A starting position 
B the hands slide toward the areola while 
exerting continued pressure 
C the hands are cupped around the breast 


Tnese two exercises are useful In 
instructing the mother in emptying the breasts 
manually, and thus preventing engorgement. 
They also facilitate a better milk ejection reflex 
once the mother begins to breast-feed her 
baby and allow her to become familiar with 
handling her breasts so that she is more 
confident postpartum. 


II In-Hospital Instruction 
This phase completes the information 
given during the prenatal period and it would 
be useful to emphasize the following points: 


Hygiene 
Meticulous washing of the breasts and 
hands is necessary before each feeding in 
order to avoid infection. Alcohol and soap 
should not be used on the breasts since they 
cause chapping. The nurse should show the 
breast-feeding mother how to clean her 
nipples before and after each feeding with 
sterilized water and absorbent cotton or 
compresses. Cleaning before each feeding 
removes any trace of creams that may have 
been applied earlier. After feeding, cleaning 
protects the nipple and the areola, for whether 
they are dry or dripping with milk, they are ideal 
places for the growth of bacteria. 


Position 
It is essential that the mother be in a 
comfortable position. Research has shown 
that the sitting position is best for efficient 
draining or emptying of the breasts. If she can, 
the mother should follow the 
recommendations given in figure 5. Or, for the 
first few days following an episiotomy the 
mother may prefer to breast-feed her baby 
while lying down(figure 6). 


D 


Fig. 5 - nursing in a sitting position 
A pillow under the arm supports the baby 
B armrest to support the arm 
C feet raised for relaxation 
D the spine supported against the back of Ihe 
chair 


Fig. 6 - nursing while in a lying position 
The mother and child are parallel to each other. 
The mother's shoulder is on the bed, a pillow 
supports her head. 


Schedule 
In general, nurses should place the baby 
at its mother's breast while still on the delivery 
table (the baby having at least an Apgar of 8 to 
10). This precocious sucking stimulates the 
secretion of milk, prevents postpartum 
hemorrhage, and by means of ingestion of 
colostrum, promotes a better intestinal 
peristalsis which helps the child to empty the 
meconium. Another reason for early 
breast-feeding is that colostrum is less 
irritating to the esophagus than water and 


o 


glucose. Colostrum produced during the firs 
twelve hours following delivery contains a higl" 
concentrationof Vitamins A and E, as well as 
antibodies. During this period, the child should 
be allowed to nurse whenever it is hungry, 
In most hospitals, breast-fed babies arE 
put on the same schedule as those who arE 
bottle-fed, (i.e_ q4h). Little consideration is 
given to the fact that the mother's milk is 
digested by the baby in two to 
two-and-one-half hours. If rooming-in is not 
permitted in the hospital, breast-fed babies 
should be placed on a three-hourly schedule 
including night feedings. According to 
Applebaum's recommendations (1970), the 
nurse should explain to the mother that durin! 
the first day the baby must suck for five 
minutes on each breast in order to facilitate 0 
promote the milk ejection reflex. On the 
second day, the feeding time should be ten 
minutes per breast, and on the third day, fiftee 
minutes per breast. Total feeding time shoul, 
not exceed thirty minutes. The mother shoul, 
not take hypnotics because these lower her 
basal metabolism and consequently the 
secretion and excretion of milk will be reducec 


Feeding 
Once in the proper position, the mothe 
needs to be shown how to support and offe 
her breast to the child by taking the areola an 
the nipple between the index and the middl 
fingers in order to project the nipple (figure 7) 


a 


Fig, 7 - offering the breast to the infant 
The areola is gripped between the index and third 
fingers to facilitate milk flow from nipple. 


She will thus be able to stroke the baby's 
mouth or cheek so that he turns his head 
towards the mpple by himself. Never try to tur 
the baby's head in the desired direction 



The CanadIan Nurse March 1976 


29 


I because he will automatically turn his head 
I towards this touch, 
It IS important to remind the mother that 
the nipple and part of the areola must be inside 
the baby's mouth in order for him to suck 
properly without injuring the nipple. While the 
baby is sucking, depending on the shape and 
size of the breast, the mother will lower it gently 
With the index finger in order to enable the child 
I to breathe (figure 8). 


Fig, 8 - to keep the baby's nose free to 
breathe, 
I I the mother presses her breast lightly with her 
index finger. 
, Tne nurse should try to encourage the 
mother to be calm and relaxed while 
breast-feeding her child. She should also be 
careful to avoid all negative behavior when in 
the presence of breast-feeding mothers. 
When the baby begins to take in less milk, 
that is to suck with small irregular lunges at the 
nipple, the nurse will demonstrate to the 
mother how to use the alternate !l1assage 
method. She will help her massage one 
section of the breast after the other in order to 
soften each region of the breast with her 
fingers (figure 9), and do so without removing 


Fig. 9 - breast divided into imaginary 
quadrants. 
The mother massages each quadrant in turn 
during lactation if the Infant has a sluggish 
sucking reflex. 


the baby from the breast. This massaging 
promotes the draining of the breast and it 
enables the child to begin to suck more 
vigorously in the middle of a feeding. 


Drainage 
In order to avoid engorgement of the 
breasts and to ensure better drainage, the 
mother, with the assistance of the nurse, 
should put into practice the exercises learned 
during the prenatal period - that is, the 
manual massaging and pressing of the 
breasts. This should be done after each 
feeding as long as the baby does not succeed 
in sucking for half an hour. 
It is the draining of the milk and not its 
production which is the "sine qua non" of 
successful breast-feeding. If the mammary 
gland is not emptied by the baby, excessive 
milk-induced pressure builds up in the ducts 
and alveoles of the breast. This results in 
flattening of the secreting cells of the alveoles 
and consequently in a significant decrease in 
milk secretion. 
In order to facilitate the milk-ejection 
mechanism, doctors prescribe ocytocin in the 
form of nasal spray a few minutes before 
feeding. The nurse should show the mother 
how and why this is used. 


III At-Home Instruction 
The nurse responsible for postnatal 
classes or for at-home visits (6-8 weeks 
postpartum) may include the following 
recommendations in her instructions to 
breast-feeding mothers: 


Drug Use 
In general, mothers who breast-feed their 
babies should not take drugs because, once in 
the mother s milk, they may have different 
effects, such as blocking the activity ot some 
enzymes in the baby, interfering with normal 
physiological functions, or provoking 
hypersensitivity reactions in the infant. Many 
factors come into play once drugs are taken: 
the ionization of substances (PH), their 
concentration and their administration. The 
way a drug is administered, for example, is 
important with respect to the drug s level of 
concentration in the mothers milk. The level of 
concentration is always higher when a drug is 
taken intravenously (Catz and Giacoia, 1972). 
Certain drugs should not be taken by 
breast-feeding mothers: anticoagulants, 
antithyroid drugs, laxatives, narcotics, 
bromides, tetracycline and metranidazol 
(Flagyl). Concentrated alcohols such as 
cognac and whisky are also to be discouraged. 
According to Catz and Giacoia(1972), 
drugs which are not as yet contraindicated if 


used in small doses are aspirin, insulin, 
caffeine and clgarettes(not more than four per 
day) These do not seem to bother the baby. 
Schedule 
Studies have shown that the baby drinks 
90 percent of the milk he needs during the first 
seven minutes of breast-feeding. No feeding 
should last longer than 30 minutes. Lactation 
increases according to the baby's needs. The 
more he drinks, the more milk is secreted. The 
ideal situation would be breast-feeding on 
demand, since this method would be based on 
the baby's needs. Also, according to 
Illingworth and Stone (1958), it would help 
prevent problems such as engorgement of the 
breasts and cracked and ulcerated nipples. 
Most mothers take four weeks to get 
accustomed to breast-feeding. If demand 
feeding is too difficult or a source of anxiety, 
the nurse can suggest a three -hour schedule 
for the first six weeks of breast-feeding. With 
this schedule, or even wIth feeding on 
demand, it is found that the baby will rarely 
feed more than six or seven times every 24 
hours. Instead, the number of feedings 
decreases gradually according to the baby's 
appetite down to four to six teedings per day. 
Most babies continue to requi re night feedings 
until about ten weeks. 
Once the mother is at home, she should at 
first give one breast per feeding in order to 
completely empty each breast in turn, At the 
next feeding, she will begin with the other 
breast. Ifthe baby is very hungry or if he IS very 
small, the mother will continue to give him both 
breasts on each feeding and will begin the next 
feeding with the breast offered last during the 
preceding feeding, 
It must be emphasized that the baby must 
never be given additional or complementary 
water or milk bottles. The use of a bottle 
requires less sucking effort. This will weaken 
the baby's cheek muscles and make him lose 
the ability to squeeze the breast with his lips, 
tongue and cheeks. An infant may be fed only 
at the breast until he is tour or even six months 
old. 


Weaning and Solid Foods 
Weaning must always be gradual one at a 
time, breast-feedings are gradually replaced 
by bottle-feedings. Weaning should normally 
last three weeks in order to avoid physical 
discomfort to the mother (engorgement of the 
breasts). This method has the added 
advantage of stopping the secretion of milk 
very gradually. 
During the weaning period, the mother 
should reduce the quantity of liquids she drinks 
during meals. and wear a good brassiere even 



30 


The CanadIan Nurse March 1976 


at night in order to avoid sagging of the 
breasts. 
Breast-fed babies double their birth 
weight by 14 to 16 weeks. Pediatricians 
favoring breast-feeding introduce solid foods 
around the third or fourth month, for according 
to studies such as those conducted by Beal, 
salivary secretion. which helps the digestion of 
food, begins only towards the third month. 
Barkwin in his study states that before they are 
three months old, babies reject food with their 
tongue, and it is only towards the third or fourth 
month that they begin to introduce food in the 
back of their mouth. With the early introduction 
of solid foods and cow's milk, the child 
consumes ten times more salt than he should 
and thus increases his susceptibility to 
hypertension later in his adult life. Solid foods 
recommended towards the third month are 
mashed ripe bananas, precooked baby 
cereals enriched with iron, and egg yolk. If the 
mother breast-feeds her baby up to six 
months, she may, when weaning, introduce 
the baby directly to the cup without the use of a 
bottle. 


Infection 
Cleanliness of the hands, breasts and 
brassiere is essential in the prevention of 
breast infection. Maternal compresses must 
be changed frequently when wet. 
If a mother complains of localized pain or 
sensitivity of the breast, the nurse may 
recommend the following: 
. doubling the number of feedings from the 
sore breast in order to drain it more completely 
(every two hours); 
. frequent application of moist hot 
compresses for a few minutes daily before 
breastfeeding; 
. alternation of breast-feeding postures 
(sitting and lying down); 
. longer rest periods: 
. a mild analgesic prescribed by the doctor 
to relieve the pain and facilitate the milk 
ejection reflex: 
. Do not, under any circumstances, stop 
breast-feeding. 


Diet 
Mothers who breast-feed their babies 
must eat a well-balanced diet, consisting of 
cooked fresh vegetables, fruits, meat, fish, 
dairy products and whole grain cereals. The 
nurse may recommend Canada's Food Guide. 
Gunther (1955) noted a relationship between 
the mother s diet and the composition of her 
milk. For example, an increase in 
carbohydrates in her diet increases milk 
secretion, while an excess of lipids/fats 
decreases it. 


Mothers who breast-feed their babies are 
often thirsty. It is a good idea to recommend 
that they drink 2,500 ml-3,000 ml of liquids in 
order to quench their thirst, increase their milk 
secretion and stimulate their milk ejection 
reflex. Too much of some foods such as 
asparagus, cabbage, onions or rhubarb gives 
a specific flavor or taste to the milk. Game or 
wild fowl are not recommended because of the 
toxins carried by these animals. A balanced 
diet that is varied and nutritional is the obvious 
solution. Above all, mothers must not be made 
anxious by unnecessarily complicated dietetic 
recommendations. 


Activities 
It is recommended that the mother avoid 
fatigue. If possible, she should rest for one 
hour every afternoon. It is obvious that 
following delivery a young mother will tire 
quickly. Her body must regain its balance, and 
in order to do so she must lead a calm and 
non strenuous life. A young mother will need at 
least six weeks before becoming accustomed 
to her new pace of life. 


Birth Control 
The contraceptive powers of 
breast-feeding have been studied by many 
authors who have arrived at different 
conclusions. Some, like Gioiosa (1955), 
Udesky (1950) and Douglas (1950), noted a 95 
percent decrease in the incidence of 
pregnancy among women who breast-fed 
continuously and intensively until the sixth 
month following delivery. However, after a 
symptothermic study of the ovulation 
mechanism, Pascal (1971) found that with 
abundant and prolonged breast-feeding, the 
first ovulation never occurs before the sixth 
week following delivery. From this she 
concluded that the period of absolute sterility 
covers only the first five weeks following 
delivery, provided that the child is only 
breast-fed. These authors agree that the more 
additional solids or feeding-bottles are 
introduced at an earlier date, the higher the 
incidence of ovulation and pregnancy. 
Therefore, given that breast-feeding is not 
a safe method of birth control, the nurse who 
gives at-home instruction or postnatal classes 
may, depending on the wishes of the individual 
couples, reinstruct them in the various 
methods of birth control. Methods such as 
IUD's and condoms may be suggested to 
couples who wish an alternate method to oral 
contraceptives. The nurse may recommend 
IUD's because their rate of spontaneous 
rejection is lower when inserted eight weeks 
after delivery, which generally coincides with 
the postnatal medical examination. 


Conclusion 
The success of breast-feeding depends 
on three interdependent variables: 
1) parental motivation; 
2) a healthy child with a good sucking reflex 
3) a competent nurse. 
It is the author's hope that this article wil 
help nurses become more successful with 
respect to the third variable. 


Mane-Elizabeth Taggart (R.N., B.Sc.N., B.A, 
Dipl. Public Health, M. Sc. N., University of 
Montreal) is assistant professor, Faculty of 
Nursing, University of Montreal. The matef/al 
in this article is based on information 
contained in her master's thesis. and on 
extensive experience in community clinics 
and public health nursing. '" 


Bibliography 
1 Applebaum, R.M. The modern management 
of successful breast feading. Pediatr. Clio. N. Am. 
17:203-205, Feb. 1970. 
2 Brazelton, T.B. Psychophysiologic reactions 
in neonate. PI. 2 Effect of maternal medication on 
neonate and his behavior. J. Pediatr. 58:1 :513-518, 
Apr. 1961. 
3 Call, J.D. Emotional factors favoring 
successful breast feeding of infants. L'enfant 
3:269-270, 1960. 
4 Catz, S. Charlotte. Drugs and breast milk, 
by...and George P. Giacoia. Pediatr. ClIO. N. Am. 
19:151-166, Feb 1972. 
5 Disbrow, Mildred A. Any women who really 
wants to nurse her baby can do so? Nurs. Forum 
2:3:39-48, 1963. 
6 Douglas. J.W.B. The extent of breast feeding 
in Great Britain in 1946. J. Obstet. Gynaecol. Br. 
Commonw. 57:335-361, June 1950. 
7 Evans, T.R. Exploration of factors involved in 
material physiological adaptation to breastfeeding, 
by...and et aL Nurs. Res. 18:1 :28-33, Jan.-Feb. 
1969. 
8 Gloiosa, Rose. Incidence of pregnancy dUring 
lactation in 500 cases. Am. J. Obstet. Gyneco. 
70:162-174, JuL 1955. 
9 Goldman, Armand S. Host resistance factors 
in human milk, bY'hand C.w. Smith. J. Pediatr. 
82:1082-1090, Jun. 1973. 
10 Gunther, Mavis. Instinct and the nursing 
couple. Lancet 1 :575-578, Mar. 19, 1955. 
11 Gunther, Mavis. Diet and milk secretion in 
women. Proc. Nutr. Soc. 27:77-82, Mar. 1968. 
12 Pascal, Juliette. Quand de I'amour surgit la 
vie. La maîtrise de la fécondité. Paris, Édition du 
Centurion, 1971. 
13 Population Reports Family Planning 
Programs Series J, Number 4, Jul. 1975. 
14 Udesky, LC. Ovulation in lactating women. 
Am. J. Obstet. Gynecol. 59:843-851, Apr. 1950. 



"The CanadIan Nurse March 1976 


31 


FREEZING 
BREAST M LK 
AT HOME 


"'-, 
... - ' 


....... 


...... 



 
'" 

 



 



 
'5 
Ë: 


d. , 
\.. l ,.
. 
ør
G4. 
:! 1
.:.7
 
, 


cnyse Theberge-Rousselet 


The consultant on breast-feeding is often called upon to leach 
mothers how to store and freeze breast milk. Breast-feeding is 
regaining popularity among new mothers, and they often nurse 
their babies for a long time. Thus, they need a reserve of frozen 
breast milk for use during their absences from home. 
Following are guidelines for the storing and freezing of breast 
milk at home: 


1 Use jars that are of convenient size for freezing; baby food 
jars are a good example. 


2 Sterilize jars, lids, containers for the milk collection, and 
breast pump (if used) either by washing them in a dishwasher 
(one that has a sanitizing cycle or where household water 
reaches 60 c C.), or by boiling them for 3 minutes, after thorough 
washing. 


3 Wash hands thoroughly before expressing milk. 


4 Collect milk by manual expression, or by a hand or electric 
breast pump. A freshly sterilized jar should be used for each milk 
t'" collection. 


5 Refrigerate the milk immediately. Once cold, place it in the 
freezer. It is recommended to freeze milk that will be used more 
than 24 hours after expression. 


6 When adding freshly expressed milk to a partially filled jar of 
frozen milk, cool the fresh milk first by placing it in the refrigerator 
or freezer for a few minutes. This prevents the warm milk from 
thawing the top layer of frozen milk. 


7 Do not fill jars or cap them too tightly when freezing milk, 
expansion caused by freezing may crack the jars. 


8 Mark the dates of collection on the jars. Milk can be kept 
frozen for 2 to 3 months, and up to 6 months under good freezing 
conditions. 


9 Before thawing the milk, loosen cap slighlly. then place jar in 
a pan of tepid water; Refrigerate the thawed milk until ready to use 
it. Before feeding the baby. shake the milk as cream rises to the 
top, leaving thin, bluish skim milk below. 


Denyse Rousselet (M. S. (Community Health 
Nursing), M.A., California State Uniyersity, 
San Jose). former instructor of pediatric 
nursing, De Anza Community College, 
Cupertino, California, is an accredited teacher 
of the American Society for 
Psychoprophylaxis in Obstetrics (Lamaze) 
She is presently teaching at the CEGEP 
Montmorency in Laval, Quebec.4I 



32 


The Canadian Nurse March 1976 


lF1E TR
TMENT OF 
MASTITIS N 
NURS NG ìr 
-MOTHERS 


--- 
., 


Denyse Theberge-Rousselet 
Considerable uncertainty still surrounds the 
question of the treatment of choice for mastitis 
(the name generally used to describe any 
inflammatory prùcess of the breast). Some 
doctors order a mother suffering from mastitis 
to wean the baby immediately, or, 
alternatively, to temporarily refrain from 
nursing from one or both breasts. Two 
principal reasons are cited for this advice: 
1. the possibility that the baby will be harm
d 
by the transmission of infection or antibiotics 
prescribed for the mother throug
 the milk . 
supply; 2. the possibility that the Infection will 
heal more slowly if the mother continues to 
nurse the baby. 
Nurses on hospital obstetncal units often 
receive telephone calls from worried mothers 
who have encountered this problem on 
leaving the hospital and returning home. In 
hospitals where a consultant in maternal 
feeding is available, these nurses look to her 
for advice in determining what treatment to 
recommend. They are upset by these calls 
and anxious that the controversy be settled so 
that they can be sure they are recommending 
the most effective treatment. 
Recent studies suggest, for example. 
that the reasons cited above for either 
weaning the baby completely or decreasing 
the number of feedings, are not valid. It has 
even been proven that the mother will recover 
more quickly if these restrictions are not 
imposed and if, in fact, feedings are 
increased rather than discontinued or 
decreased. 


Physiopathology 
Mastitis and breast abscesses (these can 
occur at any time, not only during pregnancy or 
lactation) are almost always caused by 
staphylococcus aureus originating from the 
mother's skin or the nasopharynx of the 
nursing baby. 
An important factor in considering the 
source of the infection is stasis of milk 


following the let-down reflex or following 
attempts to suppress lactallon. 4 In theory, the 
ducts distended by the milk provide a 
favorable environment for bacterial growth. 2 


Symptoms 
The first indication of the problem to 
health personnel occurs when a woman calls 
the doctor or the nurse and complains of 
discomfort in the breast. Sometimes this. 
discomfort is accompanied by a low fever. 1 If 
the woman is breast-feeding her baby and the 
breast or part of the breast becomes firm, red, 
swollen, hot or sensitive, mastitis should be 
suspected. 3 The nurse must be familiar with 
these svmptoms because she will often need 
to refer the woman to her doctor. 


Treatment 
Formerly, treatment was conservative 
and consisted of termination of breast-feeding 
and a minimum of breast manipulation or 
pumping of milk. Weaning, however, has 
never been necessary; above all, one should 
never stop breast-feeding. 1 It is more logical 
to attempt to reduce stasis of the milk. The 
most effective method of doing this is to allow 
the baby to continue to breast-feed. 2.4 The 
mother should nurse twice as often, but for 
shorter periods of time, especially from the 
affected breast. 1 2 
Supplementary treatment includes bed 
rest,34 good support for the breasts,4 and hot 
compresses 2 .4 changed every hour, or 
intermittent cold compresses
.4 used in 
combination with an analgesic to alleviate the 
pain. Antibiotics are sometimes 
administered.1 1 ,2.3,4 Vhen a general infection of 
the breast localizes into an abscess, surgical 
incision and drainage is indicated. 3.4 


Resu Its 
Studies done by the four authors cited in 
this article reveal that the majority of subjects 
continued to nurse successfully during and 


after mastitis. No babies were weaned 
because of mastitis alone 2 After studying 71 
cases. Dr. W.P. Devereux suggests that the 
implementation of prompt treatment is 
important in preventing abscesses. 2 Dr. 
E.Robbins Kimball suggests that an abscess 
is often prevented without resorting to 
antibiotics if the woman consults her doctor as 
soon as symptoms appear. 3 
There is no evidence that any of the 
babies studied suffered secondary effects as 
a result of the inflammation. 2.3This was true 
even for babies who were breast-fed 
immediately after incision and drainage of the 
abscess. 
Implementation of this treatment 
shortened the duration of the disease - often 
by as much as one-half or one-third. In 
addition fewer of these women developed a 
breast 
bscess than those who stopped 
nursing. 


Conclusion 
When a mother reports symptons of 
mastitis to the nurse, she must be made 
aware of the importance of communicating 
this to her doctor with a view to preventing a 
more serious infection, or even an abscess. 
It is to be hoped, from a nursing 
standpoint, that most women being treated for 
mastitis will continue to nurse. This has the 
advantage of being both the most efficienf 
treatment and also the easiest to initiate. At 
the same time. it allows the mother to 
continue feeding her baby in the way she has 
chosen. 


Denyse Rousselet (M.S. (Community Health 
Nursing), M.A, California State University, 
San Jose). formerly instructor of pediatric 
nursing, De Anza Community College, 
Cupertino, California, is an accredited 
teacher of the American Society for 
Psychoprophylaxis in Obstetrics (Lamaze) 
She is presently teaching at the CEGEP 
Montmorency in Laval, Quebec. '" 


References 
1 Applebaum, A.M. Mastitis in the lactating 
mother. The modern management of successful 
breast feeding. Pediatr. Clio. N. Am. 17:1 :203-225 
Feb. 1970. 
2 Devereux, W.P. Acute Puerperal mastitis: 
Evaluation and its management. Amer. J. Obster. 
Gynecol. 108:78-81, Sep, 1, 1970. 
3 Kimball, E. Robbins, Unpublished research 
Nursing mothers' Council's Medical Advisory 
Board. Glenview, III., 1973. 
4 Newlon, Michael, The normal course and 
management of lactation, by , . . and Niles Newton 
Clio. Obstet. Gynecol. 5:1 :44-63, Mar. 1962. 



;;; 

 
" 
, 


.g 
c 
Ö 
Õ 
.c 
II. 


.. 


. 


" 


The Canadian Nurse 


, 


\ 


t 


o 


\ 


. 


- 


March 1976 


33 


. 



34 


The Canadian Nurse March 1976 


A guide to drug use during breast-feeding 


BABES 
AT R SK? 


, 



t 




 


Denyse Theberge-Rousselet 


\ 
I 


In recent years women have increasingly 
chosen to breast-feed their offspring with the 
result that a growing number of babies have 
become the passive recipients of drugs, 
prescribed or otherwise. To date, however, 
little research has been done on the presence 
of drugs in breast milk and their effect on the 
young recipients. Although it is generally 
agreed that any substance taken by the 
lactating mother will, to some extent, be found 
in her milk, not enough is known of the 
necessary precautions or the amounts that 
may have a harmful effect on the baby. 
When he has to prescribe drugs to the 
lactating mother, the doctor must weigh the 
drug's benefits and the need for the drug 
against the known and unknown risks to the 
child. In many cases, risks may be reduced if 
careful consideration is given 10 the choice of 
drug and the explanation given the mother. If 
possible side effects in the mother and baby 
are also taken into account, risks are even 
further reduced. 
The nurse who is in contact with mothers 
who breast-feed their babies must be familiar 
with types of drugs that may cause problems 
and are, therefore, to be avoided. She should 
also know certain principles considered by 
doctors in prescribing drugs to these women. 
Some of these factors include: 
1 Type of drug: some drugs are excreted in 
the mother's milk in greater quantities than 
others. 
2 Dosage: the baby's age as well as the 
quantity of milk consumed daily must be 
considered. 
3 Duration of drug treatment. 
4 Method and liming of administration in 
relation to the baby's feedings: a smaller 
quantity of the drug will be found in the milk if 
medication has been taken immediately after 
Ihe previous feeding. 


5 Cumulative effects of the drug. 
6 Development of the baby's organs; 
immaturity of hepatic and renal functions may 
decrease the excretion or inactivation of drugs 
and thus increase the concentration of a drug 
in the infant's bloodstream. 
7 Hypersensitivity of the infant. 
8 Possible secondary effects on the mother's 
behavior, for example, drowsiness. 
9 Possible secondary effects on the quantity 
of milk. Oral contraceptives, for example, are 
known to influence the milk supply. 
Many drugs taken by the mother affect her 
breast-fed baby. The list that follows is based 
on the most recent medical literature, but only 
the most common drugs are mentioned. 
Information on a variety of less common drugs 
may be found in the references cited in this 
article. 


Analgesics 
These are the most commonly used 
drugs. Occasional therapeutic doses generally 
affect neither the quantity of milk produced nor 
the baby. However, mothers who take large 
doses for prolonged periods (for example, 
mothers being treated for rheumatoid arthritis) 
have not been studied and, consequently, data 
on these women are not available. 1 
Aspirin appears in the mother's milk in 
moderate quantities. 11 may produce a 
tendency to bleed either by a decrease in 
the quantity of prothrombin in the baby's 
blood or by interfering with the function of 
blood platelets. 2 
Codeine does not significantly affect the baby 
when taken in therapeutic doses. 3 
Heroin appears in relatively high concentration 
in the breast milk when the mother is 
addicted to the drug. 3 Thus, it will prevent 
withdrawal symptoms in the newborn 
addict 



 


Meperidine (Demerol) has an insignificant 
effect when taken in therapeutic doses. 
Morphine has little effect when taken in 
therapeutic doses. 3 However, it is found in 
sufficient concentration in the milk of an 
addicted mother to prevent withdrawal 
symptoms in the breast-fed infant. 
Nisentil has a sedative effect on the infant 
when taken in therapeutic doses. 
Darvon has little effect on the baby when taken 
in therapeutic doses. 3 


Antacids 
These drugs are rarely absorbed in 
appreciable amounts and should present no 
problem unless the mother develops an 
electrolytic imbalance. 


Anticarcinogenic Drugs 
These drugs may inhibit formation of bone 
marrow in the baby. They should be a 
contraindication to breast-feeding. 2 
Antimetabolites (methotrexate, 
mercaptopurine) may be secreted in the milk 
and breast-feeding should be avoided. 


Anticoagulants 
Oral anticoagulants should be avoided 
because they have not been sufficiently 
studied They have been reported as causing 
severe bleeding in the infant. 2 ,4 For other 
anticoagulants, both mother and baby must be 
watched very carefully in order to avoid 
hematomes and hemmorhage in the 
baby. 


Antihistamines 
These drugs are often taken to alleviate 
colds and allergies. They generally reduce the 
production of milk, but this is not always 
noticeable if the drug is taken intermittently 
and in small quantities. They lead to 
vasoconstriction in the mother and limit the 
quantity of oxytocin reaching the breasts. The 
decrease in milk supply may be minimized if 
the mother's intake of fluids is greatly 
increased. Benadryl has a more marked effect 
than Chlor-Tripolon which, of the whole 
group, has least effect on the production of 
milk. 


Antimicrobial Agents 
and Antibiotics 
Studies have shown that these drugs 
pass into the mother's milk in small 
concentrations. In addition, the presence of 
these substances in the mother's milk may 
alter the baby's intestinal flora; normal 
intestinal flora are Important in the early 
development of immunities. 1.2,3 
Ampicillin is secreted in milk and may cause 
allergy and/or diarrhea. I 



The Canadian Nurse March 1976 


35 


What are the known and unknown effects on the breast-fed 
Jaby of drugs consumed by the nursing mother? 


Chloromycetin may cause the "gray 
syndrome" in the newborn and may also 
damage the bone marrow. 2 
Erythromycin, although secreted in milk, may 
be used. but may cause allergy to the 
drug. 
Kanamycin requires the baby to be watched 
: carefully for signs of toxicity.4 
,Penicillin is secreted in milk, but may be used. 
However kernicterus may develop in the 
newborn, 
Streptomycin IS secreted In milk. It may be 
used but may cause toxicity.5 
Sulfonamides may cause kernicterus in the 
newborn J and also hemolytic anemia,2 
Sulfapyridine has caused cutaneous 
eruptions. 4 
Sulfathiazole may be used in therapeutic 
doses. 4 
Gantrisin may cause kernicterus in the 
newborn and should be avoided during 
the first two weeks postpartum. 4 
Tetracyclines may cause dental stains in the 
baby and retard bone growth. 2 


Oral Contraceptives 
Recent research seems to indicate that 
smaller doses of oral contraceptives do not 
I significantly affect lactation in the majority of 
women, once the supply of milk is well 
I established (6-8 weeks). If the mother has 
imtial difficulty in establishing a good milk 
supply for her baby, even small doses of oral 
contraceptives may add to her problems. 
Large doses of oral contraceptives 
suppress lactation and even usual doses can 
decrease the milk supply. The immediate anc' 
long-term effects of oral contraceptives on the 
baby are not known. Other methods of 
contraception should therefore be 
encouraged during the entire period of 
lactation. S 


Corticosteroids 
These appear in milk and may hinder 
growth, interfere with the endogenous 
production of corticosteroids, or cause other 
undesirable effects. Breast-feeding should be 
discouraged. 2 


Diuretics 
These drugs should be used with caution 
during breast-feeding. No secondary effects 
have been reported in the literature cited here. 
but diuretics seem to inhibit lactation by 
dehydrating the woman. Diuril may cause 
thrombocytopenia in the baby.2 


Hyponotics and Tranquilizers 
Several sleep-inducing drugs contain 
bromides. Such drugs should not be taken as 
the baby's reaction to them may vary from 


cutaneous eruptions to drowsiness. 3 
Chlordiazepoxide (Librium) may be used in 
therapeutic doses. 5 
Chloral hydrate may have some sedative 
effect on the baby, but may be used in 
therapeutic doses. 3 4 
Chlorpromazine is secreted in the mother's 
milk but no effect was found in babies 
even with large doses. It may cause 
galactorrhea. 5 
Diazepam (Valium) in large doses sedates the 
baby.2 It may cause hyperbilirubinemia 
and its use is not recommended during 
lactation. s 
Meprobamate (Miltown, Equanil) requires 
that the baby be watched carefully for 
signs of toxicity. 5 
Phenobarbital has a sedative effect on babies 
with hypnotic doses of 100 mg. It is 
possible that there is no effect with 
sedative doses (30 mg t.í.d.),21t may also 
affect the endogenous production of 
corticosteroids in the baby or have other 
undesirable effects. 1 2 
Secobarbital Sodium (Seconal) has no effect 
on the baby with sedative doses: 
however, there may be some effect 
with hypnotic doses. 


Laxatives 
The forms that are not absorbed, such as 
castor oil, Dulcolax, mineral oil. and 
standardized senna concentrate (DSS) do not 
cause any problems. 
Cascara causes increased intestinal activity in 
the baby with habitual doses. 
Rhubarb has no ill effects when taken in small 
quantities but large doses increase 
intestinal activity in the baby. 
Senokot and Doxidan can cause loose 
stools in a baby. 


Drugs Affecting Endocrine Glands 
Thyroid preparations are not harmful to 
the baby when the mother takes them in 
habitual doses. It is believed that they 
sometimes increase the amount of milk 
produced. 
Radioiodine is passed into the mother's milk in 
large quantities and may significantly 
suppress thyroid function in the baby_3 
Propylthiouracil and thiouracif3 5 have effects 
similar to radioiodine. However 
concentrations of thiouracil in the 
mother's milk are higher than in the urine 
Or blood and may cause goiter in the baby 
or agranulocyfosis. 4 
Drugs Affecting the Autonomic 
Nervous System 
Atropine may reduce the amount of milk 
produced when large doses are taken: it is 



 
 
-1
 


not secreted in appreciable amounts in 
the milk. It may cause atropine poisoning 
in the baby.23 
Ergot (Cafergot) may cause various symptoms 
in the baby, from vomiting and diarrhea to 
a weak pulse and unstable blood 
pressure. 34 


Other Agents 
Stimulants, depressants. narcotics, and 
psychedelics have not been studied in relation 
to breast-feeding. They are believed to be 
secreted in the milk in appreciable quantities 
and should not be used. 
Alcohol if used moderately. has no harmful 
effect on the baby. Large quantities may 
cause sedation in the baby or inhibit the 
milk secreting reflex In the mother. 2 J S 6 
Certain foods have been found to cause 
allergic reactions in the baby: white beans, 
Indian corn, egg white, chocolate, seafood, 
peanuts, wheat, and gherkins. 3 
Methadone is not passed in significant 
quantities to the breast-fed baby whose 
mother takes a daily dose of this drug. 
Tobacco (nicotine) affects the baby if the 
mother smokes heavily. Effects may vary 
from diarrhea, vomiting, and tachycardia 
to agitation. s 
Vitamins that are fat soluble must not be taken 
in large doses. One study reported 
anomalies in the baby when the mother 
had taken large doses of Vitamin D during 
pregnancy. Vitamin D may also cause 
hypercalcemia. 47 


Conclusion 
Because so many factors are involved in 
choosing drugs for the lactating mother, and 
because so little conclusive research has been 
done in this area, it is difficult for the doctor to 
advise the mother. In general, the best advice 
would seem to be to avoid the use of drugs If at 
all possible. ... 


References 
1 Catz, C.S. Drugs and breast milk, by . . . and 
G.P. Giacoia.Pediatr. Clin. NorthAm. 19:151-166, 
Feb, 1972 
2 Drugs in breast milk. Med. Letter Drugs Ther. 
16:6:25-27. Mar. 15. 1974. 
3 Knowles, J.A. Excretion of drugs in milk-a 
review. J. Pediatr. 66:1068-1082, Jun. 1965. 
4 0 Brien. Thomas E. Excretion of drugs in 
human milk. Am. J. Hosp. Ph arm. 31 :9:844-854, 
Sep. 1974. 
5 Arena, J.M. Contamination of the ideal food. 
Nutrition Today 5:4:2-8, Winter 1970. 
6 Cobo. E. Effect of different doses of ethanol on 
the milk-ejecting reflex in lactating women. Am. J. 
Obstet, Gynecol. 115:817-821, Mar. 15, 1973. 
7 Goldberg L.D. Transmission of a vitamlO-D 
metabolite in breast milk. Lancet 2: 1258-1259. Dec. 
9, 1972. 



- 



 


... . 


I:.. .......... 
Ca-e 
............ ...... M. D 


- 


- 


-- 



 

 
.
_......
..,,
 
..... 

 - 


\ 
.\ 
 .... 
'. . 
. . -. 
.- '-. 
.. 
..
 
. - 
. 


. 
. 


. 


.. 
. 
-., 


From Lippincott. 


@IHE PRACIICE OF EMERGENCY 
NURSING 
Practical guidelines in this comprehensive new book will enable 
the emergency department nurse to properly assess the patient 
and implement a sound plan of nursing management. It's the 
most complete book of its kind! All types of clinical emer- 
gencies 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 ex- 
clusively with "medical practice." Expanded responsibilities of 
emergency nursing are stressed, as is the need for teamwork, 
based on a colleague relationship between physician and nurse. 
By James H. Cosgriff, Jr. M.D., F.A.C.S. and Diann Laden 
Anderson, R.N., M.N.; with 31 contributors. 
LIPPINCOTT 
488 Pages/lllustrated/1975 $15.75 


" 
I 


@ s MANUAL OF DIAGNOSIIC 
, PROCEDURES FOR PAIIENI 
lEACHING 


For constant day-to-day reference, this handbook, places at the 
nurse's fingertips two types of important information (1) a 
general description of the purposes and means of performing a 
wide range of clinical tests (more than 70) and (2) clear direc- 
tions on what to tell patients to expect, in order to spare them 
unnecessary anxiety. Many of the procedures discussed are 
very new ones and may not be familiar to all nurses. Helpful 
information on preparation and aftercare of the patient is 
featured. 
Edited by Barbara Skydell, R.N., M.S., and Anne S. Crowder, 
R.N., M.A. 
LITTLE BROWN 
248 Pages/ 1975/ Paperback $6.95 


. 


@)INIENSIVE CARE 
This is the first complete reference on the dramatically expand- 
ing field of intensive care. It presents clinically proved proce- 
dures to help physicians, nurses, and respiratory therapy per- 
sonnel deliver the finest possible care to critically ill patients. 
Also included are discussions of the organization ct an inten- 
sive care unit and the management of general physiological 
problems encountered and specific clinical situations faced in 
an intensive care unit. Nurses, physicians, and therapists work- 
ing in an intensive care facility who assume first responsibility 
for their patients will want to have a copy for daily reference. 
By John Joakkim Skillman, M.D. 
LITTLE BROWN 
609 Pages/1975 $25.00 


(1)& VD: A GUIDE FOR NURSES 
W AND COUNSELORS 
A clear overview of the physiological basis of sexually trans- 
mitted diseases is presented in this concise guide for nurses as 
well as for other health professionals. It offers specific recom- 
mendations for improving techniques of detection, treatment, 
and control. Emphasis is placed on understanding all aspects 
of the disease, including its social and psychological dimen- 
sions. Particular attention is given to developing the interview- 
ing skills necessary to elicit essential information to check the 
disease at both the individual and epidem:c levels; this is an 
especially difficult job when patients are embarrassed and un- 
willing to provide case histories or implicate others. A glos- 
sary, including slang terms, helps make this a valuable aid to 
nurses practicing in a variety of clinical and community settings, 
By Barbara Morton, R.N., B.S. 
LITTLE BROWN 
224 Pages/ 1976/ Paperback $8.95 



G) - CARDIOSURGICAL 
W NURSING CARE 
Understandings, Concepts, and Principles for Practice 
The widely published author on technology in health care, reci- 
pient of numerous professional honors, answers the two-fold 
question: What is good nursing?; in particular, what is good 
postoperative nursing care of the cardiac patient? Cardio- 
vascular sur9ical nurs:ng is presented in terms of 1) the "why" 
for nursing mtervention; 2) the "what to do"-i.e., nursing ac- 
tions to solve the patient's physiologic problems and 3) the 
"how"-suggested nursing procedures. 
Main topics: Introduction to cardiosurgical nursing. Cardiac 
conditions that require open-heart surgery. Blood imbalance 
and hematologic disorders. Water and electrolyte disequili- 
brium and disturbance of 1icid-base balance. Shock. 
Also: Respiratory insufficiency or failure; Cardiac arrhythmias 
or failure. Renal insufficiency or failure, Alleviating pain and 
discomfort. Cerebral damage, Care of adults and children 
undergoing thoracic surgery. Summary. Appendix: Research 
methodology and recommendations. Glossary. 
Rita K. Chow, R.N., Ed.D., 
SPRINGER 
386 Pages/1976 $12.50 



 - THE PATIENT IN THE 
W CORONARY CARE UNIT 
This book was written primarily for the CCU nurse in the com- 
munity hospital, where lack of elaborate monitoring apparatus 
means the nurse must rely mainly on clinical skill and judgment 
for detecting critical changes in the patient's condition. By the 
same token, coronary care nurses everywhere will welcome the 
many electrocardiographic illustrations of possible cardiac ab- 
normalities. The physiologic basis of the discussions affords 


clear understanding of the causes 0: coronary complications 
and of the effect of drugs and other fo
ms of therapy. 
Main topics: Coronary artery disease. Anatomy and physiology 
of the heart. Basic electrocardiography. Electricity, Cardiac Ar- 
rhythmias. Heart block, Monitoring systems. Pacemakers. Elec- 
trical conversion of arrhythmias. Cardiopulmonary arrest. Phy- 
siological monitoring. 
Also: Drugs used in coronary care unit. Diagnostic procedures. 
Pump failure. Surgical treatment of centricular failure. Embolic 
disorders. Respiratory support. Prevention and management of 
psychological problems. Nursing responsibilities in progressive 
patient care. Aberrant conduction. Electrocardiographic diag- 
nosis of myocardial infraction. 
Hannelore Sweetwood, R.N. 
SPRINGER 
465 Pages/1976/250 figs. $13.95 


@)INTERPRETING CARDIAC 
ARRHYTHMIAS 
A BASIC GUIDE 
A beginning text that assumes no prior know!edge of cardiac 
arrhythmias, this book provides a systematic method of learn- 
ing to evaluate an ECG strip, The presentation of basic arryth- 
mias is accompanied by extensive use of diagrams and strips 
that illustrate the abnormal rhythm under discussion. Included 
are self-test questions, selected readings, and glossary. 
Main topics: Anatomy and physiology of the heart (including 
electrophysiology). The electrocardiogram (including the ECG 
paper and normal ECG pattern). Arrhythmias (including inter- 
pretation and classification). Pacemakers (including uses 
types, and nursing care of patients with pacemakers). 
Mary Brambilla McFarland, B.S.N., M.S.N. 
SPRINGER 
128 Pages/1975 $5.25 


for the Practitioner 


@) THE LIPPINCOTT MANUAL OF 
NURSING PRACTICE 
This now-famous ready reference puts virtually all of nursing 
right at your fingertips! In three major units. , . medical/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 Guidel:nes to Nurs:ng Action, Nursing Alerts, Sections 
on Pharmacology and Medication, and much, much more! 
By LiHian S. Brunner, R.N., M.S,; and Doris S. Suddarth, R.N., 
M.S.N,; with four co-authors, three contributors. 
LIPPINCOTT 
1473 Pages/Profusely IIlustrated/1974 $21.50 


@PRINCIPLES AND PRACTICE OF 
INTRAVENOUS THERAPY 
2nd Edition 
Extensively revised and updated, this leading text includes 
technological advances in intravenous equipment and tech- 
niques, the latest findings on asepsis and hazards of contamina- 
tion, and practical rreans of ensuring safe, successful care. A 
new chapter on total parenteral nutrition has been added, as 
well as valuable information that IV therapists need in order to 
integrate their contributions into the total care program of the 
patient with optimal results. Also included is essential guidance 
for nurses involved in organizing and administering IV depart- 
ments and their personnel. 
By Ada L. Plumer, R.N. 
LITTLE BROWN 
348 Pages/l/lustrated/1975/Paperback $6.95 
Clothbound $10.95 


J. B. Lippincott Company of Canada ltd: 
Please send me the books I have circled. 


1 


2 


4 


3 


5 


6 


7 


8 


9 


Name 
Address 
City Prov, Postal Code 
o Payment enclosed. ship postage and handling paid 
o Charge and bill me 
 
o Use my Chargex master 
charge 
o Use my Master Charge 


Position 


LIPPINCOTT'S NO-RISK GUARANTEE: 
Books are shipped to you ON APPROVAL; if you are not entirely 
satisfied you may return them within 30 days for full credit. 
Prices subject to change without notice. 


Lippincott 


J. B. LIPPINCOTT COMPANY OF CANADA LIMITED 
Servmg the Health Professions in Canada Since 1897 
75 HORNER AVE, TORONTO, ONTARIO MBZ 4X7 (416) 252-5277 



38 


The Canadian Nurse March 1976 



 


. . . "I never did meet a nurse on the obstetrics 
ward who had children. . . I had no idea what 
kind of care to expect as a patient, or what was 


MATlF1EW 
MY SON: 


I. ' 
1 þ r _ 
-- " ......... 

"..::..
.....;-- 
 
- . .....-:.
 .- 
II' .
;;:: ; ... 
, .-.. 
 
 - I 
- 

 ;?

.... 
 ; ..
: I i , ; 
(:,:
 
 ..:J. _ -r" \ 
, 
I . 
,i.;J .,..
.: ;':,
:,., 1711'.1I'
""',:._ #II
 
 _
 
r.,.._ '" . "Þ... C ""ta II 

 '....I.

 '.4 '/". J J...-. .... .......,I'--r,; "..- 1. 
\. 
 I .'tP" , ,.' 
 . -' ) . ..:....!.. 
 ' 

 \\. 
 '
,' ,t
 III ',
/', . . _'.' ,;';:;;;;;;' ..' 



t'.:í J . i

. . 
,

 \ 
'" ,':"',. 11/ '.'1',/ /: "... 
",. ; .-/or;-;' ',,-,,. .. 1';";' 
 ""'" ' \ " 
- .,. ,
.. r > .:, - / .. I \I"').,,, ' 

 / ' t ' '
i: ,f .
 ..-. -r :..,....'; i!:
ø..å ' 
-þ-". " .f's'il.\ ,. '. ,('" .. . '" \ \ .' . , ' .
):..
 -- 
J..:l..- ",..... 
 I11JIÞ " , t II' 
 .. \ 't., y, '. 
... ?# . 
./ /, \ 

, '.
;'.:."., .. / . . '-ii ' .',
, ;.it " i " .. ... . 
. ..,;.&.... .....'. . . f. I . If." 
\ ''''."..,',!f''. .-L,":. I 
I ,/ .-_ .1. ::
'- '. 
I ("i' ..-... - . . . . , < 'øO .. 
, I':'" 
..... r. .,t.;..:J *'....". - -5 '.:
r.;....
 -;. ..J 

 ..;, ...#....
..."'. . 
. I . - ;. .. ,.;'
# r 
"Wo;'
 
 . - ' ) _- -, 
 '.. p' '
 I 
,,, "1T. J. ' . ,,' ' : :-. ..', To 
 ,. - "':;'/ ,:. '- 
--- ",1,... ,"'e .'''-0 ..: ,01;,00. 0 .,
 _ . 
.1 
".:.'
_" - ." ,.:,. Z 
 
 ..:- .'" ' , . 
..., ...
!,. ,," 
 0, II 0 "'-',1. 0 . , ..,-_ 
"".,,- .., .... 
./)'If'i.,:
 
 ;'
I"
.t# ,:/'"... .. . 'I II;
 \ . \ .
;
 
fp"

:'
 
/- ::
; .. . "'
>jo 
.,..
. . 
 "..,,
.- "
 . .,-1 

1I"tI
'.
 . - 
'.' /,',\' 
1JiZ '. I. If IJ1
 :\ 
. 
t'I' .'.1: 'J 
 - .. V ' J. 
. 
"" . ;., ' I
 .. 
, 
'
'

; 
 !'_"'J
'; .'/ " . 'i.," ',,\ 
I " 
 '" 
 ,;I'
 , __ \ 
" "'''' .. - -, fí' " ' 
/ '.lit t ;.;.... .. ;.,..,... .,,- -' ,r. _.:: ' 
, J. , ,. I ' :r . ø 
 ., f 
. r. . ,.
." ,:<,,' , I 


- ,,

. .' 
 :1/, 

 '.f' ..,. II 'I.
 .' . .,';
\. ' /,' ...6u.\I. .'1 , 
,
.
 
,.: y "'-f/!, 
.i,;Y :<- - / 
 4 
,. ',., -4 J .....
., _ I' , 
'J '!: I ' . 
'
..;..-;r...
' . - / / f/ 
, .(:". '\ .' .
,;' \\
 
 N,/ .v 
'J
' I.. " /l' jr 
I ;.
 \ \'-\ 
Prepared childbirth at the General 


Iii 
o 
'6 
0> 

 


c; 
o 

 


0> >- 
.c '" 
Ë
 
0'" 

 <: 
o 
c: z 
o 
 
:
 
 
E.ri 
0>...... 
0.(7) 
É -
 


 
-OIL 
0> - 
Elii 
.

 
0>0 
a::, 


Beverly MacLellan 


The promise: On the day that I gave to my 
first child, my husband wrote an exam for a 
McGill Faculty of Medicine course in human 
growth and development. During that course, 
the return to more "natural" methods of 
childbirth and infant care - breast-feeding in 
particular - was enthusiastically praised as 
logical, scientifically superior and. . . well, 
natural. 
There was no need to convince my 
husband - he and I were already enrolled in a 
prepared childbirth training program - but 
I found it encouraging that the sentimen1s of 
the faculty staffing the hospital where I was to 
have my baby were in accord with our own. 
The prepared childbirth program includes 


much the same material covered in my 
husband's school course, he said, but also a 
great deal more. Its purpose goes far beyond 
simply teaching a little physiology. The main 
idea is to take the surprise and uncertainty out 
of childbirth by teaching you in advance 
everything that is going to happen, everything 
that you will see and feel both physically and 
emotionally. 
You visit the labor room ahead of time, 
and you see pictures of the room in which 
you're going to have your baby. You know the 
beds, the chairs, the clock on the delivery room 
wall before you arrive. The frightening array of 
machines and instruments have all been 
explained, demonstrated and demythified and 
are now almost old friends. 


You know the mental states you re going 
to go through: the exhilaration, the despair, the 
depression. And in the end, you go through 
them all, just like stops on a train. 
You gain greater control over your body 
with a series of exercises so that you can 
forego drugs during delivery and thereby 
participate more fully and lucidly in bringing 
your child into the world. No amount of 
exercise can offer you delivery without pain. 
but you learn to deal with the pain. You practice 
dissociating yourself from it, to look at it from a 
distance. You try and keep one part of your 
body separate from another, so that when 
there is tension in one part, or pain, the rest of 
your body can be calm and relaxed. 
It's all hard to believe, but you feel yourself 
getting better and better as the days go on. 
Through it all, your husband is the coach, the 
trainer, the man who knows your capabilities 
almost as well as you do. During the delivery, 
he will be at your side. 
When the time came to go to the hospital, 
we felt we were ready. 


The practice: Everything began rather 
well. When my doctor announced to those in 
the case room that we were "a prepared 
childbirth family" there was only a second's 
pause to look us over - and then a helpful flow 
of encouragement and strength that continued 
throughout the delivery. Good news. 
The bad news was that I was having a 
back labor - occiput posterior :- and that all 
the labor training exercises we had done every 
day for months were largely for naught. As 
I had learned in our course, the pattern of 
contractions in a back labor is so unusual and 
prolonged that it is very difficult to anticipate 
them and remain in control. " was, in the end, 
simply a case of "doing the best you can." After 
six hours of the best that my husband Keith 
and I could muster - and some deft 
mid-delivery forceps work by the obstetrician 
- son Matthew was born. 
After it was over, I lay awake in my room, 
staring at the ceiling, overcome. After nine 
months, emptiness. Keith was gone, off writing 
his exam, Matthew was gone, my stomach 
was gone, my last bit of energy - all gone. 
I was empty. 
And I was full to bursting. The totality of 
the experience was overwhelming and 
I longed to talk about it with someone who 
could understand. "Do you have any 
children?" I asked the nurse. But she shook 
her head. I never did meet a nurse on the 
obstetrics ward who had. 
In the end, I just tried to adjust to the 
routine day of those around me. I quickly found 
out that there was something my study hadn t 
prepared me tor, I knew' was to expect 



The CanadIan Nurse March 1976 


39 



xpected of me . . . What I did find justifiably 
 
jistressing, however, was the state of the .e 
lurses' knowledge about breast-feeding." 


Ijiscomfort at first. and fatigue. and perhaps 
jepression But I was dismayed to realize how 
;ompletely helpless I was. 
When breakfast came, because of the 
jiscomfort of the episiotomy, I found it 
,mpossible to sit, or for that matter to move 
nost of my body at all. I finally ate lying down, 
:eeling foolish, but I couldn't think of a better 
"lay. 
Then, breakfast over, I waited for 
i;omeone - anyone -to come. Several hours 
,lad elapsed since the delivery. but I had not 
lad a chance to wash myself or change my 
':Iothes. and it was clear that I wouldn t be able 
,0 do these things alone. My purse layout of 
each; other things I needed were in the closet. 
: hated my dependency. 
So I had to face the question of the bell. It 
1ad taken me the better part of the morning to 
figure out what it was when I had first found il. 
Now I was quite hesitant about using it. 
'I assumed the staff functioned as a matter 
of course. My requests certainly seemed 
I routIne : perhaps the light was for emergencies 
lonl y . I had no idea what kind of care to expect 
as a patient, or what was expected of me. 
'Perhaps they were understaffed. Perhaps they 
forgot. I pulled the cord. 
A little later a phone call beckoned me to 
come and feed my son. I asked if he could be 
brought to me, just as I saw happening to 
mothers all around me. "Impossible," the 
woman on the other end assured me, as 
Matthew was in intensive care. 


Intensive care: Up until that time I had no 
idea that anything was wrong. I got someone to 
wheel me there as quickly as I could, but my 
mental state was in a shambles when I arrived. 
The nurse now explained that Matthew 
was fine, that he was only in intenSive care 
awaiting apro forma checkup by a pediatrician 
because forceps had been used during the 
delivery. Finally, and with great relief, I saw my 
son for the second time. 
As I fed him, I began to fear fhat, after a 
successful delivery. things in the hospital were 
not going to go according to ptan. During the 
next four days they never picked up much. 
Partly because I was sore and tired, I think but 
also because, in contrast to the smooth 
teamwork of the case room, the ward doesn t 
really have it all together. Whatever the 
professors teach in their courses, the ward is 
not really qeared to mothers who want to 
breast-feed and have their babies live in. 
Ideally, I would have liked to keep 
Matthew in my room at all times except for 
visiting hours, but this proved impossible. He 
didn't stay all night until the last because of my 
lack of physical mobility, but our crackingly 
efficient nurse made it difficult to keep him in 


the room just for the evening. She had very 
definite ideas, most of them about germs, and 
for this reason, I think, she disapproved of 
rooming in. She also disapproved of my 
husband for much the same reasons, I guess, 
after she discovered him on the bed one day 
surrounded by the Sunday paper. 
The first time I tried to take visitors to see 
Matthew I found out that when he wasn t in my 
room, he wasn t in the nursery either. He was 
kept in another little room by himself, 
apparently because of the contamination of 
rooming in. Fair enough, I respect the 
hospital s concern about germs and about 
possible contamination from the outside, but it 
did seem a little hollow when I discovered one 
of the professors teaching a class of sixteen 
students in the nursery itself. 
What I did find justifiably distressing, 
however, was the state of the nurses 
knowledge about breast-feeding. I had read 
several books on this practically forgotten art 
before coming to the hospital, and spoken to 
several women who had successfully 
breast-fed their children. but I supposed a 
nurse must know what an infant s nutritional 
requirements were. and how the lactating 
breast best functioned. Surely, I thought, all 
this would be a part of every nurse's education. 
But I guess they all went to different schools. 
My day nurse insisted that, in addition to 
breast milk. Matthew needed formula; my night 
nurse was an avid believer in glucose and 
water; and the apparition that borr him to me at 
two in the morning assured me he didn't need 
any supplement. 
There appeared to be a consensus on one 
point only: nursing should be limited to three 
minutes at each breast to begin with, and the 
time slowly increased over a period of days. 
This is apparently a hospital policy designed to 
prevent sore nipples. based upon the 
assumption - usually accurate - that most 
North American women will not have prepared 
their breasts for nursing in advance. 
Unfortunately, according to what I read, and 
confirmed, it seems, by my own experience, 
this seems to be bad physiology. 
It apparenlly takes about three minutes of 
sucking before the "let down" reflex makes 
milk available at the nipples -oxytocin and all 
that. So after inadequately short spells of 
nursing, the child either goes away hungry, or 
is given a topping up of glucose and water. 
But thiS, ( am told, is the start of a vicious 
circle. Unlike the breast, the botlle requires 
little sucking before it delivers its milk. The 
liqUid flows easily into the baby s mouth. His 
cheek muscles weaken and his desire to nurse 
diminishes. Poor sucking leads, in turn, to poor 
milk production and letdown, and finally to milk 
tension and engorgement. 


As the breast tissue swells, the infant can 
grasp only the nipple instead of the areola, and 
the chewed nipple becomes very painful. All 
this seems to exacerbate fhe psychological 
factors that influence milk let down - anxiety, 
fatigue, and pain. 
The point is that I knew the mechanisms 
they were suggesting were wrong. I had the 
advantage over most mothers. I had been 
warned. But it didn't matter. When the time 
came, I was in no position or shape to resist, 
and I began to doubt. I thought they really must 
know. I fumbled through each nurse s regimen 
in turn, and the predictable result was painfully 
engorged breasts and a very poor start at 
breast-feeding. 
I can only speak from my own experience. 
Perhaps I was destined to have trouble initially 
with breast-feeding. But it does seem that the 
obstetrics ward could be a positive educational 
force rather than an added source of confusion 
on the subject. 
As I think back now, I'm very pleased I had 
the training in prepared childbirth. I don't think 
the delivery could have been so successful 
without it. They had promised me no surprises 
and there had been none. Still, I realize now 
that the words don't exist that could really 
prepare you for such an overwhelming 
experience. 
And as for life on the obstetrics ward - 
well, it's clear my training was no match for 
thaI. I don't know if any really could be. 
Finally, the fourth day and check out time 
arrived. I was convinced that things would be 
better at home - as they eventually proved to 
be - and I was anxious to leave. My husband 
put Matthew in my arms and we started down 
the hall slowly. still doing the postpartum 
shuffle. It was feeding time, and we passed the 
women standing like sentinels in the 
doorways, waiting for their babies. 


.. . - . Bow down to her on Sundays, 
salute her when her birthday comes. . ,.. 


My thoughts were interrupted by two 
nurses, who anxiously asked where we were 
going. 
"Home. ' I said, rather defensively. 
Not without having our name tags officially 
cut, we weren't. Finally, we walked down the 
corridor toward home. As we approached the 
door, the cleaning woman who had been 
standing watching us, mop in hand, shook her 
head. As she resumed mopping she said, "If I 
was you and that was my baby, I wouldn t have 
no one telling me what to do." 
Indeed. 


Beverly MacLellan is a Montreal artist, 
mother, and wife .. 



40 


The Canadian Nurse 


. .......#iiW
.liiiliiJi;Wît{t.iftfþ] 


March 1976 


det Rat sOY . . ,,)f 
e""" c",e 
Berna. O\'\SI\)I\W
. . \ta.\\\J e 
,,,,,,",,,,atW' '":
"" .."" .d",
 0<13' ",.0'. . . 
1""""''''' ';'5 
 I 0< 
I<'/S"'
os .-",e' ,ee""o<"'" 
Ç>etSo\,\\'\e g ó
 Ç>fess\\'\9 ot tea.S a. te 
G 
oo,ø.."e'w,""e s '0 0"'''' 
se';'s """" s ':' 
 :: . 
pt 
""" ,es",,"s ,ee' ..." e''''' . s"og "" "","" 
""g",o",g '0, "" """ ",e ,o".og cO""Ó's. 
19\,\ot eó \
o 
ea.\\'(\ ca. te 
\a.\'\\'\
OS\\IO\'\ \0 W 
"'c\""
;s .,e 

 


;""0,,,
;.J.s """ 
 

 
"""lit""'" \0 ': ",.'0\3'0 
e""
,
,,,,, e
,,>eo" 
'",I"e",e o ' "" "' .
ecI"". . . ,,,", 
""e 
I . t 'lJot\(. \S 9 te a. 
 \'(\e \a.cI\W es . 
t 
\'(\

 e\\ec\l\Je\'\es ó S Zó co\,\\a. c \ 'lJ\\':

:s a.\,\ó a. te r\Jí\ \J 
a. ó e'/.\e\1 a.\\'(\ se.. 1 \'\ \'(\e 
c\ose a.\1 tS 0\ e'/.\s\\\'\9 '(\e'lJ'(\o \a.\\ \)e\'lJ ee \'(\e\t 
cP\'\sù({\e Ç>etSo\'\s \(. eeCa. ùse 
...",e 0\ "",sO .
 c.,e "",..., . "sO 0\ ",e 
9 ,,<\5 0\ ",e
" _ c,os" ,0 ,"" 
 "" "",,5 . O . C
I\Ó\)\{\'(\ 
. gs ",e'" 
.<e <P" ,0 \lOgs .. " 
,,0'" D''''., oo'se5 ""eO d 'J<
" "'"' 0 d' ."e",,'Og ",ee "" ",,0\<''''' "', 
cO"'""'o' , . . CO S oee"" .. " ",e' s .0 ,e"",Og. o
s e'c,,' 
aI>'" ... sO<'''c"""""oCO '" "'::. .cceI""" ."" ""oc""'" g'o' . ,0< "'" ...5 · 
",,"0 ,.... 

\O..'Oge""'g... .",o'f:

" O3\3
: 


;
< ó e 
' s e a.\'\ó a.\'\ 
5,,,,,,,,'0 d .."" ...0' \0 . ,
eoe" , ",,' e. . 
,,,,
,et<'eI"e " o\
e' o",soS ,e ,,\300'''''' , ....w ets '" e ,
e O3\\,oe' 0 "",""" ",e 
10 .5'" . "".,,
 c' < '0''''' "",,"del'CO ,0 , "".,,,, c3,e d 
""cO"'e 'o<o\<
.:
 tI'j e,
e"-:::
:o," c.,e e'
'rtØ' ""," 

'"'" 
.d."O"'
 ÓØJ,<ß I 
..0<>'" I,.e ;o).""w.ce<""''''' "",,,ecl e """" ' 0 0 ''''''' 0 0 < ø'Og tI'j oo
e:';",s "",<e \tot<' 
ctea.\IO\'\ 0 """, ó 00\""" sO"'e 
\te' ,e . "" co<>""o' 0 : rf"'<"" '0 
'" 
. Deca<"e' oots s 1 e {'J\C e Ç>ù\ ({\e 
\'\ e a.\,\\S \0 \\,\ólca.\e 





o....d ",,\0'''' "" o03 w:f" \0 0\ sl'"OI'C,oOd 0\ · ,,,",,W' 
. 0 1 .0 ,"". . ..
., , ,'iJf. e .",,,,,
 ."" 
"",,,,,,, . atsO I 
.d · 
"{'(\e e'\'o\\.1\\O
 9 nta.c\\ce \J\e'lJ
: o 
'eo\s. OÓ s""sO 
,otJ''''''' 
,oo,s<' < . ",oCO' < ,
e rp d ",.,e'o<' c3,e I _, "",,o<;t'. 
'/ e. ts 0 ^""o.", ."",5 ,0'\31 ðß",aQe ce<',e,e, _e' '0 ,t<<\' e ,,,,.,,, 10' "" 
,eg."''''' .5 ,0',e ooSs 0\ ,"" I'" e .",,,,,,. ,
e det),<ß 0 < ø
\I<e c' 0 """ ""'" 
. g,,,,,,,,g .... d "<"",, "0'" se
,o 0'" se<>eW. 10 ct e .'" · d"" .
,c\es '0 '. 
e'" .",d 0\ 
'0 
.,,,,,,, "" . sO 0\ ,,," \3",1, ""co"""" 
,otJ''''''' , 
'
;oS" """" \0 I"
, e.g. .
,c,\es 
aI'I'.,e o ' d,,",: 0"'''' "",,,,,,"5 c "".", 0<0,,"'" ",,,,, e d "" ,0 0<>'" ,t<<\',e ss '" s.,ó""" 0\ 
"""'ó a. \\oOó Ó o .,.... e . l . ".{CotS. g" ^^,^ec,esstW \0 _ate".1 ",., .. 10< """",ts, .. ""s..es 

. 0 .. .. ,gO<..... 55'" "ø)-ots.. \Ots. e . c . 
",,"d''''' . d cIO'e"O . "" I cO"",. I s\te, .."""" "' '0' .d",015'" "",e 
"" 
e cId"" "" 0\ 
 .."",e e' 
.
 0 "os"",,, 5\3' <e' ""c3" s e sO 
 1""",,"'5. I 
';;. sO"'e"""'l: """" ""d '0 


c:;: '0"'''''''''''' d''''<>>''' '::"'; ..,;\1"" .""o
 
""ø .5 
""c3"sO ","'" tl'jse ts '0 ",e .ct o '''' ,ß. I ot<' 0'''"' .- 
':'e '0 0<"'" \0 cO ,..",e ,0sw ctO e Det)"" 0 0 ' .,p"" ",.,,,,,,'' eÓ "" ''''''5. eo,,,,g "" 

 ",e"" ><;
 o",s,,,,,.,Jo"" 
 ""d \3""" '0 ""cøce '0 sO
o\O · D"el V,e s ",e 
,otJ"",. I 
"os
"at se';: """,ed. ..


e ",,\0\01 '" 0<>":'" f,,,,,IW' I 
 "", ",ate"'
' c dO,,"'''''''' '0 
5"''''''' ,"""'
' "0 0 ' "" e<e"""e " 
'orf"'" 10< 'OO
 ,e'e'''''c es a:,:",e ol3 '''''' 0\ 
,""" ..e d 0' ",e' s "",.", 0 0 ' 9 a.\J e \)a.c\(.9t a.\)\\M' \,\,\e.I({\Ç> essa.t'J \0 
a.:'eo,o,e. 'J<e 
:'e
 _"",,'Og ;
'e6 .,i'''''''0'' ",e Des' 0\ "" '" I ,o<>od < oeO 0"""""" ",e 

 ..0<>'" ",.e O . ., at"..e ..e,e ,e .."" ø" 50"" · 
,otJ'

,
 ..",tOg st
",sOwes 0< ... 
rl\' .c'\'\ \a.\e t . \\,\1 \ .", \\'\s\tÙc\ots., '" " e ",nt eSS ({\
s .... 1 " C O({\({\I\ 
. "v .. .",e''''' .",..IÛ''' .. d sO 
 .. . 
"""'" "","0 .\\,""" 0\ ",e 5' . 5 c",<ß' ,00\' · 1"'..", \0 0 ...... . 
I ,eat.. e ... ':
"e "" coIle.g
':o """"Ooe.... .... .... 
: .....".,.,';..,$*

';ii!31
$3.*rtitt
tWJi.Zi... 
I i*ifIs1*ri%.frtilØ:fi$
lt
't!tlj/ii: 
 .,..-", 
I 
I 





. 
. .,:..,
..
 




1:

 

:


-.
:".I 
.... -. 
'
"
"'-. 




" 
.":-:-.

$.%":.:". 
-. -. -. -. -.-. 
..................-:. 


f!í.:: 
-.:::::::::::::::::::::::::::. 
'::
:
{}{







?::" 
0 0 :.::-:-::.:-::-:.::-:-::-:-. 


. . . . . . 
............ 
...........- 
. . . . . . 
. . . . . . 


..... 
\
 



\
l;f;. 
$i:'
::;' 

 .-::."
,' . . 
"

,,,,-: 

.

 


The CanadIan Nurse 


March 1976 


41 


.-:. 


. 0\ a \/ef'oa\ 
. ó ea 0(\ \"e 'oaSIS Os \Cases,\"e 
.\' \0 a(\ I . \ asl(\
 
"osp"ð \ 

 "osÇ>l\a . f \e\/e\S 0\ 
..,,,,,,.0" 0 ." ",,,,, "vI'". ,0' ,,,",, ,"" 
"0'" .,ø'""" ' , ",a' "'. ,o"ga "<1<-"' .1"" 
,o",o""a'O'\,,,, ç<>' "'. "eO'
 a""'" "" 
'rl\n\e
e(\\ot, \Óeteó \"ou9 , .>leó 
e \0 
I\"Y 
eó co(\s . '50 a
 o
' 
'ot\e\ a\\O, \ot c"a(\g e , 'out I
 
"e s\\Ua\\O(\' 
Ç>tOÇ>osð 9 fas Ç> 0\ ' 0\ a 
".",,,,,,,,a\':.:'
eO'''''' '0 ""::; V,o\1' at<' '" as" 
O(\c e ó 
a\et(\IW ca su\\a\\O(\' a'" 
\att\IW-ce(\\e fe , (\{\1(\9. 'lJI\" cP(\ 
\a\<.e(\, \u{\"e f . Ç>: 'lJete \e\\ \0 
e. 
\
Ç>\e
e(\\a\IO 
ð \ ",(\et \ e a\\1.eó 

\.1tSe ...- a,. .\ \a\et. t 

eO """"g'" a':J,";'" ,."," 0 1 ..
' 
cess 'lJas D te su \\ 0 
",a' "" sue I>C' "",., \ · " "",.g, 
,<p.' ,0<"''''', c"""c\ß",,,,,,:,,
, 0"'0 ",.a' 
ø"o"""" 0 '^"'''' "se ,0 se" "",. a o"ts. 
,,,a' "'" o"ts. "",. ",0'''' ",., 
 ,,,ccee'" '0 
\0< ø""<1" s "" v,o\1"",,
. ",,,a,,
,e<I. 
'lJ'rI 0 Ç>\a(\S 'rIe
e" \<.(\0'lJ\e Ógea (\\ 
\a\\\/e 
a 
"", ",,"'''''. eO.'<1'''O, "" v "" v"ct,oa'. 
O nN'\{\U(\IS\IC, \ tene\\\IOUs a ó e '\'o\e a'oOu\ 
y\>_ . \\ na\le(\' Y 
\e 9 <> 
",,,,0\1""". ... "'" '0 0 nO "".. oC 
f\ts\, 1\ 
O
'rIOOse \0 c'rla(\ge
 (\u tSe 'lJ\\\ 
,"" .... ,0" ç<> <10"'0' a"" 0, (d'cP. '0" 
aó
\(\IS\ta\o
: e,eco
\(\9 \\.(\O
e
Ç>ec\eó 
\\s\e(\ \0 
.O cteó\'o\\I\
 as a \0(\9 pto cess , 
es\a'o
I
'rI1(\9 0\ (\U fs \(\9 IS a \\"ou\ 9 00Ó 
ç"""""o", ., a cceV ' ,,,,,a' "'. ". ",., .",,,.oce. 
peoÇ>\e óo(\ ó yoU 
us\ Ç>fO\/1 
e\/lóe(\C e . a'" 


...... ........... 
.
. .....::.
:.
... 
>,>",,1,>1' . "' a ,.a"." 
se\\ as a \'rI I (\\<. 'a'o\e a'oou\. 
<ó'".''''' ,0'" an" ><,0"''''<1' ".""o"'Og 
Ó \00\<.1(\9 . "", a(\ó u(\ 
\O
af - \ sÇ>O(\S\'oI\I') pf>, \0'0\ 
,0'" a,ea 
,

 cJ. ,,'."': 

a"sI'ct''''' ,,,., '" 
0\ o\'rIet p se s . 1\ IS cause 
10 ",,,,,, oa '" ,ø:Ø"': '00 ,otC. ",,,,..,, 
"'. ",,,,,,".'.' 0 '00 "'. "o",og a' 0.Ø>'''' 
"",.",,";'>0<' ':<1' a"" "'. I'"'sO
 ,"" ..,.0' 0' 
,ea'.' ,ç<>.... .' .eI,e". ",. ,,,. .a'" ,0< 

o ."ec\ a 

 
o .,,,,,,,,,,,,,a'

,,,,,, '" .'V."" 
",,,a"''"C , ,g' ".0< ,,,,, '" '" .o.,g, '" 
'rI0'lJ 
uc"e(\e . ó e a \. Þ.(\ó 
ou (\ ó e S e\'oac\<.s 
ou 
.\ 0\ a(\ I , "5 a'" 
\(\ Ç>u tSUI " \'rI e óe a) 
o..fi ,,,,,,,,,0<>') o,^",o'"".' ef'Û""" a.
 
'lJ\\\ \(\e\/I\a'o\
 e ate ó\Ssa\IS\I
Ó (\ó 
\,J'J"e(\ 
ou \' 0 c"a(\ge 1\. a 'lJ\\\ \\s\e(\' 
, \0 \t'J ' .... \. o\'rI etS 
...:.',:.:. :.:. so
e\"1(\9 \e e(\ou9'r1 \\ ,a o\'rI et 
\<.(\0'lJ\eÓ9

e \0 \(\CotÇ>ota\
a\e9
' E.\/e(\ 'lJ 
,0" ",eO . ,"''''' ,0'" , "" a""'" "" 
o"a"ct. o '"'" '" v,o\1""". . ". ,.a"'o"" 
..'0'. ,""lOg 0.'0,,"""'0<\'-. V'''''' ,,,a' ... oeft 
.,,,.a" La, "'. go,," ""all o"aog

, ",',11 ,.a" '" 

a\<.e a(\ó Ç>t

ó eas\\
 a'osO

(\seN\Ce 
,,,,.a'.o''''' ,p..ct".' GOa ,0",0"'0 .,aotI 
\'rI e u\\I
a\e Ó ó\sÇ>e(\SI(\9 
",,,0iØ' ",,,,a' ",,0 cJ. ",os. 
cJ. v'o!>"g'''':,
; ",ea '" ,"" a


e a""'o""'" 
a nog , ,."""nc..an 0<>' çase' a'" 
"^'" 0"" "" 0 
"n'" '" V'." '",,,,ng""'" ç<>\ 
0' .".ri 0""". a."'" ,t\ eo a 

"."og ,0<"" 0 
",0''00 a 

.",,,,,,, ,"" '"::
o"'. """ ,'n'1" 
a'lJasÇ>. ate \t'i\(\9 \0 CO tOÇ>osa\. 
,,,",,, ,"" ",,"0""" ,n "'. 
 ,,,,.0' ,0<>' 
"",,,, ,,,. . 'n'1" ",e''"o V " 01'1""""". 

o 
a\\et Ó \Of CÙ\\CIS
 a(\ . "\,,a\ \"e lt 
nteÇ>a te \' e ó \0 \'rI I (\ 
.",.as... . , ... '00<'0 00<1 '" "" 
1 00 ",at" o"
",,,.o" ",," '

as ,0< ø"""'" 
",.as ... ,. '0 01'1""\\<"'" a ""a" 0' ""'" 
e
O\IO(\
\ 'lJ

 ot \'rIe
 ca(\ 'oe 'rI0 Ó O {\\ 
ca(\ 'oe \I
e 
e(\\ 'lJ'I\'rI \'rIOs e 'lJ U(\Óets\a(\ó, 
\\
e. e,e Ç>
 ot Ó O {\\ 'lJ a ,:\ \0 \a\<.e \\
e \0 
u(\Óets\a(\ uteauctaCles \\a\ 
".",.",,,"'. . ,. 'oo\,,<I,Og 

o, a""'" ,,,,,, 

:;.

:::, :e

:

,,
ct.,
:
;:t

 . ........ ..... 
v,oI"''''''. ù se , 00'" "",Va<' . a "'0"""" ,0 a ., .<.. . ... 
"o"..,g"","" " ,,,. ."0",,. , ",a' cas. ." """ '.: .....i'.'... 
, """ eo" 0 a O " ,0 ,",. ,'0 '.' 
\5 (\0. (\\/itO(\
e(\\' Sl'ol\\\
 IS (\0 
teceÇ>\I\/e e '{ out tesPO(\ 
,oe" ",. ,
a

 ,"" '0'.""" '11 "a". a catlt. 
 
"'. ,,,,,a'. .' "...". ,0" "" ",0<1\. ,,,, "" 
00(\ \ e\/ 'rI0'lJ\\\ Ó O ,,,e 
",,,,,,,,, 'cJ.",,"
" '" cceV"" """ 
"0 ",. ",0<\'-' "", ",.a "a' "":"'",:o"Og ". ,.'" 
\,J'J'rI e (\ 
. \O'lJ atÓ I
P e 
1\OSOÇ>'rI
 \0 
,"" a,e ",0<\'-''''' "a". ,,,. """. ';,., ,,,,,,,"" 

 0"'." 
.a a"".' ".

. 
"",g ",,,0 
".W,eev so<"eo<'. "" . 0'. 0'."'''' 
"oC' V.

o" .,. ",. """,g ""

. 0 1 ,0<>' 
",,\I ,a,. "'''' . ,,,.," 1"" ". ",," ,eO.",,,, 
{\\ 'lJe c'rla(\9 'lJ'rIe(\ \\ 9 to 'lJ S 
';0\1"'" ,o"ea'.' WI'/.',"h
' 
ø ",....' %.
%;i""- 
...:-:$




.. 
..:-


:...:...!. 
. -.. . 
. 


a Ç>a\\e(\\ 
S\.1{'{\{'{\a{'l . \ see 

 to\e as 5 \'rI e 
It> ","0'"'''''' '."" "",,,,, ,,,. "'
J. '" "atI 
\. sa
I(\9 \ . \ ....e'lJ efe .. "I 
aó
oca\e, Ó 'rI\
se\ I \' Ó \a
I\lat . . . 
Va "eO' ",0"" 0'0'" ",. SO"o 0 0 ,,,,,"0""'" 
"'. ,ç<>"'

 ...."gW,a ".o""'
sC"',,,,,, '" 
\(\\e tes \I(\9 (eP\ \(\\0 \'rI IS 
cJ. ou""'" "a' ';.o'Og. ,,0 "a""". 
".aII" oa'. 
oca'. ,cJ... , a"
' '0'0 a ..I.. 
\(\ \'rI e g (\ cO(\SiÓ eta I (\S\Óeteó 'o
 
oeeP' """ ",,"'';., ,,,., 0"" '00 c
"""'" e",,,09 
""",a oe V,o<)". "'. Vo"'.' '" 0 ",e<I a""'" 
,,,,,so ",,,,, "a" """,,,,,II, ""'CO 0' """ '" ",j 
,.",c"" , .
 '0 ",a'.'o'" c a '.: ",.\1. a"" at<' 
,,,,v,o,,,,,,,.o' . ø"'''o'''' a . "" .,\('
" II 
"",..''''''''' ,
:;., ",," "",,"."
, ,o"..Ie. ga<o 
assessl(\9'lJ'lJa 0\ \I\e'. \/o\u

e . 
..ø.' · ,,' ".a le . 1fi ,\. Ion G"".'
 
\; (\\\0(\' a(\ ..1 Ed rT10n , . 
ate Ra tSoY (R.'
" . of en tlSh 
eernadet N., LJni\1ers
tý Ith 

oSp"al' a.Se..",.,n al CO"d 
f,,,, ,n 
co,u",b,a) IS 15 1 pa""s 
oSp 
."'IO C..' 
coordinator and 
 rT1erT1ber of the istered 

""o",..,.. ",,,,.. o' Ih.. R.Bo,u",b,a. Th' 
Pla nn ,n9 CO"'e,a l ''''' of B"",h. 10 a,
sl B.C 
NU rs "" p.s'o "",. o.iBo"". IS .001h c". 
C orT1rT1ittee s P rl\e in\101\1ed In h d a p ted trorT1 
t becol" . le Was8 . 9 
nu rs '" 0 b"".a rllO uol ",.e"n 
pl""n ln9 . Th. a a,lh. RNABC ann 
ee ch gl\1 en . . . .:.':': 
aSP 19 15 . 
 ,.' .:..:::...::..:::.::.:. 
,n 

'}'å
ß
fltt
ii.;t\
Ir*i;tj
ljJ1
 


I 


'!-.

.... 
'h..... '"$:'S:" 


.a::;:.:"" 
-!I.:y:.'" . . '. 
'l:-::"}.s::"X' 
..
. .
:..-:::;.-:
 

..../l:.
$.:.:.::. 



42 


OUINPOOl 


@) 


1. 
2. 
3. 
4. 
5. 


Hotel Nova Scotian 
Chateau Halifax 
The Lord Nrlson 
Holiday Inn 
SI. Mary.s University 


SPRING 
GARDEN 


:D 
o 
t!J 
m 


@) 


COGSWEll 


-4
 
 
UJ 3 
o 
c 
--< 
I 
-u 
þ 
:D 
:>; 


DUKE 


INGLISH 


@ 


t!J 
Þ 
:D 
:D 
Z 
G> 
--< 
o 
z 


L 
;1 

 
 
\ 


<D 


" 


The Canadian Nurse March 1976 


\]OU

ælJ
 
neXT COn\7EnTIOn 


Plenty of room 
for you and 
your family! 


r 
o 
:z: 
m 
:D 
:z: 
þ 
--< 
m 
:D 


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 


-- 
-
, 
" 


.... 



t 


) 



 


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. 


x 




 
UJO 
UJ.r: 
Ë'C 

æ 
ciõ 
-B.
 
(1)-= 
L.._
 
ê
 
'Co 
e- 
<0(1) 
c<e:5 

IJ;
 
.!! ...- 0 0 
yC')
 
g 
 c. 
1II 0 e 
<(NO 
-III 2! !!2 
5!

 
:; u5 'C 
Z ._ 
cZ
 
.!!! 1i.!:1 
..'0_- 
o


 
-mIe 
Gl E 0 ë-Q 
-<0- 

 
+= æ"E 
_._
><o 
.
 Qj èJ3 g () 
g'
 
 () Õ 
... o
-- 
Glñiz'5
 
III
_:><- (I) 
:R2
'E
 
 
ë:<(I
!!!Z 


i!i 
'" 


.. 
Ei: 
.. 
c: 
:> 
<I) 


UJ 
UJ 
(I) 
-c 
'C 
oe( 


e 
g g 
(ñ c 
8. Q 
ë 
 
(I) !Q 
UJ 0> 
(I) (I) 
à: cr: 


0> 
!!! 
Õ 
> 
o 
à: 


>- 
TI
 
(1)<0 
c.'C 
CJ) 



(I) 
.õj iõ 
Q
 


0> 0 0 
ïõEoo 
õò) on ó 

 
 
 
 


III 
GI 
.!! 
c 
.2 
ñi 
.. 
Ui 
.Õ\ 
" 
a: 



 
Q) 
.c 

 UJ 
E 
 
oe( 'C 
Z 
 
U ü5 


o 0 
C! 0 
o on 

 
 


Q 
(1)('1 
-w 

... 
::...c.. 
1t3('1 
Q.
 
.... 
Q) 111 
't):t 
ê5S 

Õ 
c - 
0>- 
E 111 
:t 
ð
 
Q)"i:, 
g.o 
Q)GI 
..c::.r. 
0- 
....0 
::)11) 
o . 
::"'c 

.Q 
-

 
c y 
0 0 
Q.III 
::) III 
0<( 
o. 
",III 
-_ GI 
..c::1II 
- .. 
c:: 
 
:ï Z 
-c 

 m 
(1)'6 
'" 111 
It3c 
ïið 



44 


Ntl111PS 


The Canadian Nurse March 1976 


;:\)1(1 F;:\ces 


Lecturers appointed to the faculty of 
the school of nursing, Lakehead 
University, Thunder Bay, Ontario, 
include: Elizebeth Marie Clarke 
(R.N., St. John's General Hospital 
school of nursing, St. John's; B.Sc.N., 
Lakehead University) who has nursed 
at the Oshawa General Hospital, the 
McKellar Hospital and Port Arthur 
General Hospital in Thunder Bay; 
Joanne 51. Germain (R.N., St. 
Joseph's school of nursing, Thunder 
Bay; B.Sc.N., Lakehead University) 
who has been a staff nurse at St. 
Joseph's General Hospital, Thunder 
Bay; and Frances Marie Welch 
(B.Sc. N., Lakehead University) whose 
most recent appointment has been 
that of lecturer at McMaster University 
school of nursing, Hamilton, and who 
is currently working toward a master's 
degree in education. 


..... ..... 


. 


- 
-. _" 


.... 


- 


..IÌ' 


'I. 
. 


Jannice E, Moore (B.Sc.N., 
University of Saskatchewan) has won 
the t975 Canadian Liquid Air Ltd. 
award of $1,000. She was the top 
student in the first year of the 
University of Alberta's health services 
administration program during the 
academic year 1974/75. 


Lorreine Dawson (R.N., University of 
Alberta Hospital school of nursing; 
B.Sc.N., University of Toronto) has 
been appointed to the employment 
relations staff of the Registered 
Nurses' Association of Ontario. Her 
career includes positions in hospital 
nursing service and staff 
development She also brings 10 her 
new position experience in collective 
bargaining both as a member of a 
nurses' association and as a 
supervisor. 


Lorraine Mills(R.N., Hotel Dieu 
school of nursing, Edmundston, N.B.; 
B.Sc.N., University of Ottawa; M.A., 
Columbia University, New York) has 
been named associate executive 
di
ctor, patient care services, at the 
Dr. Everett Chalmers Hospital, 
Fredericton. She has worked as a 
head nurse, operating room nurse, 
supervisor, in service coordinator, and 
director of nursing in hospitals in 
Canada, the United States, and 
France. Prior to her current position, 
she was a nursing consultant with the 
New Brunswick department of health. 


Yvette Loiselle of Montreal has 
become the first woman to be 
appointed Deputy Chief 
Commissioner for the St. John 
Ambulance Brigade in Canada. She 
will assist the Chief Commissioner, Dr. 
AI Harrop of Winnipeg, in his duties as 
head of the close to 13,000 St. John 
Ambulance Brigade members 
throughout the country. 
Loiselle is an administrative 
officer with Celanese Canada Limited 
and is well known in the Montreal 
business world as an expert in 
administrative and employee relations 
matters. 
Her association with Sf. John 
Ambulance began in 1944 when she 
joined the Brigade as a nursing 
member. She advanced 10 serve as 
Divisional Superintendent and in 1959 
became Provincial Superintendent 
(Nursing) of the Brigade in Quebec. In 
1972 she was appointed Chief 
Superintendent and assumed 
responsibility for the general 
organization, administration, 
efficiency and discipline of all St. John 
nursing members in Canada. 
Jean Back of London, Ontario 
succeeds Loiselle as Chief 
Superintendent. Back was involved 
with St. John Ambulance during the 
war in her native England. Her 
association with St. John continued on 
her arrival in Canada where she has 
held various positions within St. John. 
In 1952 she was admitted to the Order 
as a Serving Sister. In 1953 she led the 
Canadian Cadet contingent to the 
Commonwealth St. John Cadet Camp 
in England for the celebration of 
Queen Elizabeth's coronation, She 
was promoted to Officer in 1955, 
Commander in 1966, and Dame of 
Grace in 1972. 


\ 


.,.... 


. 


I .. 
..... 





 


., ."'1.,... 

.- 

\ 
,........ 


Carrol Ann Hartin, (R.N., Brockville 
General Hospital regional school of 
nursing) has accepted a two-year tour 
of duty in Honduras with MEDICO, a 
service of CARE. Prior to jOining the 
MEDICO team based at the 186-bed 
Hospital del Sur in Choluteca, Hartin 
spent six weeks in Guatemala 
studying Spanish She will instruct 
classes in obstetrics for Honduran 
auxiliary nurses in a hospital school 
which was established by MEDICO. 
She has worked in the obstetrical unit 
at Lady Minto Hospital in Cochrane, 
Ontario and in the burn unit, pediatrics, 
at the Hospital for Sick Children in 
Toronto. 


Ann Taylor has been appointed 
assistant executive director of the 
Registered Nurses' Association of 
British Columbia. She was formerly 
director of public health nursing of the 
Borough of East York Health Unit in 
Toronto, prior to which she was 
executive assistant to the director of 
nursing at the Vancouver General 
Hospital. 


George Feilotter was recently named 
administrator of the Cornwall General 
Hospital. He joined the teaching staff 
of the hospital's school of nursing in 
1965, shortly after which he became 
assistant director of nursing services. 
In 1968 he became director of nursing, 
and a year later, assistant 
administrator. 
Following his basic nursing 
education, Feilotter studied nursing at 
the Manitoba Rehabilitation Centre, 
earned a B.Sc.N. in nursing education 
from the University of Ottawa, and 
completed the hospital organization 
and management course from the 
Canadian Hospital Association. 


The Hospital for Sick Children 
Foundation, Toronto, has awarded 
nearly half a million in grants and 
fellowships. June Kikuchi, R.N.,M.N., 
has been granted $27,000 to study for 
3 years at the University of Pittsburgh 
She IS to work at a doctoral level in the 
area of nursing care of children. 


Monique Foisy has been appointed 
public relations officer with the Order 
of Nurses of Quebec. Her nursing 
career has included emergency care, 
research, and intensive care; and she 
has been on staff at the LaSalle 
General Hospital and the Montreal 
General Hospital. 
Foisy earned her nursing diploma 
at Hôtel Dieu in Montreal and a 
certificate in public relations at the 
University of Montreal. She is currently 
working toward a degree in public 
relations. 


. 


"9 


..... 


-.. 


L'Ecole des Infirmières de Bathurst 
School of Nursing, Bathurst. N.B.. will 
offer a nonintegrated bilingual nursing 
diploma program, with classes 
scheduled to commence in 
September, 1976. In effect, two 
programs, one in French and one in 
English. will be offered. 
Constance Morrison, (R.N., 
Hôtel Dieu Saint Joseph school of 
nursing, Bathurst, N.B.; B.Sc.N., 
University of Moncton) has been 
appointed Director She has had 
experience as a general duty nurse, 
head nurse, supervisor, and private 
duty nurse. In 1965, she became 
associate director of the Hôtel-Dieu 
Saint Joseph school of nursing, 
Bathurst, N.B., and was its director 
from 1968 until its closure in 1975. 



,Æ \ 


 
r,
\ 




\
 ' 
'( 
\ 


\ 


J 


---------- 
 
Style 131 PantSuit 
Polyester/Nylon Corded Jersey 
Knit-White Lace Trim 
White-Blue- Pink- Yellow 
Sizes 3.15 $30.00 


,..
 }.:.. 
\t. - .," 
. t. #0(04 .:; 


\ 
7 r., 

\ ' 
\
 
.. 



 


) 



 


, 


\ 


Style 814 PantSuit 
Polyester Textured Wrap Knl. 
White-Blue- Yellow.lc
 r ,t 
Sizes 6-18 $28.:0 


the 
MJ
GI(: 
I J
(:iICN 
sleeve 


UNIFORMS 
REGISTERED 
778 KING ST WEST, 
TORONTO, ONTARIO 
M5V 1 N6 
AT BETTER 
rol J 
THROUGHT CANJ.,...A 


-fl"
' 
,f F 


 

 
s... 
., 


j
 

, 
I .. II 
, 


, 
/6\ 
l . 



 

- 


\ 


Style 138 PantS, 
F ' 



 


v 


.. -.. 



- 


46 


The Canadian Nurse March 1976 


'Vlltlt
S Ne\y 


J..:j . . 

 P 
t 1 
... 
,ìp " 
T- I 


Q 


Q 


Vernitron Sorenson 
Mobile Aspirator 
Vernitron Medical Products, Inc., 
has introduced the new Model # 181 0 
Sorenson Mobile Aspirator. 
The unit is equipped with the 
patented Visi-Dome Lubrication 
System that guards against pump 
damage from inadequate oil supply, 
and with an airvent overflow cut-off 
that protects against pump damage 
through flooding. It has additional 
features: enclosed motor and pump to 
control noise factors and assure 
dust-free operation; vibration-free 
motor mounts; vane type pump; visible 
oil supply; visible dial gauge 
flush-sunk into front panel; and 
hospital-grade safety plug and built-In 
cord storage, 
For information, write: Vernitron 
Medical Products, Inc., 5 Emptre 
Blvd., Car/stadt, New Jersey, 07072, 
U.S.A. 


Face Masks 
Two lightweight masks to protect 
against cold air and pollen inhalation 
have been introduced by 3M Canada 
Limited. 
The 3M Air Warming Mask 
provides prOlectlon against Inhaling 
cold, dry air and remains easy to 
breathe through and comfortable. 


When tested at sub-zero 
temperatures (minus 29 0 C) the mask 
warmed and mOistened the air to at 
least 16 0 C and 90 percent humidity It 
is reusable. 
The disposable 3M Pollen Mask 
protects against pollens that can 
cause hay fever and helps keep 
allergens and dust from nasal 
passages. 
For information, write: Consumer 
Products Division, 3M Canada 
Limited, Box 5757, London, Ontario, 
N6A 4 T1. 


Hot/Cold Food Cart Brochure 
Crimsco, Inc., manufacturers of 
airline and health care dietary 
equipment systems, announces a 
colorful, illustrated brochure, "Model 
ER, Meals-on-wheels, Hot and Cold 
Food Carts," which deals with the 
versatility and economics of 
employing the ER Hot and Cold Food 
Cart in hospitals and nursing homes. It 
describes how to convert to a central 
patient tray assembly system in 
existing kitchen space and use as few 
as 3 persons to perform all patient tray 
assembly operations. 
For further information, write: 
Crimsco, Inc., 5001 East 59th Street, 
Kansas City, Missouri 64130. 


. 


Weighted Wrist Exerciser 
Chick Orthopedic Company has 
developed a new weighted wrist 
exerciser. The shot-filled, 5-pound 
exerciser is used to exercise muscles 
of the phalanges, wrist, elbow, 
shoulder, and shoulder girdle. 
One size fits any adult on either 
the fight or left hand, a Velcro closure 
assuring snug fit. Made of vinyl, the 
Chick Wrist Exerciser is easy to clean. 
For further information, write: J. 
Stevens and Son Co. Ltd., 2050 
Kipling, Toronto, Ontario. 


Specimen Collection 
Systems Brochure 
Sage Products, Inc. has prepared 
a four-page brochure illustrating and 
describing their full range of specimen 
collection containers. 
Containers have been designed 
for all patient specimen requirements 
- urine, stool, sputum, tissue, and 
kidney stone. All containers are 
completely disposable and designed 
with hospital, lab and patient in mind. 
For copies of this brochure write: 
Sage Products, Inc., 1300 Morse 
Avenue, Elk Grove, IL 60007. 


Burn Spray 
Time lost at wo!'1( due to burns and 
scratches is effectively reduced by 
G-63, the pain killer in an aerosol can. 
One spray of G-63 isolates the 
affected area with an invisible 
protective film, helps reduce painful 
swelling, speeds natural healing 
through analgesic action, and guards 
against secondary infection. Neither a 
cream nor ointment, it does not require 
bandaging, 
G-63 is packaged in B-ounce 
spray cans and distributed for export 
to industry by General Scientific 
Equipment Company, Limekiln Pike 
and Williams Ave., Philadelphia, Pa., 
19150, U.S.A. Requests for 
descriptive literature (Bulletin G-63) 
are invited. 


Emergency Trauma Kit 
The Cryopac Emergency Trauma 
Kit offers immediate and effective 
on-site treatment of injurieS, sprains 
and bruises. 
The cold compress completely 
surrounds the injury. combining 
constant pressure and low 
temperature to assure comfort and 
reduction of shock. A built-in 
automatic pressure regulator prevents 
overinflation. 
Compresses are reusable, have 
indefinite shelf life, and are X-ray 
transparent. The complete kit is 
available in a convenient carrying 
case containing six cans of cryogen, a 
valve and hose assembly, a boot, 
glove, and a wrap-around. 
Additional information is 
available from Safety Supply 
Company, 214 King Street East, 
Toronto, Ontario M5A IJB. 


Q 


" 


- 


-- 



 I 
 ":1 


 
"'-. 
 



 


Teletrace Telephone EKG 
System 
Medtronic's Teletrace Telephone 
EKG system uses the public 
telephone system to provide 
pacemaker implant centers and 
fOllow-up clinics with follow-up data 
from patients with implanted 
pacemakers of any manufacturer. 
From pacemaker patients TeleTrace 
provides precise digital rate and 
interval readings from pacemaker 
activity as well as a quality 
electrocardiographic trace. 
It is also used for monitoring 
patients for arrhythmia detection, and 
postinfarct patients for potential 
rhythm changes, and for interhospital 
telephone transmission of patients' 
electrocardiograms for immediate 
diagnosis of cardiac rhythm disorders. 
For information, write: Medtronic 
of Canada Ltd., 6733 Kitimat Road, 
Mississauga, Ont., L5N 1W3. 


Shock-Guard Packages 
Eyeglasses - hearing aids - 
fragile electronic components move 
safely through the mail in Poly-Foam's 
"Shock-Guard" mailers. Because of 
polystyrene's extremely high shock 
absorbent qualities, breakable 
products are completely protected. 
Also, packaging and postage costs 
are reduced in many cases. 
The closed packages, available in 
two sizes, are molded with slotted 
edges for positive closure. The 
Shock-Guard packages may also be 
ordered with additional urethane pads 
cut to size. The packages are sealed 
with either 3" paper or 1/2" filament 
tape. 
For additional information, write: 
Poly-Foam, Inc., Lester Prairie, MN 
55354. 



right... 


henever 
the potential 
for infection 
i evident or where 
infecti n is present 



 


· ull
 


Bactericidal 
Dressing 
effective agai nst 
both Gram-positive 
and Gram-negative 
infections of the 
skin-including 
pseudomonas 


Remains 
Active 
even 
in the presence 
of blood I pus 
and serum 


Soft 
pliable 
Not Messy 
the significantly 
increased 
lane-paraffin base 
is Just Right 
Indicated 
In 
burns 
ulcers 
wounds 


ROUSSEL Â 


Rouue! (Canada) Ltd.lLt.. 
153 Graveline 



I 



48 


The CanadIan Nurse March 1976 


11()ol:s 


Critical Care Medicine by 
Wilbur W. Oaks. New York. 
Grune and Stratton. Inc., 1974 
473 pages. 
Reviewed by Elizabeth Weber, 
Coordinator. Post-Diploma 
Program in Adult Intensive Care 
Nursing. Ryerson Poly technical 
Institute. Toronto Ontario 


Cnllcal Care Medicine is 
composed of forty articles covering a 
range of subjects. all related to 
intensive care areas. These articles 
are the product of the fwenty-eighth 
Hahnemann Medical Symposium and 
have been organized into six main 
headings: Shock and Trauma: 
Cardiovascular Management; 
Pulmonary Management; General 
Intensive Care Unit: Neurologic 
Emergencies; and Musculoskeletal 
Emergencies. 
Under each main heading, a 
wide variety of topics are covered. For 
example. the section on 
Cardiovascular Management 
Includes tOpiCS which run the gamut 
from the clinical applicallon of 
monitoring equipment to the 
mechanism and treatment of 
pulmonary edema and congestive 
heart failure. An article on heart block 
presents a brief look at temporary and 
permanent pacemakers explaining 
the indications for pacing. the types of 
pacemakers available, modes of 
insertion, and management concerns 
A concise review is also given of the 
pathophysiology and management of 
cardiogenic shock. Finally. the 
mechanism of action of the commonly 
used diuretics is clearly presented in 
an article on fluid and electrolyte 
balance in heart failure. 
A positive feature of this book is a 
well-annotated bibliography at the 
conclusion of each article that gives 
the reader a wealth of resources from 
which fo do further readings. Good 
use is made of charts X-rays and 
diagrams to clarify significant points. 
The major drawback is the brevity of 
each article, which severely limits the 
depth attainable Thus, few articles 
cover the background 
pathophysiology of a condition before 
delving into the specifics of medical 
management, or reviewing related 
research findings Some articles take 
the form of a brief overview of many 


aspects of a topic, while others zero in 
on only one aspect, attempting to 
ensure depth but tending to limit 
general appeal. 
This book would be of most 
benefit to experienced intensive care 
nurses who are seeking further 
information on topics about which 
they already have a good 
understanding. As well, students in 
postgraduate education and 
educators may benefit from these 
readings. 


Pain: Clinical and 
Experimental Perspectives, 
edited by Matisyohu 
Weisenberg. Sf. Louis, The C.V. 
Mosby Company, 1975. 
385 pages. 
Reviewed by Dianne Schultz, 
Teacher, Toronto General 
Hospital Campus, The George 
Brown College of Applied Arts 
and Technology, Toronto. 


This is an excellent 
publication with a multidisciplinary 
approach to the phenomenon of pain. 
The emphasis in terms of the 
experimental view lies in the 
measurement of pain, its correlates 
and the variables used to manipulate 
the pain reaction. The clinical aspect 
emphasizes measuremen1, surgery, 
and clinical techniques independent 
of drugs for the relief of pain. 
The selected readings reflect a 
comprehensive expression of this 
problem from various points of view. 
Section one deals with concepts of 
pain reactions including the 
physiology of pain and the 
psychological aspects. SecllOns two 
and three deal with the cultural and 
social factors and how these 
influence pain percepllon, e.g. how 
children perceive pain, and studies on 
selected ethnic groups. Section five 
provides information on the laboratory 
manipulation of pain perception. Of 
interest in Section six is a current 
account of hypnosis and acupuncture 
In the control of pain while Section 
seven is dedicated to surgical 
Intervention Selected diseases and 
pain associated with them are dealt 
with in Section eight. 


This book will prove invaluable to 
researchers, clinicians and anyone 
interested in increasing their 
knowledge of and ability to control 
man.s problems of pain and suffering 


Guide to Diagnostic 
Procedures by Ruth French. 
New York, McGraw-Hili Co., 
1975. 357 pages. 
Reviewed by Sheila Money, 
Teacher, Humber College of 
Applied Arts and Technology, 
Health Sciences Division, 
Weston, Ontario. 


This book was formerly entitled 
.The Nurses Guide to Diagnostic 
Procedures" but the shorter title is 
more appropriate, for indeed the book 
can be used by a variety of health 
care professionals. The guide is 
concerned with explanations of 
fundamental principles, definitions of 
the common terms associated with 
diagnosis, the role of the nurse In 
each of the diagnostic tests, and 
interpretation of results. 
The book is divided into twelve 
major dvisions. The various 
procedures are presented under the 
following headings: urological, 
hematological, biochemical, specific 
functions, immunological, 
immunohematological, 
microbiological, cerebrospinal, 
miscellaneous, radiological, and 
radio-nuclide examinations. The 
author has done a thorough job of 
researching the book and it covers all 
the diagnostic procedures known to 
this writer. Other texts of diagnostic 
procedures are often organized 
according to body systems but in this 
book the material is well-organized 
and the excellent index makes it easy 
to find the desired information. 
Since the book will be used in 
areas where the Celsius scale is 
used, it would have been helpful if the 
author had included Centigrade 
readings when discussing 
temperatures. 
One outstanding improvement in 
the text is that the normal range for 
the various tests are given 
immediately after the heading. 
This book would be highly 
recommended for any unit which 
does extensive diagnostic testing. 


....\udio\"hnu\1 


. Health Promotion 


King Size 
This 7-minute amusing animated 
film is intended for youngsters but 
carries a message for adults as well 
Anything can happen, and does, 
including a visit to the kingdom of King 
Size where "No Smoking" is 
forbidden. Produced for Health and 
Welfare Canada and available from 
regional offices of the National Film 
Board. 


A Fight For Breath - 
Emphysema 
This is a 12-minute, color 16mrr 
film produced by the National Film 
Board for the Non-Medical Use of 
Drugs Directorate of the Department 
of National Health and Welfare. The 
film features illustrations on the effects 
of pollutants, e.g., cigarette smoke on 
the human lung. The theme messagE 
is that one out of every seven 
Canadians suffers from a chronic 
obstructive lung disease. The film is 
available to Canadians from any of the 
regional offices of the National Film 
Board. 


For Those Who Drink 
This is a 39 minute black and 
white film produced by Health Films 
Limited, Canada. Dr. R. Gordon Bell, 
 
recognized authority on drinking and 
alcohol problems, narrates this film 
dealing with drinking and those 
problems associated with drinking. 
Some suggestions for a solution to thi: 
complex problem are presented in thi
 
filmed lecture. To request this film 
contact the Canadian Film Institute, I 
303 Richmond Rd., Ottawa, Ontario 
I 



GENEROUS NEW GROUP DISCOUNTS on an 
Items shown, for group purchases. graduation gifts. favors, etc 
6-11 Same Items, Deduct 10"10; 12,24 Same Items, Deduct 15 0 ,," 
25 or More Same Items, Deduct 20 0 ,," G 


:'1L 
 7Z,v...;-
 


r-------------------------------------. 
. IT'S EASY TO ORDER REEVES NAME PINS FOR YOURSELF OR FRIENDS! . 
I f.:::t C::r

 w:J.ed
ne"s 
rac:. Pé'


:
e
:,:r:: :O
Ê SA
lt
 tlirtirDE
1:


 '
 .a: t =,,::. I 
box" on chart, clip thiS section 
nd attach to coupon "'... . cay.' I'N. 


. 
. LETTERING.______________________ 2nd LlNE._______________ 
: S11lE IEseøTlOM 1IfTN. I IEIAl'
 I UTTER"" PIICtS 
IIØ COlOR AIIISH 0'IaIbc1 COLOR 
 I L.t EIIIWM 2 L-. 
. ALL "ETAL Smoorn rounded 1 0 Ouotone Does 0 Black 0 . PIn 2.09 O. p.n 3.2S 
I ;c 


g
:
 sa

Iß. or B Gokt 0 Polished not 0 Ok Blue 
I ba4;...,roundwlthPohsheded
 Silver OSatin apØly DWhrt
 D


.:' D


5 
. D PlASTIC LAMINATE. slimmer OWh 
 te Black 01 Pin J.2S 0 J PIn l..BS 
I . 
=;i,':

o

ru B:...e
 to B
:= Wh: Blue 0 2 Pins 1.95 0 2 Pins 2.90 
I I:Jofder matches tenefln&- 0 Cocoa letters only IWIN 
I IMnIR.--.,' 
. D ..ETAlFRAMEO C
SIC White o Baack OlPin 249 \ OlÞln 325 
. I design; snow white plnhC ".Ih Iy 0 Ok.. Blue 0 20.'1s 1.99 O? Pins 4 95 
I smooth poliShed beYeaed frame on I -e.,.,rnt 
 ..n- 
. ID MOLDED PLASTIC Slmp l e.Sf1\íIrt Mute 0 Black 01 rln 12!i 01 Pin 1..B!Þ 
I I sc=

 =1:=nOd
ees only 0 Ok Blue 0 2 Pins 1.95 0 2 PinS 2 90 
--
I - 


Does Does 
nol not 
apply apply 
o GoIo PoltShed 
r..me 
05,'- n' 
Does Do.. 
nol no! 
apply appl)' 


... ,I 


. ,. I' ...::t. 


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'
'" 
4". 
5". 
JY.."" 


KELLY FDRCEPS 
0..--- So hand)' for every nurse1ldeal for cJarnpil1l 
.- off tubing ete Stainless st!el. 5Y:J:"" 
No. 25.72 Stroillht. Box Lock.. . . . 4.49 

 No. 725 Curv.d, Box Lock. . . . . . . . 4.49 
No. 741 Thumb Dr...ini Fo",op, 
S.rrat.d, Strliiht, 5'," . . 3.75 
For enlf3ved mit.als add 5Ot: per mstrument 


MEDI-CARD SET Handi..1 refer 
ence ever! 6 smooth plastic cards ß!h" I 
5Yz""J crammed With Il1fOnRibon. Equm- 
lencles of Apothecary to MetrIC to Household 
Yeas. Temp_ ac to F. Presccip. AbbJ, Unß- 
01"... Bod, Chem , Blood Chem ,liver Tests, 
Bone Marrow Disease Incub. P!rlods. AIiIlt 
Wgb , etc. In wtnt! vln)1 holder_ 
No. 289 Card Set. . . 1.50 ea. 




:".SaJ:I:c;:
amped an back of 




;G] 
\ ',-.
 


POCKET SAVERS 


PreY!nt stains and wear! Smooth. þli. 
.ble pur. ..M. ..n,1 Ideal 100H:0S1 
I"OUII gifts Of f...... 
MI. 21M ""r loft). two comportments 
p

k
rÒ'

:$
 Cl<b:eus . . . 
NI_ 111 O.ftJ Delu.. S....., 3 comPl, 

':
l:tø::i

r 
.
haln . 
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 ... .. 


- - 



'-. / 
t
, 


........ 
\ 
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
":t
 
hë

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
e 
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 


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 reæive them when available. 


Item 
No. 


Author 


Short title (for identification) 


Request for loans will be filled in order of receipt. 
Referenæ and restricted material must be used in the CNA library 


Borrower. 
Registration No. 
Position. . . . . . , , 


Address 


Date of request . . 



'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 



POSEY 
QUALITY 
PRODUCTS 


,(, 
j-,;, 


"'
() 
"'I 


Posey "Swiss Cheese" Heel Pro- 
tector - simplitied design, gener- 
ous coverage of heel and ankle. 
Hook and eye fastener to keep it 
in place. Synthetic fur; washable. 
#6121 


... 


fo, 


, 


I
 
Posey Body Holder - popular in 
hospitals and nursing homes, this 
is an all-purpose Posey for bed or 
chair security. Available in sturdy 
canvas with flannel padding or 
quick drying nylon. S, M, L, wash- 
able. #1731 (cotton wlties) 


" 


... 


:
 
---- - 


Posey "Cinch" limb Holder - 
all purpose, mild limb control with 
maximum comfort 36" strap al- 
lows degree of treedom desired, 
#2528 


,....{:; 
( POSEY 
II 
y 


Send your order loday! 
Enns and Gilmore 
2276 Oixie R""d 
Mississ.1up
 Ont"-"o. 
C;anada L4Y 115 
(416) 2ï4-2
7
 


The Canadian Nurse March 1976 


Director of Nursing 


Director of Nursing required for a 
32-bed active treatment hospital 
located In Southern Alberta. 


Major renovation program 
scheduled for 1976-77, 
Previous experience desirable. 
Duties to commence June 1, 
1976, 


Please forward complete resume of 
experience and qualifications to: 


The Administrator 
Macleod Municipal Hospital 
Fort Macleod, Alberta 
TOl OZO 


Assistant Director 
of Nursing 
Assistant Director of Nursing required 
for an accredited 130-bed General 
Hospital with a major expansion project 
underway. 
The city of Grande Prairie is located 285 
miles northwest of Edmonton and is well 
serviced by bus and air. 
Preference will be given to applicanl with 
practical experience at the senior 
administration level combined with 
baccalaureate degree and/or other 
formal education in the field of 
admìnistration. 
Salary commensurate with education and 
experience. 
Position available by May 1 st 1976. 
Please apply to: 
Director of Nursing 
Grande Prairie General Hospital 
Grand Prairie, Alberta 
T8V 2E8 


North Newfoundland & Labrador 
requires 
Registered Nurses 
Public Health Nurses 
International Grentell Association provides 
medIcal services for Northern Newfoundland 
and Labrador We staff four hospitals, eleven 
nursing stations, eleven Public Health units. Our 
maIO 180-bed accredIted hospital is situated at 
51. Anthony. Newfoundland. Active treatment is 
carned on In Surgery. Medicine, Paediatrics, 
Obstetrics, Psychiatry. Also, Intensive Care 
Unrt. Orientation and In-Service programs. 
40-hour week. rotating shifts. living 
accommodations supplied at low cost Public 
health has challenge of large remote areas 
Excellent personnel benefits include liberal 
vacatIon and sick leave. Union approved 
salaries start at $810.00. 
Apply to: 
International Grenfell Association 
Assistant Administrator of 
Nursing Services 
St. Anthony, Newfoundland 
AOK 4S0 


63 


, 


t.
 
__-.:J 


When you are 
asked about 
nursing care..a 


Health Care Services Upjohn 
Limited can assist you and 
your patients by providing 
qualified Health Care Person- 
nel for: 
. Private Duty Nursing 
. Home Health Care 
. Staff Relief 
We are a reliable source of 
nursing care with whom you 
can trust your patients. Our 
employees are carefully 
screened for character and 
skill, then insured (including 
Workmen's Compensation), 
bonded and made subject to 
our high operating code of 
ethics. 
Your patients' care and well- 
being are our business. 
If you would like more informa- 
tion about our services, call the 
Health Care Services Upjohn 
Limited office nearest you. 



 
.'I--
 
. 


Health Care Services 
Up john Limited 
(Operating in Ontario as 
HCS Upjohn) 


Victoria. Vancouver. Edmonton 
Calgary. Wmrnpeg . Wmdsor . London 
St Cathannes. Hamilton. Toronto West 
Toronto East. Ottawa. Montreal 
Trois RlV,ères . Quebec. Halifax 



64 


Guelph General Hospital 
Fully accredited - 220 beds 
Requires 
Head Nurse 
For 
Obstetric Department 
The Obstetrical facilities are presently 
being expanded and renovated to provide 
a modern Labour and Delivery area, new 
Nursery facilities and a new Post Part urn 
SUite providing for 1,500 deliveries 
annually. 
Pleasant UniverSity City of 65,000. One 
hour from Toronto. 
Apply to: 
Personnel Department 
Guelph General Hospital 
115 Delhi Street 
Guelph, Ontario 
N1 E 4J4 
Telephone: (519) 822-5350 Ex,: 203 


Operating Room 
Supervisor 


. required for 650-bed 
fully-accredited hospital 


. management experience and 
advanced preparation in 
Operating Room technique and 
administratio'l.. required 


Please apply giving full resume to: 


Director of Personnel 
Lions Gate Hospital 
230 East 13th Street 
North Vancouver, British Columbia 
V7L 2L 7 


Registered Nurses and 
Nurses Assistants 
required for 11 O-bed hospital for 
chest diseases situated in the 
Laurentians, 55 miles north of 
Montreal. 
Salaries are now being updated, 
Excellent fringe benefits. 
Quebec language requirements 
do not apply for Canadian 
applicants if registered in Quebec 
before July 1976. 
Apply: 
Director of Nursing 
Mount Sinai Hospital 
P.O. Box 1000 
Ste-Agathe des Monts, Quebec 
J8C 3A4 


The Canadian Nurse 


School of Nursing 
Assistant Director 
required in a 2 year English 
language diploma Nursing 
program 
Qualifications 
Master's degree in Nursing Education, 
preferred. with experience in Nursing 
Education. 
Administration and teaching and at least 
one year in a Nursing Service position. 
Eligible for registration in New Brunswick. 
Apply to: 
Harriett Hayes 
Director 
The Miss A.J, MacMaster School of 
Nursing 
Postal Station A, Box 2636 
Moncton, N.B. 
E1C 8H7 


Co-ordinator 


Co-ordinator required for a 340-bed acute 
care hospital in Central British Columbia 
to be responsible for the related serviæs 
of the O.R., PAR., Daycare Surgery and 
Emergency Departments. The position 
will include both clinical and 
administrative responsibilities. 


Salary per RNABC Contract. 


For further information contact: 


Director of Nursing 
Prince George Regional Hospital 
Prince George, British Columbia 
V2M 1S9 


Nursing Opportunity 
in a Progressive Hospital 
Supervisor - 
Operating Room 
and 
Recovery Room 


We offer an active staff development 
program in a 310-bed General Hospital 
involved in Acute, Extended and Mental 
Health Care. 
Competitive salaries and fringe benefits 
based on educational background and 
experience. 
Apply, sending complete resume, to: 
Director of Personnel 
Stratford General Hospital 
Stratford, Ontario 
N5A 2Y6 
(Area Code 519,271-2120, Extn. 217) 


March 1976 


Registered Nurses 
Required 


For a 138-bed Active Treatment Regional 
Hospital in Medicine, Surgery, 
Paediatrics, Obstetrics, and qualified 
R.N.'s for a 5-bed I.C.U.-C.C.u. 
Salaries according to Provincial 
Salary Guide 
Usual Fringe Benefits 
Residence accommodation available 
The Hospital is located in the beautiful 
Annapolis Valley which is a one-hour 
drive to the Provincial Capital of Halifax 


Apply to: 
Director of Nursing 
Blanchard-Fraser Memorial Hospital 
186 Park Street 
Kentville, Nova Scotia 
B4N 1 M7 


General Duty Nurses 


Required immediately for acute care 
general hospital expanding to 343 beds 
plus proposed 75 bed extended care unit. 
Clinical areas include: medicine, surgery, 
obstetrics, paediatrics, psychiatry, 
activation & rehabilitation, operating 
room, emergency and intensive and 
coronary care unit. 
Must be eligible for B.C. Registration. 
Personnel policies in accordance with 
R.N.A.B.C. Contract: 
Salary: $850 - $1020 per month 
(1974 rates) 


Shift differential 
Apply to: 
Director of Nursing 
Prince George Regional Hospital 
Prince George, B,C. 


Foothills Hospital, Calgary, 
Alberta 
Advanced Neurological- 
Neurosurgical Nursing 
for Graduate Nurses 


A five month clinical and academic 
program offered by The Department of 
Nursing Service and The Division of 
Neurosurgery (Department of Surgery) 
Beginning: March, September 


Limited to 8 participants 
Applications now being accepted 
For further information, please write 
to: 
Co-ordinator of In-service Education 
Foothills Hospital 
1403 29 SI. N. W. Cafgary, Alberta 
T2N 2T9 



Georgian College 
of Applied Arts and 
Technology 
Health Sciences Division 


Requires Faculty for Diploma 
Nursing Program in Owen Sound, 
Orillia and Barrie 


and Ambulance Attendant Program 
based in Orillia 


New, progressive, integrated 
curriculums. If you are a creative 
and innovative teacher, if you 
believe in self-directed learning, 
we would like you on our staff. 


Starting date August 17, 1976 with 2 
weeks orientation. 


Please write or telephone: 


, Miss CoM, Brown 
Nursing Administrator 
Georgian College of Applied Arts & 
Technology 
43 Colborne Street West 
Orillia, Ontario. L3V 2Y5 


Téléphone: (705) 325-2705 


I McMaster University 
School of Nursing 


Nurse faculty members required for 
the 1976-77 academic year for a School 
of Nursing, within a Faculty of Health 
Sciences. The School is an integral part 
of a newly developed Health Sciences 
Centre where collaborative 
relationships are fostered among the 
various health professions and clinical 
appointments can be arranged. 


Requirements: master's or doctoral 
degree, with clinical specialist 
preparation or experience and/or 
preparation in teaching preferred in 
adult health, medical-surgical or 
pediatrics. 


Application, with a copy of curriculum 
vitae and two references to: 


Dr. D. Kergin 
Associate Dean (Nursing) 
Faculty of Health Sciences 
McMaster University Health SCiences 
Centre 
1200 Main Street West 
Hamilton, Ontario 
L8S 4.19 


The Canadian Nurse March 1976 


65 


"Meeting Today's Challenge in Nursing" 


Queen Elizabeth Hospital of Montreal Centre 


A Teaching Hospital of McGill University 


requires 


Registered Nurses 
and Registered Nursing Assistants 


. 255-bed General Hospital in the West of Montreal 
. Clinical areas include Progressive Coronary Care, Intensive Care, 
Medicine and Surgery, Psychiatry. 


Interested qualified applicants should apply in writing to: 


Queen Elizabeth Hospital of Montreal Centre 
Director of Personnel 
2100 Marlowe Ave., Montreal, Quebec 
H4A 3L6 


SUMMER IN THE ARCTIC? 


/ 


Medical Services, Northwest Territories Re- 
gion, is offering a number of term positions 
for Qualified and experienced nurses to serve 
Canada's northland during the period of May 
through September. 
Why not see the Arctic and experience the 
challenge of frontier health care? 
Interested? Please fill out the attached cou- 
pon and mail to: 
Personnel Administrator, Medical Services, 
Northwest Territories Region, Health and 
Welfare Canada, 14th. Floor, Baker Centre, 
10025 - 106 Street, Edmonton, Alberta. 
T5J 1H2 
or call collect Area Code 403 - 425-5698 
NOTE: Permanent positions with Northern 
Health Services are also available. 


\ 


-.:
 

 .. ,,' ." 
. .. 

 
.

 
,: 



- 
'V 


.. 
 


16 Healrh and WeUare Canada Sante el Blen-elre social Canada 



 


' is 
 ' .... 
' ,. 
. 


NAME 


STREET 


CITY 


,. 

 


PROVINCE 


POSTAL CODE 



66 


Western Memorial Hospital 
Corner Brook, Newfoundland. 


Vacancies 
Staff Nurses 


For a 350 bed fully accredited, acute treatment, Regional General 
Hospital serving a population of approximately 100,000, scenic City 
with modern shopping, housing and education facilities 


Salary Scale: 


$ 9,724.00 - 11,986.00 per annum 
10,324.00 - 12,586.00 per annum 1st April, 1976 
10,800.00 - 13,110.00 per annum 1st August, 1976 
Service Credits recognized 


Shift Differential - $1.50 per shift. 
Charge Nurse - 3.00 per shift. 
Uniform Allowance - 90.00 per year. 
Educational Differential - Extra three steps on salary scale for B.N. 
Degree, four steps for Masters Degree. 
Annual Vacation - Twenty days. 


Statutory Holidays - Eight plus Birthday. 


Residence accommodation available $35.00 per month. 


Transportation available. 


Applicants please apply to: 
Canada Manpower Centre 
4 Herald Avenue 
Corner Brook 
Newfoundland 
A2H 6J7 


The Canadian Nurse March 1976 


.... 


./ -... -7:-:- 
/-:'
 :
 -:" 

:7::'= :
.;...... .0 
-- 'ox:, 'YI>_ 

 
-.- 
. 


I"":'-:! ...
p
 
.
 
....::.'" , 
;.- 
..J/ _
 ..... 
. 0;-" 
- !'''
I

 


"', 
..., .... 


,.11. 
"'Jo- 

 ".' 


r 
r 


General Staff Nurses 


required for 
Regina General Hospital 


openings in all departments 


Recognition Given For Experience 
Progressive Personnel Policies 


Apply: 
Personnel Department 
Regina General Hospital 
Regina, ßaskatchewan 
S4P OW5 


HUH



'ESS>



E illJ 


requires 


'Ðirector. QUO Vadis Campus 
Duties 
Successful Candidate will be responsible for the aca- 
demic administration and development of a unique 
diploma nursing program for adult nurse learners 
within a peer-oriented setting, the development and 
administration of formal and informal continuing edu- 
cation programs for registered and non-registered 
nurses and registered nursing assistants and the effec- 
tive operation of the Quo Vadis Campus. 
Qualifications 
The successful applicant will be a nurse registered or 
eligible for registration in Ontario and will have a 
graduate degree and broad experience in adult educa- 
tion, nursing and/or education administration. Pre- 
ference will be given to candidates with recent ex- 
perience in developing programs for and working with 
adult learners. 


'Ðirector. Osler Campus 
Duties 
Successful Candidate will be responsible for the aca- 
demic administration and implementation of the 
nursing diploma program on the Osler Campus, pro- 
viding leadership in educational design and teaching/ 
learning approaches, the effective operation of the 
Osler Campus and the management of the residence. 


Qual ifications 
The successful applicant will be a nurse registered or 
eligible for registration in Ontario and will have a 
graduate degree in nursing, education or administra- 
tion. Preference will be given to candidates with re- 
cognized experience and expertise in curriculum deve- 
lopment and/or educational leadership. 


Apply in writing with resume to: 
Personnel Relations Centre 
Humber College of Applied Arts & Technology 
P.O. Box 1900, Rexdale, Ontario M9W 5L7 


We are interested in Male and/or Female applicants 



The Canadian H..... March 1976 


I 
I;D 


'. 
"\ 



 

<I (\ 
 

, 

. 
It- 



 

<I 
 

 

 

. 


n 10 bolh 
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. 


\\ 


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 


Ë 

 


r_ IÎbT 
:;;;
;;
;;;





;
;' 
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 
[lJ@ 


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 


,-- 
. 


.- 


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. 


\ 



72 


I 


( 


. 


... 


Arctic th 
vvarm 


· · · · when 
somebody 
cares. 



\ 

 
 
 ;'In:
') 
t\
, " I . 
, I,. 

 ( 
 .?- 
, \ \ X,- "'-.. ""'_, 
\.. \ 
r." y - ;,,
 
,

 -',,_ '" (fT-:!.
' 
 J
 

 \ 
 
-;:z:,''''' 
t\
 >
;
 ) l ifyaucar.e, 
, þ-,/,':i!V'. ':fj
 k send thIs 
--(
!ïí,',,
 caupan taday. 
,-N
/_________
 
I ./ - I :;, -:.--:-/ Medical Services Branch I 
I ' 
. 1'- Department of National I 


 i'
 
 - Health and Welfare 
I 'í. Ottawa, Ontario K 1 A OK9 I 
I I 
I Please send me more information on nursing I 
I opportunities in Canada's Northern Health Service. I 
I Name: I 
I Address: 
City: Prov: I 

------------ ___ J 
. . Heatth and Welfare Sante et Bien-étre SOCial 
Canada Canada 


The Canadian Nurse March 1976 


Index to 
Advertisers 
February 1976 


Abbott Laboratories Limited Cover IV 
Bata Shoes 4 
The Canada Starch Company Limited 15 
The Clinic Shoemakers 2 
Designer's Choice 9 
Health Care Services Upjohn Limited 63 
H ollister Limited 17 
ICN Canada Limited 57 
L'eggs Products Intemational Limited 10, 11 
J.B. Lippincott Company of Canada Limited 36, 37 
M edoX 61 
Mont Sutto n 59 
The C.V. Mosby Company Limited 50,51,52,53 
Nordic Pharmaceuticals Limited 15 



m

 
 
Reeves Company 49 
Roussel (Canada) Limited 47, 62 
Sen eca College of Applied Arts and Technology 55 
W.B. Sa u nders Company Canada Ltd 1 
Three (3)M Canada Limited 7 
Uniforms Registered 45 
Uniform Specialty Cover III 
White Sister Cover II 


Advertising Manager 
Georgina Clarke 
The Canadian Nurse 
50 The Driveway 
Ottawa K2P 1 E2 (Ontario) 


Advertising Representatives 
Richard P. Wilson 
219 East Lancaster Avenue 
Ardmore, Penna. 19003 
Telephone: (215) 649-1497 


Gordon Tiffin 
2 Tremont Crescent 
Don Mills, Ontario 
Telephone: (416) 444-4731 


Member of Canadian 
Circulations Audit Board Inc. 


mE 



7& 


The Canadian Nurse 


L
7.JV F
J 
l. ,\ 1 .' L ,.) 1 f '( U,.. L r T 
 \'1 .A 
"'" Ir
 
l ..AKY 
TT l.T....I"IC 


Kif\, oN5 


. 
\ .. 
"- 

 
< f 
, , 
.. -- 
""'" 
 
. , 
, I 
, "" 
. 


/ 


.. 


\ 



 


4 


" 


t 


/ 



/ 
'j 
tl 
:11 
',. 
: ,: 
{It 
'I! 
í 
. 


I 
I 
I 
, 


t 
I f 
I 


A & B) Style No. 46592 
Sizes 3-15 
Pristine Royale 
100% Textured Polyester Warp K 
White, Blue - 3 piece suit 
About $35 
C) Style No. 6525 
Sizes 8-16 
Pristine Royale 
100% Textured Polyester Warp K 
White About 524 


A 



 


""HITE 
SISTER 
CAREER APPARI":L 


See our new line of Whites and Water Colours at fine stores across Canad1 



Now there are two versions of 
MILLER &: 
KEANE"s 
Encyclopedia 
&: Dictionary 
of Medicine 
and Nursing. 


EnCYclopø' 
and Dictl 
Medicine ' 


- 


.....".-
 


, 
, 
, 
. 
, 
, 
t 
C 
f 

 
f 
C 
f 


t EditiO I1 '\ 
S tu del1 
The 


I,.
 
eSt. 

J'}
 

,.O" 

O/
. 
70J'} 


MILLER & KEANE's Encyclopedia and 
Dictionary of Medicine and Nursing: 
Published March 1972. 1089 pages. 
122 figures plus 16 color plates, 
Standard Edition: flexible binding; thumb index; will 
remain available. Order #6355-9. 
Student Edition: hard cover; no thumb index. $11.30. 
Order #6356-7. 


On April 1 , 1976 a Student Edition of 
MillER & KEANE's Encyclopedia 
and Dictionary of Medicine and 
Nursing will finally be available. This 
Student Edition is a hard cover 
version of the well known reference. 
While the Student Edition is not 
thumb indexed like the Standard 
Edition, once you look inside the 
cover, you'll find that the Student 
Edition provides the same 
comprehensive, accurate 
information on modern nursing 
practice and medical terminology. 
Over 453,111 of your colleagues 
have already discovered the value of 
this precise, professional reference. 
You can too! 
By the late Benjamin F. Miller, MD; 
and Claire Brackman Keane, RN, 
BS, MEd. 



 !!

!

!!!!
l!!.




lTD. 


r---------------------c

 
I 
I 
I 
I 
I 
I 
I Full Name 
I 
I Home Address 
I City 
I 


On 30-day approval, please send me a copy of the Student Edition of 
Miller & Keane, $11.30. #6356-7. 


o Payment enclosed, ship postpaid. 0 Bill me. 0 Send C.O.D. 


Province _ 


Zone 


, 



o 


, 


Nature gives it. 
Zincofax * keeps it that wa
 


After every bath, every diaper change and in between, 
soothing Zincofax protects baby's nature-smooth skin. 
Protects against chafing and diaper rash, against irritation 
and soap-and-water overdry. 
But Zincofax isn't just for delicate baby skin, It's for 
you and your entire family-to soothe, smooth and 
moisturize hands, legs and bodies all over. 
\Vhat's more, Zincofax is economical, even more 
important now with a new baby at home. 


.. \ 
V 
'- 
 
... .... 
I 
" I 
 
- ... \c 
.. 

 -\ ..A 

 .... 4t' 
...... 
f , 


keeps a family's 
smooth skin smooth 



 
115g , . 

 Zincof

 1 

RBABYSSJ!.I . 
, 
 _:--- t cot )( 
h Cd 1'SS<'" In 
. 
 FoR øAØ 




' 


508 



 


-Trade Mark 
W-3056 



 
Wellcome 


Burroughs Wellcome & Co 
(Canada) Ltd 
Montreal, P.O. 



.4 76 


Input 
News 
Books 
Library Update 


The Canadian Nurse 


The official journal of the Canadian 
Nurses' Association published 
monthly in French and English 
editions. 


6 
8 
47 
47 


Volume 72. Number 4 


A Nursing Challenge: 
Replantation of a Severed Arm 
Ticket of Nominations 1976-78 
CNA Convention Program 
CNA Financial Statement 
CNA Resolutions 
A Conversation with 
the Executive Director 
That Cup of Tea 


B. Geyer 


19 
24 
35 
38 
41 


F. Warren 


44 
46 


\ 
 
. ""1 r, 
þ , 

. r' 
.., 
-- 
\ 

 
'-\ 
... ! 
 


CNA member associations will name 
249 voting delegates to officially 
represent their membership at the 
national association s Annual Meeting 
in Halifax this June. For these nurses, 
it will be business before pleasure 
when the time comes to voice the 
wishes of the people they represent. 
The cover photo of voting delegates at 
a previous CNA meeting is by David 
Portigal of Winnipeg. 


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


ISSN 0008-4581 


Indexed in Intemalional Nursing 
Index, Cumulative Index to Nursing 
Literature, Abstracts of Hospital 
Management Studies. Hospital 
Literature Index. Hospital Abstracts. 
Index Medicus. The CanadIan Nurse 
is available in microform from Xerox 
University Microfilms, Ann Arbor, 
Michigan, 48106. 


The Canadian Nurse welcomes 
suggestions for articles or unsolicited 
manuscripts. Authors may submit 
finished articles or a summary of the 
proposed content. Manuscripts should 
be typed double-space. Send original 
and carbon. All articles must be 
submit1ed for the exclusive use of The 
CanadIan Nurse. A biographical 
statement and return address should 
accompany all manuscripts. 


A Canadian Nurses Association, 

 50 The Driveway, Ottawa Canada 
K2P 1 E2. 


Subscription Rates: Canada: one 
year, $8.00; two years, $15.00. 
Foreign: one year, $9.00; two years, 
$17.00. Single copies: $1.00 each. 
Make cheques or money orders 
payable to the Canadian Nurses' 
Association. 


Change of Address: Notice should be 
given in advance. Include previous 
address as well as new, along with 
registration number, in a provincial 
nurses association where applicable. 
Not responsible for journals lost in mail 
due to errors in address. 


Postage paid in cash at third class rate 
Montreal, P.Q. Permit No. 10,001. 
C Canadian Nurses' Association 
1976. 


, 



4 


.-e'-SI)eetiye 


The CanadIan Nurse April 1976 


Three years ago, when doing some 
reading in the area of the probable fate 
of professional associations as an 
organized entity, I happened across a 
comment by a North American 
sociologist that "the danger for many 
associations in existence today, lies in 
the very distinct possibility that they 
will not adapt themselves sufficiently 
to survive the coming decade." 
And right here I must admit that. 
in 1973, the threat that a good many of 
the professional associations that 
existed at that time, would simply not 
be around in the eighties did not seem 
either very immediate or very 
ominous. After all, change has 
become an accepted characteristic of 
our contemporary conditiion. A degree 
of introspection is a healthy sign and 
adaptability is the mark of the 
well-adjusted institution or individual. 
Professional associations had been 
around for a long time and would 
probably continue to meet the needs 
of their members in one way or 
another for a long time to come. 
But now, in the Spring of í976, 
our association is faced with a crisis 
that threatens its very existence. Can 
we change fast enough to meet the 
challenge not just of new social 
attitudes and scientific advances, but 
also of an economic turnaround that 
directly or indirectly affects everyone 
who gives or receives health care 
services in this country? 
And this is precisely where the 
problem lies. Funding for the 1976-78 
biennium has become a critical issue 
for this association. And, right now (not 
3 years ago or even 4 years from now) 
is the time the nursing profession 
stands most in need of the kind of 
strength, leadership and direction that 
can be obtained only by collective 
action at the national level. 
Recently, it has become apparent 
that the lip-service that has been given 
publicly to health promotion, illness 
prevention, and the need to find viable 
alternatives to acute care, IS gOing to 
have to be replaced by concrete 
action. The implications for the nursing 
profession of this revolution in our 
health care system, are profound. 
Very soon, we could be looking at 
broader nu(slng roles, new 
responsibilities, more independent 
professional recognition, more group 
practice, more inter-professional 
cooperation, more opportunities for 


promotion and, potentially, a very real 
increase in the "political clout" that the 
profession can command. But (and 
this is a very big but) the only way that 
nursing can achieve, on a national 
scale, the kind of scientific expertise, 
information retrieval and 
dissemination systems, and climate of 
public confidence that will allow this to 
happen is by pooling its resources and 
working collectively for the 
advancement of the profession as a 
whole. 
Today, there IS more truth than 
ever in Robert Merton's comment that 
"in the professions, each practitioner 
is his brother's keeper." The future of 
the future is the present. For CNA, that 
present is as close as June 22, 1976_ 
On that day, you or your 
representatives will decide the future 
of organized professional nursing in 
this country. Are you ready to assume 
that responsibility? 


-MAH. 


lit>> lee i 'I 


Editor 
M. Anne Hanna 
Assistant Editor 
Liv-Ellen Lockeberg, 
Carol Thiessen 
Production AssIstant 
Mary Lou Downes 
Circulation Manager 
Beryl Darling 
Advertising manager 
Georgina Clarke 
CNA Executive Director 
Helen K. Mussallem 


... 


.. 


.
 


The wistful face above belongs to little 
Theresa Bakx who lost her arm in an 
accident. A first-person account by 
one of the nurses involved in the 
subsequenl replantation is on page 19 
of this issue. 
Next month, what happens when 
a patient in your hospital dies? Who is 
responsible for helping the family over 
the inevitable hurdles they face in the 
first shock of their bereavement? What 
happens when no one accepts this 
responsibility is the subject of one of 
next month's articles. 
Also next month, an examination 
of the nursing care involved in 
transportation of the sick neonate - 
the steps you can take during and 
before this move to reduce the risks to 
the patient. 


Just before press time, members 
of the program committee were able to 
provide some last minute information 
on the JUl'le CNA meeting in Halifax. 
(see pages 35-37 of this issue). 
Participants In Monday's debate, in 
addition to those named, will include: 
Brenda AUt, assistant executive 
director, Patient Services, Halifax 
Infirmary, and Denise Lalancette, 
chargé d'enseignement, Centre 
Hospitalier Universitaire, Sherbrooke 
(in favor); Margaret McLean, director, 
school of nursing, Memorial 
University, St. John's, Nfld. and 
Suzanne Brazeau, doctoral 
candidate, University of Chicago, 
(against). 
Ruth May, assistant professor, 
Outpost Nursing, school of nursing, 
Dalhousie University, will also be a 
member of the group of nurses that 
Patrick Watson will interview. 
Participants in the panel discusSion on 
the quality of life in the work world O' 
the nurse will also include André 
Payeur, lawyer, who will discuss 
"Uncertainties regarding the nurses' 
legal protection." 



:ROM desi!!ner's choìc
 WURLD UI- tA
"IUN 
- 


t ,..' _ r. I-' .".-- 

f ,

j.
 )) 
;r.- I 


 . - 
 
, . r- 
., . 

 
p , 
,> 
"<:r . I 
. 
 ..t-f
 
.. -. 

 


" 
o. 
. , 


, 
c.
 
.'f., 

t,
 . 
if: 



 :\ i. 
41- 
 
ofF- .. 
.

 


c 


! 

-' \j
 
l ,. .
.. ..,., 
....' -.

' 
. 'Ji.>
 

'.>.:I: 
1". 
 
 Í 
: 

 
 

 1f;c+.1 
.. .: 
 

,,!. .', 
.. r--#
";' 
:.. ....45:- . 
c ..: 
 
, 
'II -'I: " 
. "i 
 ? 
 . .;>'l 
 
.y;- 
.. y 
" .Jk--* ,irJ 
. !to _ , 
'\.. . 
 .,- 
 
. 

 <l 
..:F . , 
...e ........ 


.L 


1 
lt1 

:'" 

. 
ï 
., 


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 


.,. 



 



 

 
-, 



,t.
 

 
 
.
 


<< 
.' 



. 



 


B 


" . 


A 


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. 



PROTECT 
SKIN 
from contact with 
IrntatlOg exudate 
with a Karaya 
Blanket around the 
wound rite 


INSPECT 
WOUND 
through transparent 
Access Cap without 
trauma of dressing 
removal to treat 
wound or advance 
dram tube remove 
Just the Cap 


p' 


--COLLECT 
EXUDATE 
m a Drainage 
Collector that keeps 
flUid away 'rom 
wound and odor 
away from patient 


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 
dressings 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'll 
want to see the "transparent dressing." Write for complete 
information. 


Hollister Draining-Wound Management System 
HOLLISTER 


HOLLISTER LIMITED. 332 CONSUMERS ROAO WILLOWDALE ONTARIO M2J IPB 


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 


. . 
. . 
: . . 
. 
: . 
.' 
Of 
I , I , I , , , , I I , , I II I I I I , 1 I I I 
D J F ,-, .. Y J J ,. SON D J F 
, A 
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 


.. 


1 


.. 
- 
- 


(. 


\. 


- 


. . 


- 


I 


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. \ 



--- --y 


t 


Pf:d 
increa. 
the aSSL 
inflation r.. 
and 4. the 


Your patients 
will amaze 
you . . . 


-., 
'r 


l 


" . 
'" 


.-- - 


-- 


.... 


... 


,
 


" 


I
 -. 
- 


" 


_ , \\. A 
,'. 

 
\ '\ r
J 
so will retelast 
''y, \
 ) 

 
Your patients will be back to normal in no (

\\ .
 
nothing happened. "., 
 
 . \ 
NOT SURPRISING.,. 'l' 
 
RETELAST is so comfortable and g ives . 
. 1 . 
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. 


J. 


- 


, 


.. 



. 
t i 
-\ 
1 
 l 
. 
.! 1. 
.t,\ 
\\ 
.. 


. 



 


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 
 
 
.." '..
 , . 
. ,-- 
- 
 
.' 
, \ 
.1 
\\ \ ! J
 
- 
 
>- 
L> 
0 
\ 1 õ 
s::. 
Il. 


Registered Nurses Association of 
Ontario (RNAO). 
CUNSA was formed in 1970 to 
stimulate communication between 
nursing schools. By 1974 all of the 22 
university schools of nursing were 
represented at the annual conference. 
Since then. the University of 'JIontreal 
and Laval University have .r'\tJdrawn 
to concentrate on the pro' \s 
peculiar to nurses in QUdition, 
UNSA 
hopes to regain their mjing 2 \hip in 
the future. \ \ 


\ 



12 


When learning 
is what matters 
most. . . 


let Mosby texts help you 
initiate interest and 
clardy concepts 


medicaVsurgical 


6th Edition. 


MEDICAL-SURGICAL NURSING 


First to effectively combine medical and surgical 
nursing, this classic text continues to focus on 
individualized care of the total patient. Throughout 
this new 6th edition, you'll find increased emphasis on 
physiology, nursing assessment, and pathophysiol- 
ogy. New material has been added on cardiac disease 
and family planning counseling, including physiology 
of reproduction and contraception. New chapters 
provide thorough and current information on ecology 
and health, neurologic disease, musculoskeletal dis- 
orders, and injuries. Other features include a new 
larger format and new easy-to-read type. 


By Kathleen Newton Shafer, R.N., M.A.; Janet R. Sawyer, R.N., 
Ph.D.; Audrey M. McCluskey, R.N., M.A., Sc.M.Hyg.; Edna Lifgren 
Beck, R.N., M.A.; and Wilma J. Phipps, R.N., A.M.; with 28 
contributors. 1975, 6th edition. 1,032 pages plus FM I-XVI, 
8Y2" x 11",608 illustrations. Price, $17.80. 


A New Book! 


CLINICAL IMPLICATIONS OF 
LABORATORY TESTS 


I 


This valuable new guide provides a step-by-step 
approach to the clinical significance of laboratory 
tests. Unit I, Routine Multi-System Screening Panel, 
covers sequential multiple analyzer (SMA 12) tests, 
hematology screening panel and urinalysis. This is 
followed by an important table of potential variations 
of normal values that compares specific entities found 
in the routine screening process. Unit II describes in 
detail evaluative and diagnostic tests that should be 
1 . 'Jsed to confirm the diagnoses of abnormalities found 
vie z 
rc. the routine screening panel. 

ec. . the . . 

6e,., arko M. TIIklan, M.D. and Mary H. Conover, R.N., B.S.N.Ed. 
ber, 1975. 232 pages plus FM I-XVI, 6W' x 9W', 42 
I :rations. Price, $7.90. 
/ 



 


, 


I 


) 


A New Book! 


NURSING MANAGEMENT 
OF RENAL PROBLEMS 


A clear presentation of the physiologic and 
psychologic bases for nursing intervention, this 
unique text approaches nephrology as a vital subsys- 
tem of the whole body system. It offers in-depth 
discussions on normal and pathologic renal function; 
causes of renal disturbances; body responses and 
acute renal failure; medical therapy; and nursing 
intervention. Methods and processes of renal restora- 
tion are carefully detailed, with special attention to 
dialysis and transplantation and the psycho-social 
aspects of each. 


By Dorothy J. Brundage, M.N. January, 1976. 204 pages plus FM 
I-X, 6W' x 9Y2", 20 illustrations. Price, $6.85. 
IVIOSBV 


TIMES MIRROR 


THE C. V MOSBY COMPANY, l TO 
86 NORTHLINE ROAO 
TORONTO, ONTARIO 
M4B 3E5 



fundamentals/basic science 


New 13th Edition! 
PHARMACOLOGY IN NURSING 
Now available in a new 13th edition, this leading text 
outlines current concepts of pharmacology in relation 
to clinical patient care. Written by a nurse for nurses. 
the text features updated discussions on mechanisms 
of drug action, indications, contraindications, toxicity, 
side effects and safe therapeutic dosage range. Two 
new chapters examine antimicrobial agents and the 
effects of drugs on human sexuality, fetal develop- 
ment, and lactation. 
By Betty S. Bergersen, R.N., M.S.. Ed.D.; in consultation with 
Andres Goth, M.D. February, 1976. 13th edition, 752 pages plus 
FM I-XIV, 8" x 10",143 illustrations. Price, $13.60. 
New 9th Edition! 
TEXTBOOK OF ANATOMY 
AND PHYSIOLOGY 
The most widely adopted anatomy and physiology text 
is now available in an updated new 9th edition. New 
features include: three chapters on the nervous 
system; new information on brain waves, conscious- 
ness, biofeedback training; expanded discussions on 
liver functions, reproduction, circulation, and much 
more! 
By Catherine Parker Anthony, R.N.. B.A., M.S.; with the 
collaboration of Norma Jane Kolthoff, R.N.. B.S. 1975, 9th edition, 
598 pages plus FM I-X, 8" x 10", 336 figures (145 in color). 
including 239 by Ernest W Beck, and an insert on human 
anatomy containing 15 full-color, full-page color plates. with six 
in transparent Trans-Vision<< (by Ernest W. Beck), Price, $13,95. 


New 10th Edition! 
WORKBOOK OF SOLUTIONS AND 
DOSAGE OF DRUGS: Including Arithmetic 
An effective, self-teaching guide, this workbook 
relates basic mathematics to common solutions and 
dosages, and provides information essential for 
proper calculation, preparation, and administration of 
drugs. Updated throughout, material places more 
emphasis on the metric system and includes many 
new problems. The totally rewritten appendix contains 
drug standards and legal regulations; metric doses 
and apothecary equivalents; dosage rules for chil- 
dren; and more, 
By Ellen M. Anderson, R.N., B.S., M.A. and Thora M. Vervoren, 
R.Ph., B.S. January, 1976, 10th edition, 168 pages plus FM I-VIII, 
7V." x 10V2", 11 figures. Price, $6.60, 


New 11th Edition! 
MICROBIOLOGY AND PATHOLOGY 
Extensively revised and updated, the new edition of 
this popular text provides basic information and 
current knowledge on microbiology and pathology, 
both general and specialized. Informing your students 
of the latest scientific advances, the text features new 
discussions on: serologic diagnosis of protozoal and 
metazoal diseases, evaluation of cell-mediated im- 
munity, immunotherapy, and more! A new unit on 
microbes, details on lab methods, and rules for 
specimen collection are also included. Review ques- 
tions accompany each chapter, 
By Alice Lorraine Smith, A.B., M.D" F.C.A.P.. F.A.C.P. April, 1976. 
11th edition, approx. 720 pages, 8" x 10",563 illustrations, with 2 
full page color plates. About $15.70. 


New 3rd Edition! 


THE FOUNDATIONS OF NURSING: 
As Conceived, Learned, and Practiced 
in Professional Nursing 
Reflecting new dimensions in present day nursing, 
this updated text helps acquaint students with 
responsibilities, opportunities, and changes in profes- 
sional nursing. Discussions focus on such timely 
topics as: patients' rights, nurses' rights. abortion, 
euthanasia, and health care delivery systems. New 
material examines death and dying, changes in nurse 
practice acts, transitional problems from student to 
practicing nurse, individual licensure vs. institutional 
licensure, and more! 
By Lillian DeYoung, R.N.. B.S.N.E., M.S., Ph.D,; with 3 con- 
tributors. April, 1976. 3rd edition, approx. 336 pages, 7" x 10",14 
photos, 29 illustrations. About $10.00. 


critical care 


New 2nd Edition! 
A COMMONSENSE APPROACH TO 
CORONARY CARE: A Program 
This important new 2nd edition reviews all major 
problems associated with acute myo
ardial.infarction, 
Completely revised and expanded diScuSSions cover 
anatomy, electrophysiology, chemical imbalances, 
complications, and more, New material discusses 
hemodynamic monitoring and drug therapy for shock 
and heart failure, 
By Maflelle Ortiz Vinsant, R.N., B.S.; Martha I. Spence. R.N., B.S., 
M.N.; and Dianne Chapell Hagen, R.N.. B.S. October, 1975. 2nd 
edition, 228 pages plus FM I-XVI, 7" x 10",439 original drawings 
by Marcellino Obaya. Price, $7.65. 



 


J \ 


New 2nd Edition! 
NURSING CARE OF THE PATIENT 
WITH BURNS 
Written by an experienced burn nurse-clinician, this 
text is a concise yet detailed resource for burn care. 
from first aid treatment to prolonged care of burn 
patients. Updated and expanded, it includes a new 
chapter on fluid therapy, and increased emphasis on 
pathophysiology, causes, and prevention of complica- 
tions. It includes information on the importance of 
nutrition and special needs of young and older bl.rn 
patients, 
By Florence Greenhouse Jacoby. R N. January, 1976. 2nd edition, 
186 pages plus FM I-XII. 6V2" x 9Y2 , 18 illustrations including 2 
color plates. Price, $7.30, 



14 


critical care 


A New Book! 


TECHNIQUES IN BEDSIDE 
HEMODYNAMIC MONITORING 


This new guide is the first comprehensive text on 
continuous bedside hemodynamic monitoring. It 
provides current, detailed information for noninvasive 
and invasive monitoring of cardiovascular function - 
with special emphasis on the critical care setting. Each 
chapter includes a review of physiological principles 
and problem and solution tables. 
By John Speer Schroeder, M.D. and Elaine Kiess Daily, R.N. 
February, 1976. 212 pages plus FM I-XII, 6W' x 91f2", 137 
illustrations. Price, $7.60. 


behaVIOral (ier 


, 


A New Book! 


CHRONIC ILLNESS AND THE 
QUALITY OF LIFE 


This unique text delineates the psychological and 
social problems faced by patients afflicted with 
chronic disease, and offers specific information on 
how to help patients adjust to their condition. Topics 
include management of crises, family stress, handling 
of regimens, social isolation, and much more. Case 
studies clarify the principles presented, 
By Anselm L Strauss, Ph.D. June, 1975. 160 pages plus FM I-XIV, 
6:Y4" x 9:Y4". Price. $6.05. 


A New Book! 


BEHAVIORAL METHODS FOR CHRONIC 
PAIN AND ILLNESS 


I 


Explaining the basics of behavioral analysis, this new 
text is the first to discuss control of pain by behavior 
modification techniques. Discussions present current 
information on: concepts of pain; how pain may 
become conditioned; methods for analysis of chronic 
pain; behavioral technology in relation to treatment 
p
anning; and treatment by behavioral techniques, It 
al
,o provides important guidelines for the support 
nurses can offer patiel"ts' families. 
By Wilbert E Ford}'ce, Ph.
, February, 1976.236 pages plus FM 
'7' ,. x 10",31 U"",,,U n,. Pri<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 


Xt.>>"-H 


- , 
>-\" 
f 

 
, J 
" \. 


I) 


. 


Nurses across Canada can expect to 
hear more from their provincial 
associations about good health and 
fitness as a result of a 
two-<!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 


... 


I' 


..... 
J 
l 
, 
.A-... 


Jr l . 


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 


.. 


- 


". 


.. 


..t 



 

 


'- 


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 


'- 


Sa\res 
"Oll 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 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 
drier than it would in 
cloth diapers. 


'" 
--""- - 


.",,1 t II 


. Þers 


f 


,.,.. 


\ 


.... 


'" 


'. 



 


.. 


4 \ 
'- 


PROCTEI! . GAMBLE CAR.SZ! 


-.......-" 



. 
Su · ical Sponges 
X-ray · etedable 
S t 
Also c . ade to or, e.. 


IONiamB 


-- 


I 


{Formerly WI Morns! 
ASubsJdaaryoilmemanonaJCherr lea"C rpofafto 
6 7 5 ItJ:r 
deLresse 
Mðr.llrt...
 J77 QuebeÇ 


- 
-........ 


--. 


-- 

 


, ' 
 
" , 



 ' 



 
- 


. - 


., , 


'\. 

 


..... 


. 
\. , 
" ., 


-I- 



4/1"" 
.,.-
. JIIi'" 
':::Þ 
i e: 
... 
t 
'1 
I 
p 
.p 


-lit. -..: 
 


" 


- 


I 


, 



TI>e Canadian Nurse April 1976 


19 


0\ 
(j0
 

'l> . 
'ò.<' '!::' 0.,0 · 

ø 
Ú
qj. 
.
Ôj. O
 

C:J
 
 

v 
 
)0.. 
 fl; 
I 0 '"tt( 
I
 
 Ib- 
'" 
o Ò 

ø 

ø 
?J0 


=' 


"It was a year ago today, " said Theresa's 
father as I sat visiting with them while they 
waited to see the surgeon. "I can't believe a 
year has gone by since the accident .. 


A year before, Theresa Bakx was a happy, 
normal two-year-old living on a farm with her 
parents and brothers. She enjoyed following 
her brothers into the fields but on this particular 
day had grown tired of trying to keep up and 
had decided to lie down in the hay to rest. 
Seconds later the hay mower severed her left 
arm at the elbow and severely lacerated her 
left leg. 
When her father realized what had 
happened, he acted quickly and with 
remarkable presence of mind. He squeezed 
her upper arm as tightly as he could. and after 
several minutes succeeded in controlling the 
bleeding. He then picked up Theresa and her 
detached arm, and rushed to the house. He 
wrapped the arm in a towel and took her to the 
hospital in the nearby town of Rimbey. By that 
time the bleeding had stopped and 
arrangements were made immediately for an 
ambulance to take her to Edmonton, about 90 
miles away. 


In Emergency 
Three hours after the accident Theresa 
was admitted to the Ernergency Departrnent at 
the University Hospital in Edmonton, She 
was conscious, her vital signs were stable, and 
she appeared to have withstood the 
ambulance trip very well. (Theresa's father 
remarked that during the trip she kept asking if 
the doctor would be able to fix her arm.) 
In emergency, an I.V. of Ringers Lactate, 
to run at 60 mllhr, was established in 
Theresa's right wrist. The stump was checked, 
cleansed with saline and rewrapped in a sterile 
towel. The detached arm was examined, 
cleansed, and placed in a sterile plastic bag 
with ice to preserve its viability. The large 
laceration on the anterior aspect of the lower 
left leg was also cleansed and dressed. 
Following evaluation of Theresa's 
condition, a team of doctors decided to attempt 
a replantation of the left arm. Theresa met Malt 
and McKhann's classic criteria for 
replantation, parphrased as follows: 1 
- Is there a life-endangering injury involving 
the contralateral extremity? 
- Is the amputated part in good condition? 
- Are the nerves capable of regenerating and 
the muscles and tendons functioning? 
- Is the amputation through the upper 
extremity? 




 


 


- What is the patient's age? 
- Are the resources of the hospital adequate 
to carry the patient through the long and 
tedious postoperative course? 
- Does the patient actively desire replantation 
and is he likely to possess the psychological 
stamina for rehabilitation? 
In considering these questions some 
particular factors weighed in Theresa's favor. If 
the amputation involves a lower extremity, 
replantation is rarely indicated. but replanted 
upper extremities are likely to be more 
functional than a prosthesis. Replantation is 
especially favored for children because they 
have a relatively shorter length of nerve to 
regenerate and they have more time available 
for rehabilitation. 2 In addition the Charles 
Camsell Hospital, where she was transferred 
for the operation, is equipped with facilities for 
a postoperative program, including 
progressive physiotherapy and occupational 
therapy departments and an active play 
program in the nursing unit. 
Mr. Sakx was warned that several 
operations might be necessary if the 
replantation was attempted and that he and his 
wife would be required to participate in a 
long-term rehabilitation program for Theresa. 
He understood the implications of the 
operation and agreed with surgeons that a 
replantation should be attempted to restore the 
function in her arm. 


Preoperative Care 
Preoperative medical treatment included 
x-rays of the left stump, the left detached arm 
and the left leg. Hypertet (Tetanus Immune 
Globulin) 250 u., Tetanus Toxoid 0.5 ml and 
Penicillin G (Benzylpenicillin) 200,000 u. were 
administered to protect against clostridial and 
other infections. A Foley catheter No, 8 was 
inserted. A CSC, electrolytes, urinalysis and 
crossmatch for 3 units of blood were done. 
Theresa's vital signs remained stable. She 
was given nothing by mouth and was on hourly 
output. 
Q.R. Preparations 
The two nurses on call for the Operating 
Room (O.R.) had only 45 minutes to prepare 
the theater and select and sterilize the 
instruments for the procedure. An R.N. who 
had previous experience in microsurgery in 
Australia selected the instruments, 



20 


The Canadian Nurse April 1976 


. 
t-..
Å..

I?';:'.. 
",I?
. 
",
'c..,'?
J''::7-;;:'" L? 
..ø
.c; .. 

,i 
 
.

..


..

-:;;.. 


many of which were normally used in 
orthopedic and eye surgery. A separate table 
was set for the debridement of the detached 
arm. The surgeons also requested an electric 
saw and a microscope. The microscope was to 
be used in the initial debridement and 
identification of the nerves and muscles. as 
well as in the actual replantation procedure. 
Several containers of normal saline were 
available for the debridement. 
Since this was to be the first time this 
particular surgery was performed at Charles 
Camsell Hospital, the order of the procedure 
was not clearly defined. The two teams 
planned to work simultaneously on 
the debridement of the stump and the 
debridement of the detached arm. Following 
debridement and the pinning of the humerus, a 
separate table was to be set for use in repairing 
the laceration on the left leg. 
Theresa was to be placed on the cardiac 
monitor and the anesthetist planned to make 
frequent checks of her temperature, pulse and 
respirations. While the O.A. was being 
prepared, the anesthetist talked to Theresa in 
simple terms about the anesthetic. 


Surgical Procedure 
The surgeons began with initial 
debridement of the proximal stump of the left 
arm. This included complete and careful 
removal of all foreign material (mostly hay from 
the mower), and irrigation with large amounts 
of saline. The patient was then prepped and 
draped, and further debridement of foreign 
material, necrotic muscle and bone fragments 
was done. The biceps and triceps tendons and 
the median. ulnar and radial nerves were 
identified and tagged for further repair. The 
brachial artery and its two veins were also 
identified. 
Debridement of the distal stump was 
carried out in a similar manner on a separate 
table. The orthopedic surgeon then removed 
one inch of the distal end of the humerus so 
that the blood vessels could be repaired 
without tension; this would also ensure that an 
adequate length of peripheral nerve beyond 
the area of trauma would be available for 
suturing. 3 


: I 


. 


Following the debridement, the patient 
was re-prepped and draped for the first.step in 
the actual replantation procedure. The stumps 
were first matched as closely as possible; then 
the humerus was united by placing two K-wires 
0.062 across the fracture site. 
The plastic surgeons then proceeded with 
neurovascular repair, utilizing a recently 
developed neurovascular suturing technique. 
This method requires a skilled surgeon and, 
although slow, is the most reliable. The 
technique utilized 10-0 nylon suture, a special 
microvascular needle and microvascular 
clamps. The veins (brachial and cephalic) 
were repaired first to prevent blood loss from 
an unchanneled venous return. 4 
Microvascular clamps were used so that the 
veins could be repaired without tension. 
The brachial artery was anastomosed 
utilizing the same technique and circulation in 
the extremity was reinstated 9 hours and 15 
minutes after the accident. 
The next step was to suture the previously 
identified nerves. In this type of operation 
nerve repair can either be done during the first 
operation or left for a second operation. The 
advantages of primary nerve repair include 
simpler identification, no possibility of scar 
fixation, and prompt commencement of 
regeneration. 5 Particularly in a small child, the 
nerves are so tiny they are not readily 
identified, and may become locked in scar 
tissue if left for a second operation, 
To prevent infection the devitalized soft 
tissue was debrided, ensuring that the 
vascular anastomoses were covered with only 
healthy, viable tissue. 6 The muscles were then 
approximated and the skin loosely closed. As 
there appeared to be a tightness in the 
forearm, an anterior compartment 


decompression was done through an 
S-shaped incision. The dressing on the am 
was completed using Sofra-tulle* and a plastl 
slab. The elbow was maintained at 
approximately 90 0 flexion. 
While the plastic surgeons were repalrir 
the arm, the orthopedic surgeon repaired th 
laceration on the left leg. The leg was also 
debrided and irrigated, and the torn tendor 
were sutured. A short leg cast was applied 
Theresa's condition remained stable 
throughout the procedure. One hundred ar 
sixty ml of whole blood, plus 480 ml of LV. 
solution were infused through the cutdown si 
in the right ankle. Other medications 
administered during surgery included; 
. Decadron (Dexamethasone) 4 mg, LV 
. Aspirin (Acetylsalicylic Acid) supp. 10 
rectally for anticoagulation 
. Sodium Bicarbonate 25 mg, upon 
opening of artery 
. lasix (Turosemide) 10 mg, LV. 
Total time in the operating theater was 7 houl 
and 5 minutes. 


Recovery Room 
Theresa's condition was satisfactory 0 
admission to the Recovery Room. Her vita 
signs were checked every 10 minutes and 
remained stable. Her catheter was draininç 
amber urine. 
Fifteen minutes after admission There 
was conscious and responding. Frequent 
ci rculatory checks were carried out on both tt 
left arm and leg; circulatory return was evide 
in the fingers of her left hand. The dressing w 
dry and intact. The toes of her left leg were pé 
but warm to touch. 


Immediate Care on the Nursing Uni 
Theresa arrived on the pediatric unit é 
0350 hours. She was awake and responsiv 
Circulation to her left hand and foot was goo 
Her blood pressure was 96/64; respiration 
28; apex beat 102; and temperature 37" . St- 
was placed in a single room on separate 
technique. 
During the next 12 hours Theresa wa! 
carefully observed for any change in her 
condition. Hourly checks included vital sigr 


\ 


. 


.-,-- 
"'- 


'Solra-Iulle IS a registered Irademark ", Roussel (Canada) LId 



The Canadian Nurse April 1976 


21 


... /'. . h
 ' 
.
 .-/1.. . 
"'
''''7
 
 
'/J ....
4... 
. 
(/
 
.. ,=,,
. 


.... 
" 
- 


---- 


. i:
å. 

-> 7 


 
.V . 


l ake and output and circulatory return. No 
dation was necessary until nine hours 
)stop when she received Codeine 
lethylmorphine) 30 mg for discomfort in her 
1 arm and fingers. A small amount of fresh 
mguineous oozing was apparent on the 
lessing on her left arm. The dressing was 
linforced. Theresa slept following the 
lalgesic until her parents came to visit at 
>00 hours. 


Postoperative Nursing Care 
A nursing history was obtained from her 
uents during this first visit. Theresa was the 
Jungest sibling, with three brothers aged 11, 
and 5 years. She ate well: fed herself table 
'ods and particularly liked cereal. milk, juice 
ld tea. She occasionally had an afternoon 
3-p and went to bed at 1900 - 2000 hours. 
Illowing a bath. She was toilet trained. 
Herimmunization was up-to-date and she 
3-d already had both measles and chicken 
JX . She had no known allergies to food or 
ledications. At present she had a "ringworm" 
Inga l infection on her face. 
When the nursing history and other 
lailable information had been gathered, 
Jrsing staff met for a conference to decide on 


... 


......." 


" " 
"" 


a nursing care plan. Theresa's postoperative 
care was designed to meet the following 
nursing objectives: 
. To prevent shock (a frequent complication 
following such a major injury) by checking her 
vital signs hourly during the first postop day, 
then once each shift 
. To maintain fluid and electrolyte balance 
by accurate hourly measurement of her intake 
and output. by maintenance of I.V. sites. and 
by offering frequent sips of juice, milk or tea to 
encourage oral intake 
. To prevent postoperative wound infection 
by checking and reinforcing the dressing, by 
administering LV. antibiotics as ordered, and 
by placing Theresa on separate technique to 
reduce the risk of cross-Infection 
. To maintain adequate circulation in limbs 
by hourly circulatory checks and by ensuring 
that she received her A. S.A. as ordered (it was 
found that Theresa would take her pills if they 
were dissolved in tea) 
. To prevent the formation of edema in the 
replanted limb by keeping her arm elevated 
dbove the atrial level at all times and by 
ensuring that the dressings were not 
compressing her arm 
. To maintain the function of her left arm by 
positioning the arm with elbow at 90 flexion 
utilizing a plastic slab, and by passive flexion 
and extension of her fingers every hour 
. To assist Theresa in expressing her 
feelings about the accident and to reduce the 
trauma caused by sudden hospitalization by 
providing quiet one-to-one play activities, 
reading stories, and allowing her to watch her 
usual T. V. programs. She spoke openly to the 
nursing staff about the accident and required 
frequent reassurance that the doctor had 
"fixed her arm." 


Progress in Hospital 
Theresa's hemoglobin was 7.7 g two days 
following surgery_ She received 150 ml of 
packed cells and 60 ml of salt-free Albumin 25 
percent. The Albumin was administered to 
maintain adequate circulation, draw fluid from 
the site of the injury, and prevent tissue 
edema.7 
On her fourth postoperative day Theresa 
developed mild phlebitis in her right leg 
proximal to the cutdown site and the 
Intravenous had to be moved to the left leg 
The site of the phlebitis was then dressed. The 
same day she also had a brief cyanotic 
episode, possibly due to a mucous plug in her 
lung. She was placed in a croupette with 
oxygen for 24 hours. 
Aside from these complications, Theresa 
recovered rapidly. On her fifth day she was up 
in a wheelchair and was socializing with the 
other children in the playroom. She celebrated 
her third birthday in hospital with her parents 
ten days following the accident. 
The dressing on her arm was changed 
daily and her arm responded well to splinting 
and passive exercises. She returned to the 
O.A. for a split thickness skin graft to the 
incision on her left arm, and for removal of 
sutures in her left leg and application of a new 
below-knee cast. 
One month after admission to hospital the 
graft dressing and the leg cast were removed. 
She began walking with assistance. but 
experienced difficulty du
 to foot drop. This 
was assisted by a pick-up splint. Most of her 
time was now spent in the Physiotherapy 
Department where she received passive 
movements to all joints In her fingers and 
hands, When she was out of bed, her arm was 


" 


, 




å. 


 



22 


The Canadian Nurse Apnl 1976 


@ 


@ 


kept in a sling except for short play periods to 
encourage active elbow movements. To 
strengthen her left leg she rode a tricycle. 
Theresa"s parents and brothers visited as 
often as possible. Prior to her discharge her 
parents were instructed regarding her care at 
home. They were taught to do daily passive 
movements of all joints in her elbow and hand, 
as well as daily massaging of the scar on her 
forearm. Theresa was to have two hour-long 
play sessions each day without her sling to 
encourage active movements of her elbow and 
fingers. Her parents were warned about the 
lack of sensation in her arm and hand, 
particularly to hot and cold temperatures 
Although there was a public health nurse 
in Rimbey, Theresa's parents were strongly 
motivated to carry out this part of the treatment 
on their own. An appointment was made for 
Theresa and her parents to return to the 
hospital in ten days. 


, 


Follow-Up 
On their first VISit, the physiotherapist and 
the occupational therapist found that 
Theresa's parents seemed to be managing 
well at home. She appeared to have active 
movement of her arm using her biceps and 
triceps. The skin across the front of her elbow 
was tight and she complained of pain In this 
area when her fingers were massaged. She 
could passively extend her fingers, but her 
thumb opposition and index and middle fingers 
were still tight. Her parents were encouraged 
to continue, and one week later they proudly 
reported that Theresa had begun to actively 
move her fingers. 
One month later, Theresa appeared to 
have good wrist extension and she could flex 
and extend her elbow actively. There was still a 


Fig. 1 - Example of venous 
anastomosis with running 
everted mattress stitch. In the 
lower vessel, two small veins 
have been joined to form a 
single large one. 
Reprinted with permission from 
illustration, JAMA, vol. 189, p. 
720. Sep 7, 1964. (91964 
American Medical Association. 


slight tightness in her index and middle fingers. 
Theresa continued to visit the hospital 
monthly. A new splint was made by the 
occupational therapist, and with It her fingers 
became more supple. All her active 
movements increased in range and strength 
She appeared to have sensation in her hand, 
although this was difficult to test. 
Eight months following the accident 
Theresa had active wrist flexion and 
extension. She could pinch using her thumb 
and all her fingers. 
On July 15. 1975, exactly one year after 
the accident, Theresa was using her arm 
functionally. Examination by the 
physiotherapist showed the following: 
. shoulder - full range of motion 
. elbow - extension 15', flexion 115 
. forearm - pronation - full range of 
motion: supernation - 15' 
. wrist - active - extension 50: flexion 45' 
with no active radial or ulnar deviation 
. fingers - flexors tight - difficult to extend 
if wrist in extension 
. space from tip of thumb to tip of Index 
fingers measured 5" in right hand; 41 /2" in left 
hand 











,. 










 


On the occasion of her follow-up visit one yea 
after the accident, I had the opportunity to visl 
with Theresa and her father while they we" 
waiting in the doctor's office. 
Although she is a quiet girl, Theresa 
answered my questions about her arm and 
was happy to show me what she could do. /J 
one point, I offered her a lifesaver: she took il 
and, using both hands, opened the packag, 
and helped herself to one. 
Theresa spoke positively of her 
experience in the hospital. During earlier 
follow-up examinations she had gone back t 
the ward to visit, and this time still asked aboL 
the other children on the ward. 
Theresa now has good function of her leI 
arm. She can lift well, and can dress hersel 
though she still has some problems with 
buttons. She plays actively outdoors except i 
extremely cold weather, but does protect he 
arm when falling or being bumped. Her fathE 
feels she has adjusted well to her replan tel 
arm and is optimistIc about the future. 











,. 

/
1?
1?




 


Barbara Geyer (R. N., University of Alberta 
Hospital School of Nursing: B. Sc., Universil 
of Alberta) was Pediatric /Obstetric 
Supervisor at the Charles Camsell Hospital i, 
Edmonton at the ttme of the replantation. 


The author wishes to thank Dr. Lobay, who 
performed the surgery: Jean Newman, 
Director of Nursing: and the nursing staff in th 
O. R. and on nursing station 32A at the Charle 
Camsell Hospital for the/f suggestions and 
support while writing the article. ... 


References 
1 Eger, Mikalos.Replantation of LIpper 
extremities, by...et aIAm.J. Surg 128:447-50. Sep. 
1974. 
2 Paletta, F.X. Replantallon of an amputated 
extremity. Ann. Surg. 168:720-7, Od. 1968, 
3 Malt, Ronald A Replantation of severed arms, 
by...and Charles F. McKhann.JAMA 189:10:716-22, 
Sep.7, 1964. 
4 Ibid, p. 719. 
5 Ibid., p. 720. 
6 Ibid., p. 721. 
7 Rowe, Marc I. The choice of intravenous fluid 
in shock resuscitation, by...and Abelardo Arango 
Pediatr Clin. N. Am 22:2:269-74, May 1975 


Bibliography 
Balderson, S. In orthopedic surgery children nee 
extensive careAORN J. 19:5:1046-52, May 197. 
Enger, W.O. Replantation of extremities, by ...an 
CA Harden.J. Surg. Gynecol. Obstet. 132:901-11 
May 1971. 
Harvey, J. Paul. Replantallon of an upper limb in 
43-year old woman, by et al. Clin. Orthop. 
102:167:73, Jul.- Aug. 1974 
Malt, Ronald A Long-term utility of replanted a/rr 
by...et al. Ann. Surg. 176:334-42, Sep. 1972. 
Rosenkrantz, Jens G. Replantation of an infanf
 
arm, by... et al. New Eng. J. Med. 276:609-12, Mé! 
16,1967. 



I 


The Cønadiøn Nurse April 1976 


23 


Share your ideas, 
make friends and enjoy yourself 
in the land of seafarers, 
fun and informality. 
Beautiful Nova Scotia 


Annual Meeting and Convention, 
Canadian Nurses' Association 
June 20 - 23 1976, 
Hotel Nova Sc tian, alifax 


Theme: The quality of life 


. 


. 
.. 
\ 
, 
 . 


\. 


. 



The Canødlan Nurse April 1976 


24 



-< President 
Canadian Nurses' Association 

 
, I 
-< 

 
,.... 
Ticket of nominations , 

-< 1976-78 Mandate 

 

-< 

 - 

-< 

 \ 

-< President elect: Alice Baumgart 

 

 (1 to be elected) 

 

-< Joan M. Gilchrist B.N., M.Sc., 
>
 (McGill) 

-< Vice-presidents: Margaret McLean 
(2 to be elected) Sheila O'Neill Present Position: 

-< Shirley Stinson >
 Professor and Director, School of 
Nursing, McGill University, Montreal. 
>
 

-< Member-at-Iarge, Marguerite Bicknell Association Activities: 
nursing administration: Marion Jackson >
 CNA- president-elect (1974-76), 


 (1 to be elected) Brenda Kelleher presently member of special 
committee on nursing research; 
Barbara Racine 
 CAUSN - member of Council of 

-< 
>
 Deans and Directors. chairman of 
Member-at-Iarge, Lisette Arcand committee on structure; discussant, 

 >
 national conference on nursing 


 nursing education: Myrtle Crawford research, Edmonton, Alberta (1975); 
(1 to be elected) Helen Glass tutor, Health Care Evaiuation 


 Seminar at Dalhousie U. (1974): 


 Marilyn Marsh discussant, National Colloquium on 
Margaret Page >
 Nursing Research at McGill U. (1973); 
formerly active in ANPQ: has 

 Joanne Scholdra published numerous articles and 

-< 

 papers and given many addresses. 
Member-at-Iarge, Lorine Besel The role of an organized profession in 


 nursing practice: Elizabeth Greene 

 health care today is multifaceted. It 
(1 to be elected) Judith Hindle makes decisions and takes action 


 >
 relevant to many spheres of 
Dorothy Pringle responsibility. In general, however, its 
Therese Schnurr concern is to provide the framework 


 >
 within which desirable changes are 
Vera Spencer identified, innovative structures for 


 their attainment are evolved, and 
Member-at-Iarge, Margaret Bentley >
 individuals are prepared and 
motivated to carry out responsive and 


 social and economic welfare: Linda Gosselin 

 goal-oriented actions. 
(1 to be elected) Anne Toupin Crucial in shaping this role In nursing 


 

 as a collectivity is the articulation of 
one central principle upon which 
national policies are predicated. This 


 

 principle is simply that nursing is 
accountable to the people of Canada 


 and is, therefore, responsive to the 


 human need of all Canadians for 
health care. 

-< >
 To achieve health services that are 
comprehensive in nature and 
It 
-< 

 universal in reach, and to exploit 
educational structures for the 


 

 preparation of new members, an 
ability and a willingness are needed or 
the part of nursing leaders to acquire 
rt
 

 vision and accept risk. 
During the past biennium, your 
Association has embarked upon a 
broad program incorporating a 



Jmber of activities and prOjects of 
>ntral concern to Canadian nurses 
ld nursing. These comprise, for 
<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 


.. 



 


}. 
J
 


t 



 


i 


., 
-1 
_:! 


r 


Marion RuthJackson, B.Sc.N. (U. of 
Saskatchewan), M.S,N. (U. of 
British Columbia) 


Present Position: 
Assistant Executive Director, 
Saskatoon City Hospital, Saskatoon, 
Sask. 


Association Activites: 
SRNA - Presently member of 
standing committee for registration 
and admission to membership and 
chairman of committee for approval of 
nursing education programs in 
Saskatchewan, past member of board 
of examiners (1968-71), chairman of 
subcommittee on publicity and 
information for the 1968 biennium in 
Saskatoon; member of Saskatchewan 
Association of Hospital Administrators 
(1975); affiliate member of Canadian 
College of Health Services Executives 
(1975); field representative for the 
CCHA (1974); author of many articles 
published in The Canadian Nurse. 


The approach to Nursing 
Administration must follow from one's 
basic philosophy of nursing. Furtherto 
this, the successful nurse 
administrator must depend on 
continual feedback from the general 
duty staff nurses, head nurses and 
nursing supervisors. These are the 
nurses who determine the standard of 
care given to the pallent. I believe the 
nurse administrator assists and 
coordinates the setting of standards of 
care, and should provide the optimum 
environment and leadership to attain 
high standards, but will achieve this 
only through free dialogue with all 
members of the nursing staff. 


In accepting this nomination, I would 
work diligently to encourage health 
care agencies to press provincial and 
federal governments for increased 
funding for nursing personnel which 
would provide for improved orientation 
and continuing education programs 
for the practicing nurse. It is my belief 
that many of our beginning nurse 
practitioners are placed in impossible 
work situations. This has been 
explained by some nurses as 
"impoverished work situation, heavy 
patient work load, unable to give 


Tne C;ana(lIan Nurse April l!l/b 


optimal care, frustration because they 
cannot give the kind of care they were 
taught to give." There is a gap 
between the beginning practitioner 
and the practicing nurse who is able to 
take the knowledge she has learned 
and combine it with the psycho-motor 
skills she has gained in order to make 
sound nursing judgments. I would also 
encourage health care agencies to 
recognize the nurse administrator as a 
vital member of the administrative 
team, equally as important as the 
Medical Director, Finance Director 
and such other administrative 
positions that may exist. 


- 


... 


..'"t 

? i..,' 


.. ... .. ,\.1M. - "It .. 
.. .. ,..,.." 
 
... Ii'........ . 
" t . "'. .
'4t-1 
';,. ."..._, . t" 


Brenda Kelleher,.B.Sc.N. (U. of 
Windsor), M.Ed. (Adm.), (Memorial 
U. of Newfoundland) 


Present Position: 
Systems Analyst, Watertord Hospital, 
St. John's, Nfld. 


Association Activities: 
ARNN - chapter president for the 
past two years, 


I believe that the ultimate goals of 
nursing service include the prevention 
of disease where possible and/or care 
of the patient from the moment of 
sickness until cure and/or optimal 
rehabilitation. In order to achieve 
these goals,the role of nursing service 
administration is to ensure the 
provision of continlJous individualized 
service to the patient, both physically 
and psychologically. The absence of a 
knowledge of administration results in 
confusion of responsibilities, and the 
dispersion of authority. This leads to 
the wasting of resources, low morale 
and the defeat of expected levels of 
patient care. 


.' 
" }:- 7" 
" . "' 
.... .,.. 


Barbara Ann Racine, BoSco, 
M.S,H.A. (U.of Alberta) 


Present Position: 
Assistant Executive Director, Nursing 
Practice, Royal Columbian Hospital, 
New Westminster, B.C. 


Association Activities: 
CNA - member of special committee 
on nursing education (1973); CNF- 
member of selection committee 
(1972 - 74); Victorian Order of Nurses, 
member of board of directors (1973- 
74); AARN - member of ad hoc 
committee on long range planning 
(1972 - 74), provincial council 
(1972 - 73); Chairman of north central 
district executive (1972 - 73); CAUSN 
- member of executive for Edmontor 
chapter of Western Region 
(1972 - 73); associate member of 
Canadian College of Health ServicE* 
Executives (1975); has given 
numerous addresses to health 
workers. 


I believe that nursing has a unique role 
in providing and promoting efficient 
and effective health care services. 
The challenge of nursing 
administration is to provide an 
environment in which nurses may 
function and to assess, plan, 
implement and evaluate the 
processes or ways in which health 
care could, should, and will be 
delivered, all the time working with thE 
individual nurses in developing 
attitudes that are conducive to high 
quality care. 



;andidates: 

ember-at-Iarge, 
Jursing Education 


"'. 


t '.... {!', 
1--- 
- , 

 

....
 
.. 
";;:',
 


.isette Arcand, M,N. 
U, of Montreal) 


;)resent position: 
)irector of continuing education 
)rograms for nurses at the Extension 
)ivision and Assistant Professor at the 
School of Nursing Sciences, Laval 
Jnivers,ty, Quebec City. 


A.ssociation Activities: 
'ONQ dunng the past five years, 
member of the following committees: 
Icommittee on research and 
Idevelopment on nursing, committee 
Ion nursing care and subcommittee of 
public health and home care nurses, 
committee on schools of nursing. 
I committee on continuing education 
I (president 1975-76), numerous ad hoc 
committees concerning a plan for 
nursing education in Quebec, reports 
such as Operation SCiences de Ja 
Santé. Le College and others; Laval 
University - committee on contmumg 
education, committee on family 
medicine, president of the committee 
responsible for admission to the 
Certificate in nursing (extension), 
president of committee on nursing 
program, president of multidisciplinary 
steering committee for the Certificate 
In nursing (extension), president of 
evaluation committee for 
demonstration projects in health 
education to the population, member 
of board of directors of the school of 
nursing sciences; federal government 
- member of national committee on 
health manpower: has published 
many documents and given numerous 
conferences. 


- 


....... 


c. 


, 


Myrtle Evangeline Crawford, BoS,N. 
(U. of Saskatchewan), M,A. 
(Columbia U.) 


Present Position: 
Professor of NurSing and Assistant 
Dean, College of Nursing, U. of 
Saskatchewan, Saskatoon. 


Association Activities: 
Member - Board of Nursing 
Education - Saskatchewan (1973 
- ): CNA - member of board of 
directors (1963 - 65), formerly a 
member of committees on nursing 
education. school improvement 
program, nursing affairs and 
committee to study the task force 
report on health services: SRNA- 
past-president (1965 - 67). president 
CNA (1963 - 65), 1st vice-presIdent 
(1962 - 65). 


I have accepted this nomination 
because I believe that I have a good 
background of experience to bnng to 
discussions that deal with current 
nursing issues. The Canadian Nurses 
Association as the vOIce of the largest 
body of nurses in Canada should be 
speaking out on some of these issues. 


My major experience and knowledge 
is in the field of nursing education but it 
is not my only concern. I am aware the 
education of practitioners is only 
relevant if it is in close touch with the 
realities of the service situations in 
which the practitioners will be working 


I would look forward to participating in 
the discussion of nursing issues at a 
nationalle'/el. 


... 


\ 


Helen Preston Glass, R.N" (Royal 
Victoria Hospital. Montreal, 
Que.) B.S, M.A.. M.Ed., Ed.D. 
(Columbia U.) 


Present Position: 
Director, School of Nursing, U. of 
Manitoba, Winnipeg, Man. 


Association Activities: 
MARN - chairman of committee to 
prepare a position paper on nursing 
education (1974), chairman of ad hoc 
commIttee on nursing research, 
(1971). president. member of board of 
directors (1966 - 68), chairman of ad 
hoc committee on the development of 
nursing education in Manitoba 
(1963-68), formerly chairman of 
committee on accreditation, 
education. careers; CNA - member 
of ad hoc steering committee for the 
development of a definition of nursing 
practice and development of 
standards for nursing practice 
(1975 - ), member of special 
committee on nursing research 
(1970), member of board of directors 
(1966 - 68), member of subcommittee 
on nursing education (1964 - 66!. 
It IS my belief that nursing stands on 
the threshold of its greatest 
contribution to society, provided we 
recognize the necessity of a sound 
educational base for nursing. In 
keeping with the movement from 
illness and cure orientation to illness 
prevention and the promotion of health 
for all Canadians, nursing education at 
all levels must prepare practitioners 
capable of assisting Individuals and 
families to attain health and to prevent 
the depletion of a healthy state in aU 
circumstances. Nursing education 
must concern itself with setting new 
goals, and the means of achieving 
these in society. This includes 
enabling practitioners to develop 
social and political skills that will be 
effective in bringing about change and 
credibility with the public through 
superior service. The foundation for 
this IS educational strategies 
developed in conjunction with nursing 
service, and with other health and 
service professions. 


As member-at-Iarge for nursing 
education, I would work toward a 
reduction of ad hoc programs 
preparing a vanety of types of 
practitioners; concentration on the 
development of diploma and 
baccalaureate nurses: the 
development of graduate education; 
and continumg education at all levels. I 
would encourage the development of 
improved programs for teachers of 
nursing, giving equal attention to 
adequate funding for their preparation. 
I would strive toward process-onented 
curncula based upon health-nursing 
models, with emphasis on the process 
of nursing based on a solid research 
foundation. I would also encourage 
the development of educallonal 
standards which would ensure our 
accountability to the public and to the 
student through responsive 
evaluation, so that we may know how 
well we are serving bolh of these 
groups. 
I believe that with my background of 
preparation, my involvement with 
many committees of the Canadian 
Nurses Association, the Canadian 
Assoclallon of University Schools of 
Nursing. the Manitoba Association of 
Registered Nurses and other 
associations concerned with 
education and health care, I will be 
able to serve effectively, the nurses of 
Canada 


__ ?-oo. 


... 



- 


- 


Marilyn Marsh, B.N, (Memoriat U, of 
Newfoundland), currently studying 
towards master's degree in 
education. 


Present Position: 
Lecturer School of Nursing, Memonal 
U. of Newfoundland, St. John's. 


Association Activities: 
ARNN -formerly 1st vice-president, 
2nd vice-president treasurer. served 
on many ad hoc committees; worked 
on committees to prepare briefs. I.e. 
Miller Report, Hall Report: Memorial 
U. representative to ICN in Mexico. 
I have accepted nomination for the 
position of member-at-Iarge 
representing nursing education 



211 


because I feel that nursing, along with 
other professions is moving into a new 
era of rapidly expanding knowledge 
that places new demands on its 
practitioners. Consequently, 
professional groups are requiring their 
practitioners to keep their knowledge 
and skills up-to-date. 


In addition to this, nurses must be 
better prepared to research their field 
so that a data base can be secured for 
nursing practice. Nurses must be able 
to give quality nursing care in 
collaboration with others in the health 
field. 


Indeed, a commitment to lifelong 
learning is the mark of the truly 
professional person. Therefore, I 
would like to be involved in nursing 
education for the future. 


- 


- 


-- 


j 


Margaret Ruth Page, B.Sc.N., 
(Lakehead U.), M.P.H. (U, of North 
Carolina) 


Present Position: Associate 
Professor, Lakehead University, 
School of Nursing, Thunder Bay, Ont. 


Association Activities: 
RNAO - member of advisory 
committee to the president (1975), 
member of planning committee for 
conference entitled Collaboration for 
Change (1975), past president 
(1964-65); CAUSN - member of 
committee on constitution and bylaws 
(1973 - ); Ontario Council of Health- 
member of subcommittee on nursing 
education (1967 -70); College of 
Nurses of Ontario - member of 
educational advisory committee 
(1965 - 68); CNA - member of 
socio-economic committee 
(1965 - 66), member of board of 
directors (1964 - 65)_ 


I 


Nursing education is responsible for 
preparing practitioners who can 
function in a health care system 
buffeted by social change. Hence the 
Canadian Nurses Association must 
be attuned to the political climate, to 
the demands of society for well 


prepared nurses in a variety of nursing 
programs: this includes nurses with 
technical expertise, generalist 
preparation and clinical specialization. 


Incorporated into all the programs 
must be the incentive for the 
development of characteristics such 
as creative thinking, flexibility and 
inventiveness. To ensure the 
practitioner the competencies to 
practice and function in a collegial 
fashion with the other members of the 
health team a sound base of scientific 
knowledge and skills is a prerequisite. 


The current changes also demand that 
efforts be directed in intensified 
programs for continuing education for 
professional nurses, interdisciplinary 
learning opportunities and greater 
involvement with service personnel in 
the educational process. 


We must constantly be aware of the 
cost of education and health care and 
tailor our nursing program 
accordingly. in order not to sacrifice 
excellence and quality forthe learners. 


It is my belief that the Canadian 
Nurses' Association has a 
responsibility for stimulating new 
concepts and supporting research in 
nursing education; improving working 
relationships within the nursing 
community, externally with public and 
private organizations, of citizens, and 
of other professional practitioners who 
are concerned about the quality of 
health care for the people of Canada 


-T 


'V' 


'- 


.. 


,t''{) ,
 


" 
'\
 


Joanne Dolores Scholdra, B.S.N, 
(U, of SaskatcheV{an), MoN., Ph.D. 
(U. of Washington). 


Present Position: 
Chairman, School of Health Services, 
Lethbridge Community College, 
Lethbridge, Alta. 


Association Activities: 
AARN - member of nursing 
education/ nursing practice 
committee (1975 - 76), member of 
nursing research committee (1976), 
chairman of provincial nursing 
education committee (1967 - 68); 


The Canadian Nurse Apnl 1976 


member of Alberta task force on 
nursing education (1975 - ); 
University of Alberta - member of 
advisory committee. department of 
continuing education (nursing 
division); (1974); University of Alberta 
Co-ordinating Council - member of 
nursing education committee (1974); 
member of the Alberta task force on 
nursing education (1975). 


The planning, implementation and 
evaluation of nursing and health care 
is a process which can be learned 
during the basic nursing program and 
subsequently deepened and enriched 
as the nursing practitioner takes part In 
orientation, in-service, continuing 
education, and graduate programs. 
This growth and enrichment 
presupposes motivation and the 
availability of formal and informal 
programs to Increase the level of 
competency of nurses throughout 
their working lives. 


In view of the explosion of knowledge, 
the complexity of man s health 
problems, the increased expectations 
of the consumer of health services, 
and the development of various 
health-care delivery systems. it 
becomes apparent that the future 
health care professional requires a 
broad educationarbase and an 
armament of fairly sophisticated skills. 
Recognizing the need for depth and 
breadth of knowledge and expertise it 
is my belief that baccalaureate 
preparation for all professional nursing 
practitioners must become the base 
and the goal to assure continued 
professional growth and improved 
nursing practice 


To this end the Canadian Nurses' 
Association and provincial nursing 
associations will be required to 
provide increasing leadership to 
government departments and 
associations responsible for 
post-secondary education and the 
setting and monitoring of educational 
standards in nursing_ Through the 
development of nursing practice and 
nursing education standards and the 
ultimate development of a national 
accreditation system. the CNA would 
promote a gradual adjustment of the 
system to the increased educational 
requirements 


The nursing practitioners of the future 
must take their place amongst health 
care professionals whose minimum 
professional preparation is at least a 
baccalaureate degree. 


Candidates: 
Member-at-Iarge, 
Nursing Practice 


,-- 


.. 


\ 


"'- 


-/
 


Lorine Besel, B.N" (McGill) M,S. 
(U, of Boston) 


Present Position: 
Director of Nursing, Royal Victoria 
Hospital. Montreal, and Assistant 
Professor, McGill University, School 01 
Nursing, Montreal. 


Association Activities: 
CNA member-at-Iarge for nursing 
practice, member of ad hoc steering 
committee on development of a 
definition of nursing practice and 
development of standards of nursing 
practice, member of ad hoc committee 
on standards for nursing care (1970 
- 72) represented CNA on national 
committee of mental health 
professions (1972), member of ad hoc 
committee on standards for nursing 
service (1966 - 70); ONO member 01 
advisory committee to board of 
management (1971 - ). 


I have agreed to be nominated for the 
position member-at-Iarge - nursing 
praclice - for the CNA Executive 
Committee of the Board. 
Nurses, as individuals and as a 
professional group, appear to be 
facing many contradictory pressures 
and pulls: specialization and narrowec 
expertise versus generalization and 
broad knowledge base, illness versus 
health focus, expanded nursing role 
versus restricted resources. Can we 
be all things to everybody? 



-- 
.... 



 


I:lizabeth E. Greene. R,N, (General 
iospital School of Nursing. St, 
oM's, Nfld.) 

 


'resent Position: 
.C.U. Supervisor. General Hospital. 

t. John s, Nfld 



ssociation Activities: 

RNN - presently member of 
>ducatron committee, restructuring 
'ommittee (1975), nominating 
;ommittee (1975), member of council 
1974 - 76); Newfoundland TB and 
RD Association - presently member 
::Jf board of directors, past-president of 
lurses section (1974 - 76); 
INewfoundland Heart Foundation - 
presently member of board of 
directors; Canadian TB and RD 
Association - advisory committee, 
Ichairman of planning committee to set 
lup a one-week course in RD nursing 
I for Eastern Canada. 


II accept the nomination for 
member-at-Iarge, nursing practice 
I because I am concerned for the total 
care of our patients, thelrfamilies, and 
for the nurses giving that care. 


I believe thaI the nursing profession 
must concentrate, not only on the 
patterns of education, but on the 
changing patterns of nursing practice. 
As research brings about more 
sophisticated medical treatment. so 
must the practicing nurse be prepared 
to adapt in order to help make this 
highly technical type of treatment 
more effective and successful. 


I be:ieve that continued evaluation 01 
ourselves, our nursing procedures 
and our responsibilities are essential 
lor better patient care. That we as 
nurses must work as a member of a 
health care team. not merely to carry 
out doctors orders, but assisting 
doctors in carrying out their own 
orders and treatments. 


-- 



 


...' 



 


Judith Karen Hindle, B.Sc.N., B.A., 
(U. of Toronto) 


Present Position: 
Currently studying towards M.A at U. 
of Toronto. 


Association Activities: RNAO- 
active member, 50th anniversary 
RNAO fellowship for graduate study; 
the Canadian Council of 
Cardiovascular Nurses - Ontario 
provincial res presentative to the public 
education committee. 


Much discussion in recent years has 
centered on the effects of change in 
the nursing profession in this country. 
In many areas of nursing practice 
these changes have unfortunately 
been viewed in largely negative terms. 
Here. deteriorating practice 
conditrons, pessimism about the 
future of both education and practice, 
and expressions of Individual 
powerlessness and loss of control 
punctuate conversations among 
nurses at many levels. The continumg 
attrition from nursing practice of 
productive. talented and once 
enthusiastic colleagues who have 
decided to opt out. rather than 
continue to .. struggle with the system" 
seems to lurther threaten the 
possibility of Improving the quality of 
what we do. 


The Canadian Nurses' Association, 
through its provmcial representatives 
and members-at-Iarge, is an obvious 
and important vehicle for collective 
action. I believe its current projects. 
directed at the study of human 
resources in nursing practice, at 
evaluation of practice, and at research 
in practice. are partlcularfy important 
in planning for changes that will occur 
in nursing practice in the next several 
years. I also believe ItS leadership role 
in predicting, promoting and guiding 
change In nursing. generally, is more 
important now than at any other point 
in our history. " I am elected as 
member-at-Iarge for nursing practice I 
would regard it a privilege, a pleasure 
and a responsibility to participate in 
that process. 


'1'" .....,_,u.... ...__ """,.. '''"V 


-- .... 


...", 'Þo 

- 



 


Dorothy May Pringle. B,Sc.N. 
(McMaster U.), M.S, (U. of Colorado) 


Present Position: 
Director. Laurentian UnIversity School 
of Nursing, Sudbury, Ont. 


Association Activities: 
Active member of RNAO, AARN, and 
Canadian Psychiatrw Association. 


Improving the quality of nursing care to 
patients and the satisfaction 01 clinical 
nursing to nurses should be the 
ultimate and mutual goals of both 
nursing service and nursing 
education. Chronically frustrated 
nurses cannot be expected to provide 
nursing care of which they can be 
proud, nor to act as role models fcr 
students to emulate. Yet clinical 
nursing is where the action is and 
where the satisfaction is for most 
nurses. Unfortunately, the daily 
demands of this action frequently 
preclude clinical nurses from having 
the time and opportunity to develop a 
long-range perspective on their role, 
and from influencing where nursing is 
going. 


Education, on the other hand, lends to 
have the long-term perspective but 
mIsses the day-to
ay clinical 
demands and timing. This can result in 
education being irrelevant and 
unhelpful when it comes to responding 
to the immediate needs of the clinician 
but it does put educators in a position 
to influence trends. 


As the fiscal situation deteriorates, 
both education and service will be 
forced to work more efficiently and to 
separate essentials from luxury. 


Neither the clinician nor the educator 
can afford to operate In Isolation from 
the other, but the mechanism lor 
bringing the immediate and the 
long-range views together for the 
mutual benefIt of both is less than 
satisfactory in most places. Marfene 
Kramer has identified the damaging 
effect this can have on new graduates 
and ultrmately on nurSing as a whole. 


As nurSIng evolved, service and 
education started as one, then 


separated to become two quite distinct 
entities and now the need and the 
opportunity eXist to create a new 
relationship that is based on 
colleagueship. This is essential. if 
nurSing as we believe it should be, is to 
survive. Service and education must 
rely on each other, lend each other 
their partIcular strengths and accept 
each other's judgment in their 
respective areas of expertise. This will 
lead to energy conservation for both 
and can result in both providing 
support to the staff nurse who carnes 
the greatest responsibility for care. 


\< 



 


M. Therese Schnurr, B,Sc.N. (U. of 
Seattle)M.N.(U. of Washington) 


Present Position: 
Director of Nursing Services. 
Registered Nurses' Association of 
British Columbia, Vancouver. 


Association Activities: 
CNA- member of ad hoc steenng 
committee on development of a 
definition of nursing practice and 
development of standards for nursing 
practice (1975): member of 
resolutions committee (1970). 


I accept the nomination as 
member-at-Iarge for nursing practIce. I 
am concerned about nursing practice 
in all areas of the health system and in 
this position it will be possible to work 
together towards the achievement of 
the essential goal, namely, the 
determination of the practice of 
nursing for the provision of quality care 
to Canadians. A concerted effort at the 
national level is essential to meet the 
challenge effectively. 



30 


The Canadian Nurse April 1976 



 


;;:
 


- 
...-::;:""'" 


I 


Vera Louise Spencer, B.N. (McGill), 
M.P,H, (U. of Michigan) 


Present Position: 
Public Health Nursing Consultant, 
Department of Health, Regina, Sask. 


Association Activities: 
SRNA - committee on legislation and 
bylaws (1975-76), president at 
chapter and provincial levels (1965 
- 67); CNA - member of board of 
directors (1965 - 67); CPHA- 
national and provincial executive 
member (1974 - 75); Canadian 
Cancer Society - member of board of 
directors, Saskatchewan division 
(1967 - 69) 


My acceptance of the nomination as a 
member-at-Iarge representing nursing 
services gave me the opportunity to 
re-examine my concerns and beliefs in 
nursing. 


I believe the Canadian Nurses 
Association has provided and should 
continue to provide leadership and to 
be concerned with the maintenance 
and improvement of health care 
services for all Canadians. 


In pursuit of excellence, I believe it is 
the responsibility of each nurse, as a 
professional person, to maintain 
competency in whatever area of 
nursing they practice. I support and 
will encourage, not only the 
development of Canadian standards 
for nursing practice, but also 
accreditation of services in all fields of 
nursing so that efficient, effective, 
quality nursing care will be provided. 


Nurses have a responsibility to 
challenge the present health care 
system and to assume leadership in 
the development of the philosophy of 
health promotion, and to promote and 
practice healthful living. 


I I 


In a world which can be encompassed 
in ninety minutes it is necessary for 
nursing to continue to ensure the 
future advancement of health care 
services in all the communities of the 
world. The involvement of the 
Association in the helping role at the 
international level in my opinion, is 
essential if a successful worldwide 
nursing profession is to become a 
reality. 


When looking to the future, plans must 
be based on the knowledge and 
understanding of both the past and 
present. The leadership role of the 
Association in the past has bee:1 
demonstrated and the Association 
must continue to assume leadership 
and initiate future changes in nursing. 


I would consider it a privilege to 
become involved in the concerns and 
responsibilities of Canadian nurses. 


Candidates: 
Member-at-Iarge, social 
and economic welfare 


"'" 
_.-" 


;;;. 


Elinor Margaret Bentley, RN (Royal 
Victoria Hospital), P.H.N. diploma 
(Dalhousie U,) 


Present Position: 
Consultant, Personnel Services, 
Registered Nurses' Association of 
Nova Scotia, Halifax. 


Association Activities: 
Consultant to and secretary of the 
provincial committee on social and 
economic welfare; secretary of N.S 
Health Services and Insurance 
Commlssion/RNANS liaison 
committee; member ex-officio of 
various RNANS ad hoc committees; 
formerly member of board of directors 
(6 yrs) and past president (1972 - 73) 
of Public Health Association of Nova 
Scotia; member of Halifax Board of 
Trade Industrial Relations Committee; 
member of executive committee of 
Citizens' Advisory Board, 
Unemployment Insurance 
Commission. 


Through education, liaison with 
resource persons and through briefs 
presented on their behalf, nurses have 
made great strides toward becoming a 
unified, decisive, recognized group of 
professional people. There is still a lot 
of work to do. It is my hope that I can 
offer stimulus and leadership to 
nurses to encourage them to become 
more involved in those matters of 
concern to themselves and to 
Canadians in general. 


"'" 

 '4 
'" 
 
"" 


Linda Roberta Gosselin, RN 
(Toronto Western Hospital), 
B.Sc,N. (U, of Toronto). 


Present Position: 
Employment Relations Officer, 
Ontario Nurses' Association, Head 
Office, Toronto. 


Association Activities: 
RNAO - past member and now 
chairman of provincial committee on 
social and economic welfare, member 
of executive committee and board of 
directors (1974-76); formerly 
president, chairman, secretary and 
nurse representative of negotiating 
committee for the N'urses' Association 
of the Lakehead Regional School of 
Nursing. 


I accepted the nomination for 
member-at-Iarge, social and 
economic welfare. on the CNA Board 
of Directors because of my firm belief 
that nurses have the responsibility of 
being involved in the determination of 
their social and economic welfare. 


The area of social and economic 
welfare is much broader than the 
examination of salar\es and fringe 
benefits. It encompasses as well such 
issues as: hazards in the work 
environment, non-monetary working 
condillons which affect the quality and 
quantity of the care we provide for our 
clients and the satisfaction we derive 
from the provision of this care, the 
availability of ongoing educational 
programs to enable the nurse to 
maintain competency, the availability 
of programs to assist the nurse whose 
personal problems threaten the ability 
to practice. 


As a profession, we must monitor and 
mold the Influences on our social and 
economic welfare so that the practice 
of nursing will continue to be an 
attractive area of endeavor, so that the 
practitioners of nursing will enjoy 
security In the employment of their 
skills, and so that those nurses who 
have been engaged in laying the 
foundations for tOday's nurses can 
look forward to retiring in comfort. 


" 



 


c, 


. \ 


.'" 


Marie-Anne Toupin, B.N.(McGill), 
M.S.(U. of Colorado) 


Present Position: 
Administrative Assistant - Director of 
Nursing, Burnaby General Hospital, 
Burnaby, B.C. 


Association Activities: 
AARN - governing board(1974); 
member of ad hoc committee to 
assess genetic counseling needs for 
Alberta (1974); council representative, 
associate members United Nurses of 
Montreal (1967 - 69); ANPQ- 
chairman of public relations 
committee for Chapter XI, English 
chapter (1968 - 69); RNABC- 
member of task committee to review 
position paper on roles and function of 
registered nurses. 


In this time of economic turmoil, 
nursing must maintain the gains it has 
achieved in economic and working 
conditions in the last few years. While 
working toward this, nurses and the 
profession must continue In the task of 
defining their functions as a member of 
the health care team. The community 
can only receive a high level of care if 
the profession continues to 
emphasize the necessity of adequate 
conditions of work and an environment 
conducive to efficiency and individual 
satisfaction. 
I believe that the directions and goals 
for the profession in relation to social 
and economic welfare should be set at 
a national level to enable all nurses 
within the nation to benefit. 


For these reasons, I am pleased to 
accept the nomination for 
member-at-Iarge for social and 
economic welfare. 



horitativ' texts for todaY's stu · 


INTRODUCTORY 


FUNDAMENTALS OF NURSING 
The Humanities and the Sciences in Nursing 
Elinor V. Fuerst, R.N., M,A,; LuVerne Wolff, R.N., 
M,A.; Marlene H. Weitzel, R.N., M.S,N. 
The application of systems the- 
ory to nursing care is a feature 
of this edition, New chapters 
focus on community environ- 
ment and the nurse's role in 
promoting optimum sensory 
stimulation. 
LIPPINCOTT 5th Ed. 450 Pages 
$10.95 Illustrated. 1974 


.., 


!{ri" 

4, 
,...1)"..9 
f'l'...'\.'" " 

. .. 
-....,.. 
.. 


1 


- 


FUNDAMENTAL SKILLS IN PATIENT CARE 


LuVeme Wolff Lewis, R.N., M.A. 
This book contains "care" content that all nurses 
must master. 
_ LIPPINCOTT 

 $9.90 


2 


495 pages 
1976 paper 


SCIENTIFIC FOUNDATIONS OF NURSING 
Madelyn T. Nordmark, R.N, M.S. 
(N.E.) and Anne W. Rohweder, 
R.N" M,N, 



 



oOI'. 
o,""I/"lngI 


-
 
....- 


3 


This book is expressly designed 
to aid the student in developing 
a greater understanding of the 
relevance of science content to 
effective nursing care. 
LIPPINCOTT 480 pages 
$7.50 3rd Ed., 1975 


MASSACHUSETTS GENERAL HOSPITAL: 
Manual of Nursing Procedures 
By Department of Nursing, M.G.H. 
This book makes available to 
all nurses a practical, compre- 
hensive manual from one of the 
leading hospitals in the United 
States. 
LITTLE, BROWN 389 pages 
$8.95 Illustrated, 1975 



 


- 
ë 


4 


- 
! 
t 


s- 

 


Is. 


PERSPECTIVES IN HUMAN DEVELOPMENT 
Nursing Throughout the Life Cycle 
Doris Cook Sutterley, R.N., M.S.N. and 
Gloris Ferraro Donnelly, R.N., M.S.N. 
It is a superb foundation for curricula built around 
the human organism as an open system within an 
ecological and social framework. 
LIPPINCOTT 331 pages 
$8.75 Diagrams and Charts, 1973 


5 


COMMUNICATION IN NURSING PRACTICE 
Eleanor C. Hein, R.N" M.S. 
LITTLE, BROWN 242 pages 
$6.95 1973 


6 


PERSONAL, IMPERSONAL, AND 
INTERPERSONAL RELATIONS - 
A Guide for Nurses 
Genevieve Burton, R.N" Ed. D. 
SPRINGER 
$6.50 


304 pages 
1970 


7 


A GUIDE TO EFFECTIVE STUDY 
By Edwin A. Locke, Ph.D. 
Typical student motivational 
problems are discussed with 
suggested corrective mea- 
sures. 
SPRINGER 
$4.50 


( ."..
'7 ,..ToDDMØIId 

 tW ToDDAIIIIÞCI ::;:: 
...., I'fcM' TID"'" ::.... y_ 
. __..
 tøf':""" ....'0 
, 1JIeIInOI'Y.n...... cJ Sc*'klad'- 
PrøgrØ": Y04l' 
 CoIIfØ1r1SWY 
. =- SOC:
9toðr ttcJIITO""" 
, A Guide 10 ElfectIW SIIJdY 
1-"''- 


200 pages 
1975 


. 


-- 
'R1''''
 gwd9 
.".n--
",rdT"'E-:'
 
, ,.- -""'::.
 

 _- 10"'''- 
HØ6'TOc:...E1IO"I HØI' 
 
øødØto 
'oc:øø-
 

 
--...... 
....... 
 TOO ... 


8 


ASIC SCIENCES 


BASIC PHYSIOLOGY AND ANATOMY 
Ellen E. Chaffee, R.N., MoN., M.Utt.; and 
Esther M. Greisheimer, Ph.D., M.D. 
Redesigned with a handsome 
new format, this major revision 
of a well established text re- 
tains the successful organiza- 
tion of earlier editions. 
LIPPINCOTT 530 pages 
Illustrated, 

 $12.50 3rd Ed., 1974 

- 
....
 


9 



LABORATORY MANUAL IN 
PHYSIOLOGY AND ANATOMY 
Ellen E. Chaffee, R.N. M,N" 
M.Litt.; and Esther M. 
Greisheimer, Ph.D., M.D. 
LIPPINCOTT 


264 pages 
Illustrated, 
3rd Ed, Revised 1974 


$5.75 
BASIC MICROBIOLOGY 
Wesley A. Volk, Ph.D., and Margaret F. Wheeler, 
M.A. 
Extensively revised, reorganized for greater sequen- 
tiallogic, and updated to include recent research 
findings, the Third Edition meets all of the criteria 
for a one-semester course. 
LIPPINCOTT 592 pages 
$14.50 Illustrated, 3rd Ed., 1973 
11 
LABORATORY EXERCISES IN MICROBIOLOGY 
Raymond B. Otero, Ph,D. 
Designed for use with Basic Microbiology, this 
manual is adaptable for use with similar one- 
S2mester textbooks. 
LIPPINCOTT 
$4.95 


10 


165 pages 
1973 


12 


BASIC PHYSIOLOGY FOR THE HEALTH 
SCIENCES 
Ewald E. Selkurt, Ph.D. 
Here is a complete basic textbook covering all phy- 
siology from the standpoint of the allied health pro- 
fessions, 
LITTLE, BROWN 612 pages 
Paper $11.50 
Cloth $16.50 Illustrated, 1975 
13 -- 


14 


PHYSICS FOR THE HEALTH 
PROFESSIONS 
J. Trygve Jensen, Ed. D. 
LIPPINCOTT 249 pages 
$6,95 2nd Ed., 1976 
TEXTBOOK OF MEDICAL-SURGICAL NURSING 
Lillian S. Brunner, R.N., M,S.,; Doris S. Suddarth, 
R.N., B.S.N,E., M.S.N. 
Outstanding in its depth of scientific content and in 
the practicality of its applications, this leading text 
has been heavily revised and updated, with much 
new material. 
LIPPINCOTT 
$19.75 Illustrated, 3rd Ed., 197
 


s 


15 


16 


CARE OF THE ADULT PATIENT 
Medical-Surgical Nursing 
Dorothy W. Smith, R,N., Ed.D.; 
Carol P. Hanley Germain, R.N.. M,S. 
A superbly useful tool for nursing education and 
practice, this well established text has been mas- 
sively revised, updated and expanded, and provides 
an authoritative basis for understanding the patient's 
therapeutic regimen. 
LIPPINCOTT 
Paper $15.50 
Cloth $19.75 Illustrated, 4th Ed., 1975 


j uthoritati 


Ie 


A GUIDE TO PHYSICAL EXAMINATION 
By Barbara Bates, M.D. 
An expertly-illustrated. "how-to" text that bridges 
the gap between anatomy and physiology and their 
application to the physical examination, 
LIPPINCOTT 375 pages 
$18.75 Illustrated, 1974 


17 


Also available. . . 
PHYSICAL EXAMINATION FILMS 
A series of twelve sound motion pictures, correlat3d 
with the content of A Guide To Physical Examina- 
tion. 
(Write to the Marketing Coordinator, A/V Media for 
information.) 


18 


PHYSICAL AND APPRAISAL METHODS IN 
NURSING PRACTICE 
Josephine M. Sana, R.N., and Richard D. Judge, 
M.D. 
Eighteen contributing authors, all experts in their 
fields, have written a comprehensive survey on all 
aspects of physical examination and appraisal. 
LITTLE, BROWN 402 pages 
Paper $9.50 
Cloth $14.50 Illustrated, 1975 


19 


NURSES' HANDBOOK OF FLUID BALANCE 
Norma M. Metheny, R.N., M,S.: and 
William D. Snively, Jr., M.D., FAC.P. 
The nurse's expanded role in diagnosis, treatment 
and evaluation of lab findings is reflected in this 
edition. 
LIPPINCOTT 325 pages 
$8.75 lIustrated, 2nd Ed., 1974 


20 


ADV ANCED NURSING 


AMBULATORY CARE MANUAL FOR NURSE 
CLINICIANS 
Peter T. Capell, M,D" and David B. Case, MoD, 
This is the first book of its kind 
S written specifically for nurse prac- 
, tioners. The student is taught to 
interpret signs and symptoms on 
the bases of history, physical ex- 
amination and laboratory findings, 
and formulate a diagnosis. 
LIPPINCOTT about 400 pages 
about $15.00 June 1976 


21 


CLINICAL PROTOCOLS: A GUIDE FOR NURSE 
PRACTITIONERS 
Carolyn M. Hudak, R,N., M.S., et al 
S Designed for portability and quick 
reference in the field, this manual 
of clinical guidelines will fit con- 
veniently in the pocket. 
LIPPINCOTT about 300 pages 
about $9.00 May 1976 


22 



. 


tomorro 


's nurses. 


CRITICAL CARE NURSING 
Carolyn M. Hudak, R.N., M.S.: Barbara M. Gallo, 
R.N., M.S.; and Thelma Lohr, R.N" M.S. 
With 21 Contributors. 
Unexcelled in scope and content, and holistic in ap- 
proach, this text deals with the physiological/emo- 
tional problems of the ICU patient. 
LIPPINCOTT 351 pages/drawings, charts, tables 
.
 1
 
:
 
Also available. . . 
WORK MANUAL FOR CRITICAL CARE NURSING 
LIPPINCOTT 99 pages/perforated and punched 
$3.95 1973 
., --- 
CARDIOSURGICAL NURSING CARE 
Understanding, Concepts, and 
Principles for Practice 
Rita K. Chow, R.N" Ed.D. 
SPRINGER 386 pages 
$12.50 lIustrated,1976 
THE PATIENT IN THE CORONARY CARE UNIT 
Hannelore Sweetwood, R.N. 
SPRINGER 465 pages 
$13.95 IIlustrated,1976 
6 ----- 
THE PRACTICE OF EMERGENCY NURSING 
J. H. Cosgriff, M.D. and D. M. Anderson, R.N. 
LIPPINCOTT 507 pages 
$15.75 Illustrated. 1975 
7 
INTERPRETING CARDIAC ARRHYTHMIAS - 
A BASIC GUIDE 
Mary Brambilla McFarland, B.S.N., M.S,N, 
SPRINGER 119 pages 
8 $5.25 Illustrated. 1975 
DIAGNOSTIC PROCEDURES - A REFERENCE 
FOR HEALTH PRACTITIONERS AND A GUIDE 
FOR PATIENT COUNSELING 
Barbara Skydell, R.N.. M,S., and Anne S. Crowder, 
R.N.. M.A. 
LITTLE, BROWN 
$6.95 
!9 - 
PROBLEM ORIENTED NURSING 
F. Ross Woolley, Ph.D.. et al 
SPRINGER 
Paper $5.25 
Cloth $8.50 

O 


s 


5 


248 pages 
Illustrated, 1975 


1 ì6 pages 


1974 


A TERNAL CHILD HEALTH 


EMOTIONAL CARE OF HOSPITALIZED CHILDREN 
An Environmental Approach 
Madeline Petrillo, R.N., M,Ed" 
and Sirgay Sanger, M.D. 
Techniques of communicating 
with children and their parents 
are presented in realistic and 
practical terms. 
LIPPINCOTT 
Paper $6.25 
Cloth $8.50 


1JI!I#iI'!J.liI' 
? 
--- 


259 pages 



 


Illustrated. 1972 



1 



þ 


NURSING CARE OF THE GROWING FAMILY: 
A MATERNAL NEWBORN TEXT 
S . Adele Pillitteri, B.S.N.. M,S., P.N.A. 
A basic comprehensive textbook 
of maternal and neonatal nursing 
designed for the student. 
LITTLE. BROWN about 700 pages 
about $16.00 May, 1976 


NURSING CARE OF CHILDREN - 9th Edition 
Eugenia H. Waechter, R.N., Ph.D, 
S and F. Howell Wright, M.D. 
A new edition of the text that is 
without peer as a comprehensive, 
in depth study of pediatric nurs- 
ing. 


LIPPINCOTT 
about $16.75 


about 700 pages 
May, 1976 


MATERNITY NURSING - 13th Edition 
Sharon R. Reeder, R.N.. Ph.D., Luigi Mastroianni, 
M.D.: Leonide L. Martin, R.N.. M.S.. and EHse 
Fitzpatrick, R.N., M.S. 
Recent changes in the field of 
S maternity nursing have been start- 
. ling, The new edition reflects both 
these advances in knowledge and 
changes in family life styles, re- 
sulting in a truly family-centered 
te xt. 
LIPPINCOTT about 650 pages 
about $16.00 April. 1976 
34 
MATERNAL CHILD NURSING 
Violet Broadribb. R.N., M.S.; and Charlotte Corliss, 
R.N., M.Ed. 
A family-centered text, designed for combined 
maternal-child nursing courses. covering the entire 
maternity experience, and the child from birth to 
adolescence. 
LIPPINCOTT 702 pages 
$12.50 1973 


FOUNDATIONS OF PEDIATRIC NURSING 
Violet Broadribb, R.N.. M.S, 
The text has been broadened and enriched to reflect 
nursing concepts stemming from recent findings in 
child psychology. and advances in pediatric medi- 
cine and surgery. 
LIPPINCOTT 500 pages 
Paper $8.95 
Cloth $9.95 Illustrated 2nd Ed.. 1973 


MENTAL HEAL T" 


BASIC PSYCHIATRIC CONCEPTS IN NURSING 
Joan J. Kyes, R.N.. M.S,N.; and Charles K. Holling, 
M.D. 
This revised edition focuses on the dynamics of the 
nurse's role and function, and facilitates student pro- 
gress from the theoretical to the operational level. 
LIPPINCOTT 600 pages 
$9.75 3rd Ed., 1974 


32 


33 


35 


36 


37 



Instructors are invited to write to our educational consultant 
NANCY C. CASHIN, R.N., M.Sc., concerning their requirements. 


38 


THE PRACTICE OF MENTAL HEALTH NURSING 
A Community Approach 
Arthur James Morgan, M,D. 
LIPPINCOTT 211 pages 
Pap er $5.95 1973 
- 
NURSING OF FAMILIES IN CRISIS 
Joanne E. Hall, R.N., M.S., and Barbara R, Weaver, 
R.N., M.S. 
LIPPINCOTT 250 pages 
$6.95 197 4 
THE NURSE AND HER PROBLEM PATIENTS 
Gertrud Bertrand Ujhely, R.N., Ph.D. 
SPRINGER 192 pages 
$5.50 Sixt h Printing, 1972 
MENTAL HEALTH AND MENTAL ILLNESS- 
2nd Ed. 
Mabyl K. Johnstone, R.N., B.S., M.S.Ed.. and 
Arthur James Morgan, M.D. 
S Emphasis throughout is on the 
kind of supportive nursing care 
required by patients suffering 
from mental and emotional dis- 
orders. 


39 


40 


LIPPINCOTT about 350 pages 
41 about $8.00 May. 1976 
HUMAN DEVELOPMENT AND BEHAVIOR 
Psychology in Nursing 
Bernard D. Starr, Ph.D. and Harris S. Goldstein, 
Md., D.Med.Sc. 
This book delineates the major 
psychological concepts as they 
relate to the life cycle of indivi- 
duals in periods of health as well 
as illness. 436 pages 
1975 


S 


SPRINGER 
42 $10.50 


PHARMACOLOGY 


CLINICAL PHARMACOLOGY IN NURSING 
Morton J. Rodman, B.S., Ph.D. and 
Dorothy W. Smith, R.N., M.A" Ed.D. 
This entirely new text by the authors of Pharma- 
cology and Drug Therapy in Nursing offers quick, 
easy access to information needed for expert patient 
care. Essential scientific material is clearly, con- 
cisely presented. 
LIPPINCOTT 701 pages 
43 $11.75 1974 
included: NURSES' GUIDE TO CANADIAN DRUG 
LEGISLATION David R. Kennedy, Ph. D. 
This pamphlet outlines the history and application of the 
Food and Drugs Act and Regulations of Canada and the 
Narcotic Control Act and Regulations of Canada. 
LIPPINCOTT 
 
PHARMACOLOGY AND DRUG THERAPY IN 
NURSING Morton J. Rodman, B.S., Ph.D. and 
Dorothy W. Smith, R.N., M,A" Ed.D. 
LIPPINCOTT 738 pages 
$11.50 IIIustrate d,1968 
- 
INTRODUCTORY CLINICAL PHARMACOLOGY 
Jeanne C. Scherer, R.N., M.S. 
LIPPINCOTT 367 pages 
$8.75 1975 


44 


45 


PROGRAMMED MATHEMATICS OF DRUGS AND 
SOLUTIONS 
Mabel E. Weaver, R.N., M.S. 


109 pages 
LIPPINCOTT Paperbound, 
$2.75 1966 Printing with Revisions 
4E 
ARITHMETIC FOR NURSES 
Marilyn Ferster (Gilbert), M.A. 
SPRINGER 
$5.50 


128 pages 
2nd Ed., 1973 47 


DIET THERAPY 


NUTRITION IN HEALTH AND 
DISEASE - 16th Edition 
Helen S. Mitchell, Ph.D., Sc,D., 
et al 
LIPPINCOTT 
about $12.00 
NUTRITION IN NURSING 
Linnea Anderson, M.P.H.; Marjorie V. Dibble, R.D., 
M.S.; Helen S. Mitchell, Ph.D., Sc.D.; and 
Henderika J. Rynbergen, M.S. 
A compact text that provides the essentials of nor- 
mal nutrition and patient-centered clinical nutrition, 
withol1t extensive coverage of biochemistry research 
data, or food preparation. 
LIPPINCOTT 
$9.75 


S 


about 700 pages 
May, 1976 
41 


406 pages 
Tables and Charts, 1972 


4! 


J. B. Lippincott Company of Canada Lid: 
Please send me the book(s) I have circled 
1 2 3 4 5 6 7 8 9 10 
11 12 13 14 15 16 17 18 19 20 
21 22 23 24 25 26 27 28 29 30 
31 32 33 34 35 36 37 38 39 40 
41 42 43 44 45 46 47 48 49 


Name 
Address 
City Provo 
Postal Code Position 
D Payment enclosed, postage and handling paid 
o Charge and bill me 
D Use my Chargex 
D Use my Master Charge 


LIPPINCOTT'S NO-RISK GUARANTEE: 
Books are shipped to you ON APPROVAL; if you are 
not entirely satisfied you may return them within 15 
days for full credit. 


J. B. LIPPINCOTT COMPANY OF CANADA LIMITED 
Serving the Health Professions in Canada Since 1897 
75 HORNER AVE. TORONTO, ONTARIO M8Z 4X7 (4166) 252-5277 



Tha CanadIan Nwse April 1976 


35 


Canadian Nurses' Association 
Annual Meeting and Biennial Convention 
Program Highlights 



,tf
 
. :;. 


, 

 



' 


- .....r-, 



 



 
-;,i 


-l -J, J , 
-I . _J
 
. t "... . ""
 :. 
,-._
 
-- ""fl' ... 
-- 

-J 'to, ., 
- 
, ,'-- , .t
i'_ - I I,.. 
J .>. ..

 i r It! J I.)!}'
'J . I 
- -. 
.... 
 - ,
 --:. 1 
ry 
 


' ,.;.-- .. 
- .' .íf-: . 

_... ... " 


. ).... 
_ .c,.,
. "
1.t" "'- 


. 
 ..x.....,. ,}
. .
...:"
 -..... 
---.- 

 




 
-
 


- 


20 


Sunday, June 20 
1 2 :00 hours 
14 :00 hours 
19:45 hours 
20;00 hours 


Registration 
Canadian Nurses' Foundation - Annual Meeting 
invocation - Sister Barbara Muldoon 
Opening Ceremony - Chairman - Huguette Labelle 


President CNA 
Minister of Health of Nova Scotia 
Mayor of Halifax - Edmund Morris 
Mayor of Dartmouth - Irene Stubbs 
Executive Director CNA 
Representatives - ICN, PAHO/WHO, ANA 


21 :00 hours 
22:00 hours 


Welcome - Registered Nurses' Association of Nova Scotia 
Guest Speaker - W.O. Mitchell 
Reception - RNANS 


Welcome to Nova Scotia Punch Party 


Place: 
Date: 
Theme: 


Hotel Nova Scotian 
June 20-23, 1976 
The Quality of Life 



36 


The Canadian Nurse April 1976 


" 
" 


.....i f,) 1\,. 
_.J ,
 


ì 
. 


. 'I 
.j, 
t' 
'(
 


- 


:\, 


t 


L 
..,.,... .,..." 
,
-<<'?<'J'r. 
'" 
 , j;


.:- 
.'.. " 
.'1 
 -7 
"1 . 
 


"". 
 
J "'Il 
. ",--- 
f4
--::"?:f", 

.

... 
. 
;j:
 


t 


f': 


i. \ "'. 


.
 


21 


22 


, "; 
 .'1',.., r 
'",-:ft- 'J-._
t'-.); 
.\. ).>.
"


 r
 
.1'
':;. \
. ::.1..\. 

4 :-4,.... - : '.' 
 

...
... :
J ... ,.
 .
, 
,X
II:"'__ a-;
", 
.",,-
, .
 
.\ _'..r :tÅ 
'( 
 "} 
. '": 't; >.[, 
..... " 'Ì1'4: .\
 - 

._ 
. "-tt-'\: L 

 5
.
-._ .
, :Áot. 

..,..
... .-'-: 
.. 


_
 _ it 
",..- 
\ 


 




, .; 
. '- 
c. 


.. 


'" 


( 


. 
 
'- 


," 
, 


" 



 
" 

 
 
.,. r
 
l
 - ':"'\:J . 


'j 
. . 
\,\ S.,. ,
 



 
 


-...... 


'" 


Monday, June 21 
08;00 hours 
08:30 hours 


08:45 hours 
09;00 hours 


14;00 hours 


15;30 hours 


Registration 
Report of the Committee on Nominations 


Nominations from the floor (delegates) 
Report of the Arrangements Committee - RNANS 
Keynote Speaker - Ralph Nader 


Following the address there will be an open forum discussion 
with the speaker, - 
Debate 


"Resolved that nurses have a responsibility to take a stand to 
preserve life in the event of any decision by a patient. a family, 
or a professional to discontinue life-maintaining Intervention." 


Chairman; Apolline Robichaud 
Participants: At press time confirmation had not yet been received 
regarding participants 
Interview by Patrick Watson 


Subject: The impact of the nursing profession on the quality 
of life. 


Interviewees: Cathlyn Macaulay, Head Nurse, Palliative Care Unit, 
Royal Victoria Hospital, Montreal. Pamela Poole, Chief, Information 
and Evaluation Division, Research Program Directorate, Federal 
Government. Shirley Post, Health Care Consultant. Irene Desjarlais, 
Nurse-in-charge, Medical Services Health Centre, Fort Qu'Appelle 


Evening Recreation: Tour of Peggy's Cove or Water Tour of 
Halifax Harbour or Lobster Dinner and Ceilidh 


Tuesday, June 22 
08:00 hours 
09:00 hours 


Registration 
Opening Address 
Address, Huguette Labelle, President CNA 
Roll Call 
Reports; Executive Director 
Special Committees: Testing Service 
Treasurer's report Nursing Research 
Auditor's report 
Appointment of Auditor 
Mortgage burning ceremony 
Official admission of the NWTRNA 
Evening Recreation: Tour of Peggy's Cove or Water Tour of 
Halifax Harbour or Lobster Dinner and Ceilidh 



_...J- L. 



 


23 


Photos: Nova ScotIa Commun,cabons 
& In'ormabon Centre 



 "" I 



 ! \ 
""" 1'1 
:.Þ.
 
"'1rW,,
 
... .j--- 
.. 


'-. 


" 


.:,
ç 


,:.I -J' 

 
.... J.' 


.... 


, t 
 :- 



. 


) I 


1-- 1 
-I 


1 
 


, ... 


I 

 


. ,. L-f'" .. 

....... 


'
 
..
 ... 
;;.10" 
..... -..-, . 


Wednesday, June 23 
08:00 hours 
09:00 hours 


11 :00 hours 


14 :00 hours 


16;30 hours 
19;30 hours 


RegIstration 
First Session: The quality of life in the work world of the nurse 
Chairman;Jeannine Tellier-Cormier, President ofthe Order of Nurses 
of Quebec 


Specific Topics: 
a) The incompatibility between educational preparation and the 
practice setting -Ginette Rodger - Director of Nursing. Notre 
Dame Hospital, Montreal 
b) not yet confirmed 
c) The enforced proximity to stressors in the client en vi ronment 
- Mary Vachon - Mental Health Consultant, Clarke Institute of 
Psychiatry, Toronto. 
d) The social and economic pressures in the work environment 
of the nurse -Anne Gribben - Chief Executive Officer of the 
Ontario Nurses' Association 
Second Session; You and the quality of life - action for today 


This session will feature an artistic representation of the theme 
Report of the Resolutions Committee 


Report ofthe scrutineers 
Installation of Officers 
President's Reception 


All events held in the Hotel Nova Scotian Commonwealth Room 
unless otherwise indicated 


Coffee served daily from 10:30 hours to 11 :00 hours Lunch Recess 
at 12:00 hours daily 


Exhibits open at 09:00 hours daily from Monday, June 21 to 
Wednesday, June 23 at 13:00 hours 



;<11 


Tne LanaOlan Nurse Apr11 1976 


Canadian Nurses' Association 
Balance sheet 
December 31, 1975 


Assets 


Current assets 
Cash in bank 
Short term deposits plus accrued interest 
Accounts receivable 
Membership fees receivable 
Prepaid expenses 


1975 


1974 


$ 148 , 119 $ 97,132 
5 36,357 712,593 
58,824 51,280 
12 , 220 10,852 
11 , 519 10 , 292 
767,039 _ 882,14 
 


Sund lY.Ê sse t
 
Marketable securities - at cost (quoted value $12,868; 1974 $9,957) 
Loans to member nurses plus accrued interest 


4,065 
11 , 289 
15,354 


3,779 
9 , 088 
12 , 867 


FIxed assets - note 1 
C.N.A. House -land and building - at cost less accumulated depreciation on building 
Furniture and fixtures - at nominal value 


488 , 066 
1 
488,067 
$1,270,460 


519,932 
1 
519,933 
$1 , 414 , 949 


Liabilities and surplus 


Current liabilities 
Accounts payable and accrued liabilities 
Defe rr ed revenue - subscriptions 
- other 
MOr1qaqe payable within one year 


$ 39 , 146 $ 20,863 
21 , 900 27,500 
306 
324 , 534 20 , 235 
385 , 886 68 , 598 


Mortgage payable - 6 3 /4% due 1976 - payable in monthly instalments of $3,548 
to include principal and interest (less portion payable within one year) 
Gra n ts for special projects - unexpended portion - note 2 
Reserve for support to the Northwest Territories Registered Nurses Association - note 3 
Sur plus 


324 534 


31,493 
11 , 000 
842 , 081 
$1,270,460 


15,000 
1 . 006 . 817 
$1 , 414 , 949 


Approved on behalf of the Board: 
Mme Huguette Labelle, President 


Dr. Helen K. Mussallem, Executive Director 



':;anadian Nurses' Association 
resting service 
'3tatement of income 
(ear ended December 31, 1975 


I 
, Revenue 
, - --- Examination fees 
Interest earned 


_IIÇ' ""_:U'GUIIIII nUI:!M:::r ""..nn I
ID 


3" 


Canadian Nurses' Association 
Notes to financial statements 
December 31, 1975 


1975 


1974 


$ 401,534 
4 , 153 
405,687 


303,703 
5,691 

09,394 


, Expenditures: 
: Sal aries and benefits 
Board and committee meetings 
Item writing 
Operating (data processing, printing, warehousing) 
Consultants 
Rent 
Trans lation 
Office supplies and stationery 
Postage and express 
Telephone and telegraph 
Travel - non-committee 
Equipment, maintenance and rental 
Books and periodicals 
Furniture and fixtures 
Miscellaneous 
Leasehold improvements 
Moving expenses 
Insurance 


176 , 493 142 , 656 
39,878 37,834 
23,457 19,123 
77,740 70 , 326 
5 , 239 
28,570 7,869 
5,478 705 
8,726 4,765 
3,612 2,472 
4 , 046 2,737 
2,496 1 , 628 
884 866 
562 467 
10,417 7 , 700 
3,737 994 
22,338 
787 
483 559 
414 , 943 300,701 
$ ( 9,256 ) $ 8,693 


Surplus (Deficit) for year 


Ve have examined the balance sheet of Canadian Nurses' Association 
IS at December 31, 1975 and the statements of income and surplus for 
he year then ended. Our examination included a general review of the 
Iccounting procedures and such tests of accounting records and other 
,upporting evidence as we considered necessary in the circumstances. 


11 our opinion these financial statements presp.nt fairly the financial 
IOsition of the Association as at December 31, 1975 and the results of 
s operations for the year then ended, in accordance with generally 
Iccepted accounting principles applied on a basis consistent with that 
If the preceding year. 
Jeo. A. Welch & Company, 
;hartered Accountants 


January 29, 1976 


1_ Fixed assets 
It is the policy of the Association to 
expense purchases of furniture 
and fixtures in the year of 
purchase. The C.N.A. House is 
being depreciated over 20 years 
at the rate of 5% per annum. 


2. Grants for special projects 
During the year Health and 
Welfare Canada and the 
Canadian International 
Development Agency advanced 
funds to the Association in respect 
of grants for special projects. The 
unexpended portion of these 
grants at December 31, 1975 
totalled $31,493. 


3. Special reserve 
In 1974 a special reserve of 
$15,000 was established for 
support to the Northwest 
Territories Registered Nurses 
Association. In 1975 a payment of 
$4,000 was made to the 
Association leaving a balance of 
$11,000 at December 31,1975. 


4. Retirement income plan 
During the year changes were 
made to the Association's 
retirement plan resulting in 
additional benefits for past 
service. Actuaries have estimated 
that an annual amount of $38,500 
for 15 years will be required to 
fund the past service benefits. 



40 


The CanadIan Nurse April 1976 


Canadian Nurses' Association 
Statement of income and surplus 
Year ended December 31, 1975 


Revenue 
---- 
Membersh i p fees 
SUQscriptions 
Adv e rtising 
Sund ry income 


1975 
$ 9 55,238 
38,922 
339,604 
7,196 
1,340,960 


1974 


$ 888 , 904 
40,820 
299,264 
8 , 127 
1,237,115 


Expenditures 
Operating expenses 
Salaries 
Printing a n.QJ:>.u blic ations 
Design and graphics 
P ostage on journal 
Computer service 
Committee travel 
Translati on services 
COl-rll'russion on advertising sales 
Affiliation fees - I.C .N. 
- Ca nadian Council on Hospital Accreditation 
Professional services 
Travel - non-committee 
Office expenses 
Books and periodicals 

al and aud it 
Building services 
Sun d ry 
Furniture and fixtures 
- - - 
Landscaping an Q irr1Q rovements 
Qgpreci ation - C.N.A. House 
Insurance 
Ge nEH
1 meeti ng 
Continqency for special proiects 


759,924 
245,436 
14,399 
118 , 773 
44,894 
36,272 
33,546 
65,707 
5,000 
14,121 
22,347 
36,614 
10,238 
5,2 00 
88,398 
13,725 
2,954 
189 
31 , 867 
6,295 
1,661 
303 
1,557,863 


NOrH>Peratm:q -e xpense s: 
1974 convention 
Canadian Nurses' Foundatio n - aaministration 


568,306 
222,4
 
7,943 
113,175 
25,658 
23,176 
2,319 
20,663 
47,130 
5, 000 
9 , 725 
12,061 
35, 387 
6 , 645 
8,747 
70,256 
5,320 
602 
948 
31 , 867 
367 


1,217 , 717 


1,557,863 


18,869 
1,954 
20,823 
1,238,540 


Surplus (Deficit) for year bef oreltems below 
Ç.i'J. A. Te st.i!:!9..Se rvice - perstatement 
Investment income 


( 216,903 ) 
( 9,256 ) 
61 ,4 23 


Surplus (De f icit) for y ear 
Sur p lus at be q innin g of y ear 


(164,736) 
1 , 006 , 817 
842,081 


(1,425) 
8,693 
66,475 
73,743 
948,074 
1,021,817 


Les s reserve for Northwest Ternrories Reqistered Nurses Ãssociation 
Surplus at end of year 


$ 842,081 


15 , 000 
$ 1 , 006,817 



The Canadia" Nur. April 1976 


41 


Resolutions of the Board of Directors 
to the 1976 Annual 
Meeting and Convention 


Changes in By-law 


1, BE IT ENACTED as a By-law of Canadian Nurses' Association 
- Association des infirmières canadiennes (herein called 
"Association") that: 
I) The Association be and is hereby authorized to make 
application to the Minister of Consumer and Corporate Affairs 
for supplementary letters patent amending the letters patent 
incorporating the Association by changing the name from 
"Canadian Nurses' Association - Association des infirmières 
canadiennes" to "Canadian Nurses Association - Association 
des infirmières et infirmiers du Canada" and amending 
paragraph D from: 
"The membership of the Corporation shall consist of the tell (10) 
provincial associations: The Alberta Association of Registered 
Nurses, Registered Nurses' Association of British Columbia, 
The Manitoba Association of Registered Nurses. Association of 
Registered Nurses of Newfoundland, The Registered Nurses' 
Association of Nova Scotia, The New Brunswick Association of 
Registered Nurses, Registered Nurses' Association of Ontario, 
the Association of Nurses of the Province of Quebec, The 
Association of Nurses of Prince Edward Island, and the 
Saskatchewan Registered Nurses' Association, or their 
respective successors and assigns, and such other classes of 
members as the Corporation may establish by by-law from time 
to time:' 
to: "The membership of the Corporation shall consist of eleven 
(11) association members; Registered Nurses Association of 
British Columbia, Alberta Association of Registered Nurses, 
Saskatchewan Registered Nurses Association, Manitoba 
Association of Registered Nurses, Registered Nurses' 
Association of Ontario, Order of Nurses of Québec, The New 
Brunswick Association of Registered Nurses, Registered 
Nurses' Association of Nova Scotia, The Association of Nurses 
of Prince Edward Island, Association of Registered Nurses of 
Newfoundland, and Northwest Terntories Registered Nurses' 
Association, or their respective successors and assigns, and 
such other classes of members as the Corporation may 
establish by by-law from time to time." 
b) The directors and officers be and are hereby authorized and 
directed to do, sign and execute all things, deeds and 
documents necessary or desirable for the due carrying out of 
the foregoing, including effecting necessary editorial changes in 
the Association by-law. 
2 Section B(b) 
five members-at-Iarge, elected to represent respectively the 
fields of nursing administration, nursing education, nursing 
practice, nursing research, and social and economic welfare 
(originally submitted by MARN) 
3 Section 16 
Powers and Functions: It shall be the responsibility ofthe board 
and the board shall have the authority (a) to establish the policy 
of the Association; (b) to revise the policy in the light of changing 
beliefs; (c) to appoint the executive director and delegate 
responsibility and authority for Implementation of Association 
policies to this position: (d) to ensure that Association policies 
are implemented satisfactorily; (e) to report fully to the 


Association at each annual meeting upon the business 
transacted since the last annual meeting; (f) to honour those 
who have made an outstanding contribution to nursing: (g) to 
make decisions and to take all such appropriate action as is 
necessary to further the objects of the Association 
4. Section 25 
Composition: There shall be a committee of nominations of 
three members elected at an annual meeting of the Association; 
one of whom shall be named chairman by the board. 
5. Section 47(a) 
A special committee may be established by the board at any 
time for a short or long term and may be dissolved by resolution 
of the board of directors. The appointment by the board shall set 
forth in reasonable detail the subject matter for study by the 
committee, its composition and such other terms as the board 
deems fit. (b) an ad hoc committee may be established by the 
board for a specific purpose on precise terms of reference which 
shall provide that the committee shall cease to function upon 
completion ofthe specific task; the composition and other terms 
of reference of the committee shall be set forth in the board's 
appointment. (c) there shall be a standing committee, known as 
the Testing Service Committee, constituted by the board of 
directors. 


B. Others 


1. THAT members of CNA be urged to initiate and conduct 
projects that will advance the discipline of nursing, (originally 
submitted by MARN) 
2 THAT all CNA members be urged to support the CNF so that it 
can carry out its mandate, namely, 
(a) to provide bursaries, scholarships and fellowships to persons 
enrolled in educational institutions for the purpose of obtaining a 
baccalaureate degree in nursing and to nurses enrolling in 
masters or doctoral degree programs; 
(b) to provide grants in aid of or to undertake research in nursing 
science which may help to advance the knowledge and art of 
members of the nursing profession with a view to providing the 
best possible nursing care and attention: 
(c) to solicit, acquire, accept or receive gifts, donations, bequests or 
subscriptions of money, or other real or personal property, 
whether they be unconditional or subject to special conditions, 
provided any special conditions are not inconsistent with the 
above objects. 
(originally submitted by MARN) 
3, THAT the CNA pursue with legal counsel the feasibility of trying 
to bring tobacco under the Food and Drug Act. 
(originally submitted by MARN) 
4, Whereas nurses are concerned about the Quality of life; and 
Whereas nurses attempt to enhance the quality of life by their 
actions; therefore be it resolved: 
THAT CNA take action to have removed from the market such 
items that are detrimental to health: and further be it resolved 
THAT nurses bring such items to the attention of CNA for action 
(originally submitted by RNAO) 
5, The RNAO supports CNA in its efforts to provide statistical data 



The CanadIan Nurse Apnl 1976 


42 


Resolutions 


related to registered nurses in Canada and recommends that 
every effort be made to: 
(a) maintain tables in a consistent manner so that their usefulness 
is maximized and trends can be monitored over time; 
(b) ensure a publication date that allows data to be available when it 
is still relevant to planning for the profession; 
(c) engage in a review of CNA's publication "C?un!down" 
it
 a 
view to publishing current statistical information In that onglnal 
format. 
(originally submitted by RNAO) 
6. Whereas it is unlikely that educational programs established by 
each province to prepare nurse-midwives would be viable, 
RNAO recommends that CNA, in conjunction with provincial 
nurses' associations, develop a position statement regarding a 
realistic distribution of educational programs for 
nurse-midwives in Canada. 
(originally submitted by RNAO) 
7 Whereas the Board of Directors has already allocated 
resources to the development of nursing practice standards in 
response to a resolution passed at the 1974 annual meeting and 
convention and, in view of the increasing need for national 
guidelines; be it resolved THAT the necessary resources 
continue to be allocated to ensure that the project on national 
standards for nursing practice be completed; and be it further 
resolved THAT this project be a priority in this biennium. 
8 Whereas nurses are in a unique clinical role to maximize 
effectiveness and minimize side effects of pharmacotherapy: be 
it resolved THAT CNA seek funds to hold one or more symposia 
on the subject of pharmacotherapy to raise the level of 
awareness of nurses to their responsibility in this aspect of 
practice. 
9. Whereas the Board of Directors has already allocated 
resources to the development of nursing education stan
ards in 
response to a resolution passed at the 1974 annual meeting and 
convention, and in view of the increasing need for national 
guidelines; be it resolved THAT the necessary resources 
continue to be allocated to ensure that the project on national 
standards for nursing education be completed: and be it further 
resolved THAT this project be a priority in this biennium. 
10 Whereas the CNA Health Promotion Program for Nurses was 
mounted in response to a resolution passed in 1974; and 
Whereas member associations have unanimously supported 
the Program; be it resolved THAT CNA seek funds to conduct a 
program in multi-risk health counselling for nurses in this 
biennium. 
11. THAT CNA develop a policy statement on Consumers' Rights in 
Health Care, using the Consumers' Association of Canada 
document Consumer Rights in Health Care as a beginning point 
for discussion. 




 


OFFICIAL NOTICE 


Annual and Special 
General Meeting 
of the 
Canadian Nurses' 
Foundation 


In accordance with By-law Section 
36, notice IS given of an annual and 
special general meeting to be held 
Sunday, 20 June 1976, commencing 
1400 hours at the Nova Scotian 
Hotel. Halifax, Nova Scotia. The 
purpose of the meeting is to receive 
and consider the income and 
expenditure account, balance sheet, 
and annual reports. The election of 
the CNF Board of Directors for the 
1976-78 term of office will be 
conducted during the meeting. 
Members will be asked to consider a 
by-law of the Board of Directors 
concerning acceptance of a bilingual 
name for the Foundation and a 
related change in By-law Section 1. 
All members of the Canadian Nurses' 
Foundation are eligible to attend and 
participate in the annual and special 
general meeting. - Helen K. 
Mussallem, Secretary-Treasurer, 
Canadian Nurses' Foundation 




 



\ 


\ 



 



10V 


(,0 
, 1\ ""'
 01'5 
'GS' tot 
J b
 

'(O
l:' 

\\e 



.313 
l c. Suit 

 Cord Jersey Top 

 stripe Jersey skirt 
50 Polyester. 40% Nylon 

Ite only 
S3S: 4 to 20 
Sjgested retail: $27.98 
I 



 
l, 


-- 

 



.' 


, 


'-- 


-G 


'" 


I 


-(; 


-(; 


-0 


\ 




 


\ 
\ 


H.J. 309 
2 Pc. Suit 
Warp knit Lacost Jersey 
with rib combination 
90% Polyester, 10% Nylon 
White only 
Sizes: 3 to 15 
Suggested retail: $34.98 


H.J. 300 
2 Pc. Suit 
Warp knit Lacost Jersey 
with rib combination 
90% Polyester, 10% Nylon 
White only 
Sizes: 3 to 15 
Suggested retail: $35.98 


Manufactured by 
HAMPTON MFG. (1966) LTD. 
125 Elmire St., Montreal 



ILABLE AT YOUR FAVOURITE STORE 



. fees? 
. d for an increase In . 
Q HoW o,g.nl is ,h'S n.. _so e"'''s cas" 

. IN 01'. "s ".<'1 0'9 00 ' "" I>'J "'. 00' 01 "'. ,.oJ. 
,...",.s ",,, "" osod o
,ci' 01 ."","","''''.,' 
f. ci09 "" 0""","09' ,cO"ûo"'09 '0'1>"0 0 '<'1 b'. 
$A2 4 .(jYJ ",IS ,ear. "" "ea"" e"''' "',,, "" 0 0 ' 
",...",05 '0 sob"""o"". s '0 "'. ",,\""0'" o",SO 
... . Ò tesef'\ set'i ICe . 
\0 ptO"1 e? \ òòi\iOf'a\ \if'af'c l f'9' t from 
",."",., ",,moo · d s tho indiV"o", no's. 9. 
Q. What ser.lIces De se reach her? - 
eNA .nd hOW do tho "". "", ",""'9''''. . 
". eN" "",WloS bO'" '''':
. _, ",s"". p'od"" " 
se""coS '0 .. ",.",b.'s., '0"""" ",""'''''' '" "'. 
"'. i"",n"" soo"'''''1''; iDo,n'" _""""o
' ,....;., 
,""9""". 0' """",e. . '" """"IS "", _,o\OOos 
"","' e tS un_\O-òa\e 'oNI . . e "f'a òa ' 'oNI\n f'e'oN 
{'('e" ,u .... o\esSIOf' If' 0.., '
 'oN 
""eel "'. 0",s"'9 '" 1" ,". .".,,,,,,,,1'1 0 o. 
0"","'9 ,""'0""":' 
'" '0 eN" "b"'<'1 ...d """, 
0",s\ll9 ",....",. \0,-' """"""o",oS. 
p"",IS".'" _ ",,," .",p ""'". . 0 
,act\CaI ;d.'s. ""d SO 0 ,". ,,,,,,,<'I s.""coS. 0 
p Q\ cD>',SO. ",e,e oJe .,
""'s "",e """ 0."0 0 '''' 
0,,'0"'"' '0' 'os,,,,,ce. "". Gao. d '? "0' e"''' 
'J c09 f'iZ eò f'utSif'9 \IDtat'J .If' ."'tou 9 n if'\8t\iDtat'J 
te \ne set'i ICes ,I' 
{'('e{'('De t caf' u
e eN!>. \,,\ou se . . 
\Oaf'. òite c \ {'('a l \ 0 \ ' .
 o.û""", s,,,,,sû eS _ce"':'
 
e"''' alSO c" "" ","., ",,,, dO. ",".,1\'" 
'" '"S _ ",".'. ,"e, "",Õ<,. '''' 0".0'. ,0" "",,,". 
o ".,01 """caI\Oo 'so '"'S 's \0 P,oÒ,ct ",.,ds. \0' 
':;'_SO s"ûs\\CS ar. ,
;: 
"","e' .".,,,"""'. 
e)l.a{'('p\e, {'('OD
\I\'J '. f'
 9 af'Ò sa\a ties . 
d'S"''''''''''' '" 'os",,,''',,'' ròo< '0 .ssoSs "'" ,"., 
1". '0""'9'_ ar. '" fO< ,os,,,,,ce. e"''' 
."eeI "'. 0"''" '0 . d"",,.;:
;(;, o"'s,,'" proleSS"'o 
. a sttOf'9 \/Olce 
spea
SIf' ? 
f'a\iOf'a\\'J' t h ' S dO for the indi\lidual nurs\

\ net 
Q. Wh el dOeS' . .,"''''.,s "",are 
". The '0'\"''''"' o",SO '
s . ,001'1'1 """""s. "'. 
,e s "'" ",oI oS """" ,ole ,od f"'" '" ",OII""'Og 
po"'s.s ,"., oIoeeò"" "0<1
'
 ",as .ccort'pllS"oÒ I>'J 
0",s"'9 as' pro'''''''o. ,ro 09 "0''''' "o,ce. "0 
o",SOs s""....'09 0'" \II · s 01 ,0rÌ\"'''''''s """ s",,"" 
. ,,"'d"'" 0' . s",." 9'''''P "" ",,,.. ".". · s.""9 
:'" b"" '0 0,'0< \0 "" ",...;')."", """"",,,go 01 "'. 
Ot9 a f'iZ a \ iO f' teptesef' If' 
""""'. cOoco<""". ",.0 ""s.10 """",,ce "", 
ßu\ eN!>. òo eS 
ote to\esSIOf', eNt>:s 
s.""9""'0 ,"e 0",s"9 
o, act,,,,û oS 'oc,"". s""
 
,0'oSs"",,,, .d"""- ,."e'oI"""'" 01 n"""" 

"",,'09 ",oieelS as 

"""û"". 0",s"'9 "'
 
s,,,,,,,'d s ,0< o,,'s'o "'. o",SO '0 ",e o><paI' Q\ 
",.0'-'" s"",., o
 "..,," ",,,,,,01\00 proteel. , 
,,,., "", ",.0'-' . ,I>'J ,oSea"'"' "",ari "", 
cD>',SO. ,"e"" .,. b' c .
 alSO ,". "',,'s,"" ",,'0' 
o\\iC e set'iiCes.1nete I 


44 


I 


The Canadian N 
urse 


April 1976 


.. 


-... 

 



 coo"etS3t\OO 
",,\th the 
e
eC\1t\"e d\tect01 


ee
if'9 e{'('p\O'J{'('ef'\ 
'0' (;aI"'''''' o",s.s s , ,". "",,,,,s\OO 
pt09ta
 
essiOf'a\ \/isi\S aDtO
' e to{'('o\iOf' 
0< "'....,09 ",0. \J" ","'0''''''-''" P Id gO 
CO","" '" ",,,_9 0 . fO"""'\Oo -c\>. ,cO" 

 \n e eaf'aÒiaf' Nu tS8S 
o . h n hOw can 
of' af'Ò of' . ' . ..moneY QuestiOn t e., ? 
Q r 0 got b.ck '0 th.. noC' its set",c 05 . 
CNA'S Iin.nd", SIO" O \':, sa\d ""''''.' e"''' ,aces 
!>. \f'a'oNotò,drastlcaI 4 IY. oo o òe\ici\ \0 catt'J Of'I\S 
. . \e\" a $42 . ., \n e sl\Ua\IOf' 
.91"0,""" :' IN'''' "s'09 ces.s. " . 0011> . 
pro9'aro s th's ,ea" "e IS 'ocreas"" s" or' 
""" ",O's"'" ,,"'.ss ''ê'";'.v.n oe co",e fro"" 
Q. Whore does CNA s .",,,,,,,,,,'0 ,ee s , ", 
. ",os' 01 " oo"'.s 
"'" '" ,$8."" "'" ",.",,,... '" 
,.... eN!>. tecel\/es aDDU 
ptesef'\. t {'('Of'\n. .? 
abD'" 7' c"",s "" nt 'e. ...ebh-"od. , 0 
Q "",en was thO pro"" 0 'ocrea"" \II ''''' pas' 

 '0' gfß. Th.,e"as ""OO,
. ces' 01 .""<'1"',,,9 "as 

'" '0'. as ,0" ,,,,,,,,. b."."e "'. oJ. ",.0 0 " 
'"sot' '",p;d". s,oc.,


" "'" ".. 0 0 ' "ad .0 
\atg e assoCla\IOf' eats. 
If'ctease if' \n e \a d s \ 

n
 to recommend a fee 
Q. Isn't the Boar 9 
incro es . in Jon.' b '" "."e ,od rIeÓ '0 , 

;,,
;
 
;;
 ,,
b


,,
';:oo,
ee , 
$'5.0<> "0" base '01 ,9 td prod""" .".",go ""o,,
o 
\o",,"I>"""'b


 ;:'$'0.0<>'0;9" ""

':;"'01 
,..s p.' ",.'" . ..,,,, 001 ">1'<,,," ",e pros. 
. '\918 E.\/ef' \n ls ,- 
If' . . ht fold? 
'ò,"?;
:.. 8M pcØ


 
:

.:. :;
'09:%
 
" Q\> ,,,,o,,1d ""pe . ",,01<"'9 0 ",SO '" "" 
\'Id Bot \ """.". "'" "'" Id "'."" "'" '0 "."e · 
o. \ ' ,\\" a\ 'oNn a \ 1\ 'oN OU 
\/et'J cate ...J . \iOf' d' 
0'_" o"",oS as
\ "'. indiVidoel cene ,." 
Q HOW would thiS a . 
. _ petnaps. tS 
nt

. """ "", \0 al'S",."":,



'::;"oI.SS""''' 
. , oo"",n oS "'".ro. ",s ".<'1 ",ea' 
'0 """'s". ssoci""'" 0' " 'W. 's ""
 'me ",ortd ""'.,. 
f'U tse "",af'" couf'\t\es I,. 
_ af\ò \nete ate ",J 
\n is si\Ua\iOf' e



s
ffect nurses? {\ \n e 
Q. HoW does are "0"",.'0 o><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


\

: 


: \


s;
:;
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 



- 


Uniforms. technical medical and 
general purpose hospital coats. designed 
for actIon-comfort as you work Seams 
are firmly sewn Fastenersstayon Fabncs 
wash or dry clean for professIonal wear 


.. þ: 
 
, ",. 
, "T.. rC" i 


,/ 
r 


./ 


."... 


" 


STYLE 814 



I.c 

r;.cl..;.
 c 
CAREER ClASSICS 


\ 


"-.. 


STYLE 810 


STYLE 814 PantSUIt 
Polyester Textured Warp Knit 
WhIte Blue Yellow - Ice Mint 
Sizes 6 to 18 
To retail $2800 
STYLE 81 OA 
Polyester Corded Warp Knit 
White 
 Sleeves 
Sizes 6 to 20 
To retail $26 00 


STYLE 810SS 
PolYf>ster Corded Warp Knit 
White Short Sleeve 
Sizes 6 to 20 
To r ." 


/ 


I 


, 


STYLE 888 


\ 


STYLE 916 PantSuit 
Polyester Ribbed Double Knit 
White 
Sizes 8 to 16 
To retail $3800 
STYLE 888 
Polyester Textured Warp Knit 
Lace Tnm White. Pink Yello 
Sizes 8 to 20 
To retail $22 00 




 


ff 


J' 


unifolml 
Icgi/leled 


178 King St W 
Tor t Ontarlfl M5' 
A 1 



GENEROUS NEW GROUP OISCOUNTS on all 

t ms shown, for group purchases. graduation gifts. favors. etc 
6-11 Same Items, Deduct 10%; 12-24 Same Items, Deduct 15% 
25 or More Same Items, Deduct 20% G 


Mte 


, 
iN'll 


.-------------------------------------. 
I IT'S EASY TO ORDER REEVES NAME PINS FOR YOURSELF OR FRIENDS! I 
I Choose styte you want. shown nlht Pflnt Nmt (and 2nd ttom ng"" Art"". eElr. she-tl Jut 
JttOfLJl pins I 
I ;;"":
f :.ts::,
.
I:tt
"=t
lo:ndC'::c
t
:( 
:.
 :
 
v::.
':.
lounltAl PIMS.. .erl cOlrlenltat. I 


SlnI 
110 


IÆTAL 
toLOil 


I LETTERING,______________________ 2nd LlNE._______________ 
I METAl. IACK"OUND LlT1UIII& PIlUS 

 FINISH :) COLDA úrr......1 L. EIpIØ 2 '-' 


_stlIPTlDN 


All MET At _ _ Smootn rounoecl oD""'_ Ooe$ o Black o ] Pin 2A9 o 1 Pin 3..25 
æ )rT1f:ß. C
 Polished. Salin or o Gold o Polished "'" oDk Blue 
new Ouotone comb.nln. satin DSIM!!r o SoItln 0",,1y o White 02 Pn1S 
 o 2 P,ns ".9
 
I back&round will"! pOhshed ed.-s I
...mt 
. PLASTIC LAMINATE...sl'mme.. I Does I Does OW"". i Black 0 I Pm US DIP,n 1.85 
. broader, engraved thru surtac.e to not no! o G
"l Ok Blue 
)f1tmt.nl' con color. ar..,.,1ed 
UOrMr miltches Iettef'lna- opoly opoly o Slue White 0 2 PinS 1.95 o 2 Pins 2.90 
o Cocoa l.etter5only c

, (-"'rwneJ 
ID METAL fRAMED.. Cla..,c o Gold POIIsheCI >WI,.. o Black DIPln 24g o I Pin 3_25 
. . t"Sfg1!. snow-
Ite pla$hc with os....., "ome only DOk Blue 0 ?Pln4i. 399 o 2 PinS 4.95 
nooth. polished beveted frame '" r 
lID MOLDED PLASTIC. Simpl..s","", Does Does >WI,.. o BlaCk o lPln 1.25 o 1 Prn 1.85 
. onQmlul Win never dl
olor no! not only o Ok Blue 0 2 Pms 1.95 02Plns290 
'nOOth rounded comers .nd ed.-s. opp/y -Iy Iwme
J ,............ 


I' 


Finest Forged Steel. 
Guaranteed 2 yean. 


I ... . 


LISTER BANDAGE SCISSORS 
3
'" .....,dull'. Tiny, hand1. slip into 
uniform pocket or pune Choose lewelen 

 go:d or llearn.... chrome plate fißlsh 
<...Si! No. 3500 3'1," Mini. . '. . ". 2.75 
No. 4500 4""" size, Chrome only, , . 2.95 
No. 5500 5 11 2'" size, Chrome only. . . 3.25 
No. 702 7Y.... size, Chrome onl)' . ..3.75 
For enanved initials add 5Ot- per instrument 
5Y2" DPERATING SCISSDRS ....
 
Polished Stainless C:::teel, str.aulht blides. 
 - 
No. 705 Sharp 'Blunt peints.,. 2.95 
 
 ,....... 
No. 706 Sharpl Sharp points. . . 2.95 
 
No. 710 4"2" IRIS Scis.. Strailltl. . . 3.75 
For enaraved initills add 5Ot- per instrument 


3 1 1::1'" 
"'1
. 
5""" 
1'1..'" 


KEllY FDRCEPS 
So hin<ly lor evel')' nurse l Ideal tor c:lamplnt: 
NO.o;5

n
I

g
:
'
:
\..
cl.I,. 


. 449 
No. 725 Curved, Bo. Lock, . . . . . . , 4.49 
No. 741 Thumb Dressing Foreep, 
Senlted, Straight. 5"2" . .3.75 
For enaraved initials add 5Ot- per instrument 


MEDI-CARD SET llandi..t .eler 
enu everl 6 smooth plasbc t.1rcls (3"" J. 
Sm"l crammed with Informatron: Equ....a- 
leocies of Apothecal) to Metric to Household 
Meas, Temp. cC to "'F, Prt5c:rip. Abbr, Unn- 
01Y'15. Body Chem , Blood Chem, Li..r res"'. 
Bone Marrow. Disease Incub Periods. Adult 
Wgts . etc. In white vinyl holder. 
No. 2B9 Card Set. . . 1 50 ea. 




i:r
SaJ:I:õ:
amped on back 01 


POCKET SAVERS 
Prevent steins and wur
 Smooth. þli 
oble pure wII,le vinyl. Ideal low-<:osl 
group lifts or favors 
No. 21" liar loltJ. two compo1<tments 
P


J

::$f.
 coduceus 
110. 1'1 DoItJ DolulO Saver. 3 compl, 
change pocket' key chiln . . . 
Po<:kelol6 for $2.98 
Nurses' POCKET PAL KIT 
- f 
tUndlt'St '01 bus)' nurses Includes Wilhite 
Deluxe Pocket SiV'er, with S
"llster Scissor, 
(both shown above). frl-Color ballpoint pon, 
plus fwlndsome IItIIt pen liettt all silver 
finished Chinge comøartment. key chiln. 
No. 291 Pal Kit. . . 6.50 ea. 
Initials enaraved on shears. add SO... 
;/;"...
 TIMEX Pulsometer WATCH 
" Dependable r"... Hu"..' Pulsomeler/Calend.. Walch. 
Moveable outer ring computes pulse rate Date t.11en- 
dar, wtlite numerals, sweep-second hind. blue dial. 
luminous, white strap. Stainless back water and oost- 
resistant Gltt-boXed 1 year warrantee. Initbls '.lnIft. 
on Uck Fne. 
No. 237761 Nurses' Watch. . . . ' 17.95 ea. 
PIN GUARD Sculplu.ed caduceus. Chalned 
 -' , 
to your tlrotesslonal letters. each with prnba::kl . 




 
::

't'::I

er t7;:'ho
I(iNPin Gold ^ , 
No. 3420 Pin Guard . . . 2.95 ... 
ENAMELED PINS B..ul,fully sculplu.ed slotus 
I ðJ\. Insignll. 2-color kertd. hard-fired enamel on .rold 
'UY 

I
n 

zed. pm-back Specify RH. LPN. LV or 
NA No. 205 Enam. Pin 1.95 ea. 



IJ 
Bzzz MEMO-TIMER l,me hol pocks. 
 
l'1eat lamps. park meters. Remember to ctlec" vital .. 
 
SignS, liwe medication, etc LlfJlMIJht c
1 

 1.7" dlaJ sets. to buzz 5 to 60 min. key rinK . 
SWISS made 


No. M-22 Timer. . . 6.95 



..... 


_"'. _.......,. _'.: _ .....J..... 



 


cþ 



) .) 
.
 
I
 
, 


Free Initials and '-- 
Free Scope Sack with your own 
Littmaun Nursescope! 


Famous Littmann nurses' 
diaphragm stethDscope . 
a fine precision Instrument 
wIth high sensitivity for 
blood pressures. apical pulse 
rate. Only 2 015.. fils In 
pocket. wilh gray vInyl anti. 
collapse tubing. non-chliling 
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: Gøldtøne, Initials and Sack 
Silnr1one. Blue, Green, Pink." Duly Free 16.95 øa. 
*'MPORTANJ: Hew Medallion" sbllnglncluðes tubing In colors to match 
met,u oarts If deslfed add $1 ea. to prICe above. add iii! to Order 
Ho. 2161J!f on coupon 


FREE INITIALS AND SACK! 
Your inlials engraved FREE on 
chest piece; lend individual 
distinction and help prevent 
loss. FREE SCOPE SACK neatly 
carries and protects Nurse- 
scope. Heavyfrostedvinyl. with 
dust-proof press.type closure 


LITTMANN COMBINATION STETHOSCOPE 
Mallmum Sen5ltlYlb from this fine professlOlUlI Instrument Con- 
venient Z2" Oftrall length lltelam Dnly 311,z oz Chrome bl
urab 
fixed at correct angle Internal spring stamless chest piece. 1 
... 
dlJPhragro 11/4'" bell Removable non-chlll sleeve Gray vinyl tubing 
l"o Imtlò3 IC ngl Dn E:st piece rRfE SCOPE SACI( INCLUOED 
No. 2100 Combo Sleth . .. 29.95 e
. Duly Free 


CLAYTON DUAL STETHOSCOPE 
lIghtwelettt ooal stope Imported trom Japan: hlghesl 
sensItivity for aplt.11 pulse rate Chrome(! b,naurals. 
chest piece w.tll 1 J.)" belllnd 1 1 '1" dlaphraKm. 
lTey antl-collapse tubing. 4 02 29'" long Extra 
ear pluRS and dl8pt!ragm Included JWI ;mfl,al 
.ngreved Iree 'REE SCOPE SAC
 INCLUDED 
No. 413 Du.al Steth . . . 17.95 ea. 
ou 'i f.,ee 
LOW-COST STETHOSCOPE 
Our lowest cost prt!CISICH1 stethoscope I Slngte dqphrarm n 
." dla) 
Choose Blue Green Red Silver or Gold tublne and chestplece sll"er 
blnilUrals only 3 02 Three Inltqls engr
ed free fREE SC\1Pf SACK 
No, 4140 CIa,. Steth '" 11.95 ea. Duty Free 




 


( 
 


NURSES SHOULDER BAG 
Perfect '01 the Ylsltlng nurse
 Combines 
C()lwtmence and smart styling w1nle 
a'401dlng tbe flsky doctor's beg' loot.. 
AdJusteb'e shouldtr strap, or tarf)' In 
hand Generous IMide and outside pockets 
lor .!Cords, adlustoble and fixed I""", 
Inside to hold boUlt'S tubts. IÐStruments. 
etc In nch water repellent vinyl sim 
black leather. sturdy stltthing. gnld fin- 
Ished hirdware loci: clasp With .ey. 
ns 
w,dely 'or easy access ID t.1rd holder on 
end FREI ,",I,als Hold embossed 12
. 
x 911,z" x S..-.. II' Outstanding nlue
 


1 
..." 



I 


No. 149 Should.. 
BaH . . . 32.95 ea. 


--, 


.../u- 


, 
IINI 


1 


MRS. R. F. JOHNSON 
SUPERVISOR} 


,. 


---- 


CHARLENE HAYNES 


- 


- ." 

lJL
- 
.' OHN, L.PN. 


111 


.. 
51. 
AI.......-, .. 


NURSES PERSONAlIZED SPHYG 
Now in Fashion Colors! 
A superb anerOid sPhYR especlany desllntd 
tor nunn by Relsfrr preCISion craftsmen 
In W Germany Easy to attach Velcro. cub 
hetttweletti. compacl. fits Inlo soft Slm 
lea'her llpØl!f' clSe 2\7" x
" x]" Oul 
c,ihbrated to 320m", . ID-year lecurle, 
guaf anteed to "':!:: 3mm Sef)'ICed by 
Reeves I' ever required Your ,".tleJS 
engraved on rNnometer ,ind gold 
stomped on use FREE Choose BLACK 
with cttrOll'll! metal m.1noml!!!ter. or 
BLUt GHIEN o. BEIGE w,lh pI....c 
m.-M) hous1nt: tubing. cuM Ind case 
all COIOHOOIdln,ited (specify on coupon) 
No. lOIi Sphn.. . . 39.95 ea. 
Duty Free 


"Jf) 


-...... 


.. 


:
 / 
þ 


BLOOD PRESSURE SET 


An outstanding aneroid sPhyl rnadt 

 In JIPIfI e:søeciJlly 'Of Reeves.. Meets 

 on U S Gov. specs, 
3m.. oct,,,acy 
.2- l\Ioranleed 10 ,..... Block aid 
chrome minometer. cat to 300mm 
Velc." H.e, cull, _ lublnlL ..II 
leatherette 11ppet' use meas.urlnl 
Z
. . 4" I 7" s.nolCed.n USA d 
eve. needed Cllyton No fl4D' 
Slethoscope IslI...) ond Scope Sock 

 Ineluded (see pIIoto lelt!. FREE fOld 
Ie:: - 
 Inlttals on use Here is I sensible. 
· ____ p<ocl,ul, dependoble krt JUst npl 
tor every nurse
 
. No. 41-100 B.P. Set... 
Duly Free 33.95 set complet. 
<;ph,g. only No. 108 .26.95 wilh ca.. 


CAP ACCESSORIES 
 
CAP TOTE keeps ,.,.. cops en'll and clean 
Flel:lble clear plastic 'Mlnte trim Zipper t.1 r ryinl 
sl.op, hang ""'" Slo... 1101 Also lor wlgll". 
curlers. ole I
" d.. 6" hip 
No. 333 Tote. . . 2.95 ea. 
Cold init. add SOc. 


.
 


__
 J 
- I 


,.,- 


'[ 
 
 WHITE CAP CLIPS Holds caps 
_' 
 firml, '" pl""e' Han'.lo-find wtllie _ p,ns, 
,,?,.. ..... 
 enamel on fine spring steel Seven 2 01 ... faur 
...'. ';I" chps anc1uded In plastic snap bol. 
'" .;;, No. 529 Clips B5. per box (min. 3 bo..s) 

 MOLDED CAP TACS 
 
R
pJau CJp band Instantly. Tin) plastic tac. daln.... _./' ..... 
c.ooceus Choose Black Blue White or Crystal wl1 
 
Gold C-.ceus The noter way to 'asten bands . .... 

fì No. 200 - Set of 6 Tacs -::; .. 
rw c.ji' ...1.25perset \.. 
\f

 METAL CAP TACS Pair of dO,"I, 

 lewelry-<Jlahty Jacs with grippers. "
ds up 
bonds secu.el, Sculplured ...laI. fOld finIsh. 
approl 
.. w,de Choose RN, LPN, LVN, RH 
Caduceus Of Plain 
lICeus Gift boxed 
No. CT-l (SpeCIfy In't.). . . . . No. CT-3 IRN 
Cad.). . No. CT-2 (Plain Cad.). . . 295 pro 


IillID 

 


TO: REEVES CO.. Box 719- C, Attleboro, Mass. 02703 
DRDER ND. ITEM CDLDR QUANT. PRICE 


1- 


J 
I 
. INITIALS as desired, _ _ _ 
I TO DRDER NAME PINS, 1111 out all inlormalion In box, top 
left. clip out and attach to thiS coupon. 


r 
---I 
Use extra sheet far additional Items or ordef'5 
. 
I 
I I enclose S I :
e:::ea,:
o:l
ì
:

'
-:

ie r 
I No COD.s or bilJine to individuals. Mass residents add 3% S. T I 
Send to 


. 
Street 
. 
CIty.. . 

 . 


. 
. 


Stale 


ZIP .. 
. 


. 


. 


. 


. 


. 


. 


. 


. 


. 



so 


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. 


SPECIAL OFFER 18 DAYS INCLUDING AIRFARE & MOST MEALS 

**************************** 
. 
uxeEastfirican . if -
 ii' * 
* 



,
9



!?
1
ni

,'
 
ÿ 

. 
 
 
 
 : 
November 6, 1976. Nove_ 23, 1976 " . . . ,. 
111{ MONTREAL. PARIS. NAIROBI. TREETOPS. 
; I J 
-\
 * 
T SAMBURU. LAKE NAKURU . MASAI MAR A . Alllnllu
i\'I.' - 
 '/. " 
 
111{ SERENGETI. NGORONGORO. ARUSHA. Prill' From l\Iontrt'al I * 
T 2DAYSPARIS.MONTREAL 
 500 00(MinRa'ii'i) AIR FRANCE * 
. Mllet Konya Ministry 01 Health OIIicoals $.1 . . - . Luxur) Hotel! Il
' 
111{ and !he Konya Nursing Association - 1\ IIIIIß1Um 6 I\>r.ons reqUired. Auomodal1011. * 
T Visit Rur. Hospitals at Nv!tri and Nairobi In, ludil
 Airlart' and alll11('""ls l'Xlt'pt in p...ris. @ * 
111{ and Tanz..ia Ministry 01 Heolth OIf,aals 
T at Arusha Hospital. Individual _ings ..,1 .. Uk... A1 R CANADA * 
. Brochure ..ailable Irom: --. 
111{ -- african "--I -
-- 33 Bloor St..... East, Sui. 206, Toronto, 0..*'0 M4W 3H1 "
 f'j; * 
T - U
 ,,
....u Tel.: (4161967-0067 Cable: SAFARIS. T.x: 06-231127 I '.,..
' 
***************************** 


I 


(Thesis (M.Sc.N.) - Western 
Ontano.) R 
108. Black, Stella H. An investigat'l 
of the approach to early detection 
breast cancer. Vancouver, 
Registered Nurses' Association of 
British Columbia, 1975. 12p. R 
109. Fleury, Michel. Consideration 
/'évaluation en technique infirmier( 
au niveau CEGEP. Montréal, 1974 
32p. (Thèse (M.A.) - Montréal.) F 
110. Harman, Ron. Nursing servic, 
information system project. Final 
report. Edmonton, Misericordia 
Hospital. 1974. 1v. (various paginç 
R 
111. Holder, Elizabeth L. Noise in 
intensive care unit, its sources ani 
annoyance to patients. Toronto, 
c1974. 70p. (Thesis (M.Sc.N.) - 
Toronto.) R 
112. Ingenito, Françoise. MemOlre
 
la pénurie d'infirmières presenté 
par. . et Suzanne Rollin-Lepage I 
patronné par I'Université du Quebl 
direction des études Universitaires 
dans I'Ouest québecois. Hull, P.Q 
Conseil de la Santé et des ServiCE 
sociaux de I'Outaouais, 1975. 150p. 
113. Jenkinson, Vivien M. Thenursi 
standards project to establish tools 
measurement of the quantity and 
quality of nursing care at the Hospi, 
for Sick Children, Toronto. Report 
the Ministry of Health in the province 
Ontano. Prepared by . . . and Edwir 
Weinslein, Toronto, Hospital for Si 
Children, 1975. 77p. R 
114. Lewis, Geneva. An investigat, 
into the health care needs of the 
elderly in senior citizen apartment 
by . . . Margery Boyce and Pauline 
Chartrand. Ottawa. Ottawa-Carletc 
Regional Health Unit, 1975. 72p. f 
115. Proulx, Pierre-Paul. The labo. 
market for nursing personnel in 
Canada with special reference to 
shortages and partIcipation by 
registered nurses, by. . et al. 
Montréal, Centre de recherches e 
développement économique, 197
 
1v. (various pagings) R 
116. Rakoczy, Mary. The thought
 
and feelings of patients In the waiti 
period prior to cardiac surgery: a 
descriptive study Montreal, 1975 
56p. (Thesis (M.Sc. (App.)) - Mc( 
R 
117 Richard, Jeanne-Aimée. 
Perception de la performance de, 
infirmieres diplomees de C.E.G.EI 
Montréal, 1973. 169p. R 



I ne Lanao.an NurSe Apnl 111110 


Nursing Instructors 
Required 


Beginning May - June 1976 


For Two Year Independent Diploma 
Program in Nursing 
Enrollment - 270 students 
Openings anticipated in 
Fundamentals of Nursing 
Psychiatric Nursing 
Qualifications: Baccalaureate Degree 
with at least one year's nursing 
experience. Courses in education 
desirable. 


Contact: 
Anne D. Thorne 
Saint John School of Nursing 
Beaverbrook House 
Coburg Street 
Saint John, New Brunswick 
Phone No. (506) 658-2203 


.. 


Northern openings for 
health professionals 



 


'\ 


Medical Services, Northwest Territories Region, is 
offering a number of permanent positions for qual- 
ified health professionals interested in serving at 
nursing stations, public health centre and hospitals 
throughout the north. 
Enquiries are invited from qualified applicants pos- 
sessing any of the following: Certificate or Diplo- 
ma in Public Health Nursing; B.Se.N.; or Advanced 
Obstetrics (midwifery). 
Interested? Please fill out the attached coupon and 
mail to: 
Personnel Administrator. Medical Services, North- 
west T erntories Region. Health and Welfare 
Canada, 14th Floor, Baker Centre, IOlJ25 - 106 
Street. Edmonton, Alberta. T5J 1 H2 
or call collect Area Code 403 - 425.6787 


, 
-S
..._ ,
 
.
 (J" 


'- 
'l( 


.... 


......."':::: 


I. Health and Welfare Canada Santr el Blen-elre social Canada 


---------------------------------------------- 


I

 


.. 


NAME 


ADDRESS 


CITY 


"-- 


PROVINCE 


POSTAL CODE 


PHONE 


.... 


At Last... 



 
--f, 
Y" 


a ; .'; n supplier 
fex nurses needs 
No 
 IIbouf CwIomI- Noduly tolØY. 


"I1:H E\ ER\ ORDER. 
f R f f "hitr viDyl POCKET SA \ ER lor 

ÐS. sd!thOr!i o e-tc. ('ht'C1f. box OD 
C:OUþOD. 


STETHOSCOPES 
:-'l R..t:<; .. TETHOS('OPES... 5 
colov.n. ExceptrmtallOJlM 
tronsmis.ion. adj1Utabk 
Iig"l1æ.g"t bma..ra!I: 
replacement parr. m-'OIIßbú 
in Canada. 1/1,14 Siltier. 1U15 
Gold. 1/.90 BIJU. ".92 
Green, 1/.9. Red 19.00 
e.-b. [ftClwe. ìmtiala 
engra:ved free. 
III AL Hf' AD STt:THOSC;OI'L. 
oJ. mpl.j!e. all freqlU!1U:ll!'. Bowln 
sf'ctima laa.a extra large daaphravm. 
AdJ....tabú C""mI. bma..ra!I #41$. n:;.9:; each. 



PHYG)IO'IA:\"O)IETER 



 R..ggl!dandd.pendabú.ruitll 
oJ.nerOld ga..ge caLbroted to!JOO 
, m m Velcro to..c" and."uld 
) ;:::- 
 - .. ""tt Handsome Zippered coal! 

 
 10 year 9"'lrant.e. 1/115 
" 
 12
.95 each. 

....... 
 IndJUles ;1IItrals f'7Igravf?d 


OTOSCOPE SET 



- 
f1 
;.!._ 
!if .-"" 

 


On
 oJ Gennany's fmest 
rn.stMtments Excepf.OJUJl 
.UlI.ml1latI01l. poll r/ul 
71Iatl111jying lens. J standard 
lZe 
s
cul.a Sue (" batlenea 
. dll.ded \It'taI carrying CQ.Sf 
t,ned with '''lt clfJtlt 11:/09 
156.00 each. 


SCISSORS & FORCEPS 
'1 
W 
'I 


11" n R 8\ ""\
F ..n.....'R... 
-t mll.stj"retery \urse 
'lanuftJ("I
Tf'd oj flllest stt'el and 
"
Islaed 111 sanitary clarome 
#
99 
. " 12.60 
"700 51 13.00 
#70
 13.7:; 


III'FR \ r"t. ..ll....IIR<; 
:.j(amtt'
 Stt't'l. strtllght bJ&J I. 
lIi05 51 .. ....harp blunt S2.k5 e-a
h 
"706 5" 
harp "iharp S2.
 e-at'h 
MilO -II r "IRIS ...ri
'""ûr<;,; 13.65 e-ach. r 

, 
FIIR('f'I'<;. 
F,nest 
laln/
ss 
tt't'l 51Z' long 
 
!\.ell
' Forct'p' "72
 Slra'l(hl. box lock 54.35 each 
Kt"II
 Fur("'t"p'" "";':!5 lurvt"d. box lock S4.35 each 
Thumh Drt"'colnK "7.11 Strai
ht. st"rratt"d13.35 rach 


'\TRSES WATCHES 
4. dt'pendabk. attructll.-t' watch. Full 
numbers 1m Ii Ititf' JUCf'. R
d lueep 
c'IRd laand Clarome ("a.u'. .stainless 

tf'f!t tHu-k JelA.'eUed motJement. black 
t.atlaer strap. 1 yr_ gtUJrantf!t' II!JOO. 
11\.50 'p/ru 93cenls;n Ontario I 



 
/ 
" ) ) 
'" . 
11 


"..nTl no, \L:-.l R
E
: Write on yourCompan} 
letterht"ad for our 2-1 pg catalogue. Quantity 
discounts a" ailable. 50 cent handling chargE" for 
ordt"rs less than S5.00 
----------- 
Urder '0. Iu.om l"ol. QuaD. "'Î.l.e Prirt 


Hj\ In \IFUll' \1 "ll'l'l \ ('II. 
1'.11. 1111'\ .. !6.... BRIIC!\.\ III F.II'T K6\ 5\ R. 


I 
I ......nd to: 
I ....rr
r:: 
I l"ih: Prm, .: 
I I'o"tal C'ode _ _ .I 

------------' 



S4 


"The more you 
want from nursing, the 
more reason 
you should be 
Medox:' 


Virginia Flintoft, R.N., Staff Supervisor 


\ 


'", 



..... 


Do y ou want to: 
. increase the variety of your work and gain 
experience to help you specialize? 


Work in a hospital, a nursing home or a doctor's office. Enjoy as- 
signments in a private residence, hotel or summer camp. Perhaps 
you want specialized experience in CC., IC or another field. Medox 
can give you more variety. 


. work for a company that takes special care 
of its nurses in every way, including pay? 


Medox employs the best people at the best rates of pay in the 
temporary nursing field. You owe it to yourself to contact Medox. 


. free yourself from too many mandatory 
shifts and shift rotation? 


Medox nurses get the best of both worlds: the assignments they 
want and the shift work they prefer. Because there are more as- 
signments available. 


. to take advantage of free-lance nursing 
without the paperwork? 


When you work with Medox, we look after all paperwork. We pay you 
weekly and make normal deductions. Medox is your employer: the 
times, shifts and assignments are yours to choose. 


trade the rigid schedules of full-time nurs- 
. ing for the flexibility of temporary or part- 
time work? 


. choose to work only one or two days a 
week? 


As a Medox nurse, you can ease off the strict schedules of full-time 
nursing, Cut down to a few shifts or split shifts a week: the choice is 
yours. 
As a Medox nurse, you can pick the days you want to work: you're 
automatically on call for the time you want. Medox nurses have more 
time to themselves, they can arrange as many "free" days as they 
want. 


. work shifts that tie in with your husband's 
work schedule? 


Wouldn't it be nice to work the same shifts as your husband; both 
home together and both earning good incomes? If his shifts change. 
Medox will arrange to change yours too. 


. retire from nursing, but not completely? 


If the idea of retirement appeals to you, yet not the thought of forced 
inactively, becomes a Medox nurse. Be retired on the days you want. 


'i 
f 


.. A
 a registered nurse 
with more years experi- 
ence behind me than I 
care to think about. I 
know how important it 
is to keep growing in your job-to 
a\oid that awful feeling of being 
stuck in the same rut. Certainly 
what you're doing is tremendously 
worth-while, and heaven knows 
there is a desparate shortage of 
nurses. But your job must be 
worthwhile to you, or else youll 
e\entually want to drop out"". 
"That's why Medox has so much 
to offer a nurse today". "You see. 


at Medox, we supply quality nurs- 
ing staff on a temporary assignment 
basis to hospitals. clinics. doctor
' 
offices. nursing homes and private 
residences. We're a part of the 
world-wide Drake International 
group of companies and we operate 
in major cities acros
 Canada, the 
U.S. U.K. and Australia". 
.. As far as you're concerned, 
however. the key phrase i
 "Tem- 
porary Assignments". Because. as 
you can see by the chart abo\e. you 
can choose just about any working 
condition, or shift. or professional 
discipline you want". ..It comes 


down to this: if you want more from 
nursing than you're getting now. 
talk to Medox". 
"Write to me. Virginia Flintoft. 
R. N.. Staff Supervisor, Medox, 55 
Bloor St. W.. Toronto, Ontdrio, or 
call the local Medox office". 


[MlmoX] 


. DRAKE INTERNATIONAL company 


If you care for people, 
you're Medox, 



Clllssi fïl-(I 

 \(Ivl-I.. ÎSel11el1ts 


une 23 - 25. 1976 Seventh Annual Meeting 01 Ihe Canadian AssOCla- 
on of Neurosurg.cal Nurses to be held In Winnipeg Manitoba at the 
orthsrar Inn For IOformatlon wnte Myrna Dnedger. Program Coor- 
nator 500 Barker Blvd. Winnopeg, Manotoba, R3R 2C2 


l\lberta 


UMMER VACATION: I-tave you conSIdered horseback ..ding and 
ampong In the Rodoe Mounlalns near Banff, Albena? Eight 6-day 
nps sponsored by a non proht ndlng club are planned lor Ihe summer 
11976 For brochure wnle to Trail Riders 01 the Canadian Rock...s 
x 6742 Station D, Calgary. AIber1a T2P 2E6 . 


British Columbia 


=legistered Nurses and Nursing Supervisors required by a 100- 
lAd acute care and 4Q.be<]' eJ<.ended care accreål.ed hospItal Must 
'E! ebglbJe for B.C registration Permanent and summer relief paSI- 
I()f"'S available for general duty and operating room. Experience pre- 
erred for operating room POSitionS. SUperviSOry apphcants muSi have 
!xpenence In administrative or supervisory nursmg R N s salary 
\104910 S1239 and Superlllsor s salary $1258 to 51481 (RNABC 
\greemenl-1975) Apply In wnllng to lhe Dnector 01 Nursing. G R 
'!aker Memonal Hospotal 543 Fronl Street Ouesnel. BnloSh Co/um- 
)la. V2J 2K7 



EGISTERED NURSE requned lor Independenl Boarding SChOOl lor 
,o1s 150 slodents ages 11-18 Resldenl pOSItIOn commenCIng Sep- 
mber 1976_ Apply In wntlng to HeadlTllstress Stralhcona Lodge 
nooI. Shawnogan Lake. B C_ VOR 2WO 


a:xperjenced General Duty Nurses requued for small hospnal NOr1h 
I.ncouver Island area Salary and personnel poliCIes as per RNABC 
"On'ract ReSl(Jence accorr,mod'allon 530 00 per monih Transpor1a- 
.un Dæd from Vancouver Apply 10 D"ector of NurSing 51 George s 
3sPdal. Box 223 Alen Bav Bntl
h Columbia VON 1 AO 


General Duly Nurses lor modern 41-bed hospital localed on ''''' 
.aslo(a Hlgnw3't Salary and personnel policies In accordance with 
RNABC Accommodal,on available In residence Apply D"ecIO' 01 
. urslng. Fort Nelson General HOSpital. For1 Nelson British Columbia 


Exoerienced Nurses (eligible lOr Be reglstrahan) requred h... 
41J:I-bed acule care leaching hospllal localed In Fraser Valley 20 
Inutes by freev.'ay from Vancouver. and within easy access of vaned 
recreallonal facilities Excellent Qnenlahan and Contmulng Education 
I programmes_ Salary $1.049 CO 10 $1 23900_ Clinical areas Include 
MedICine General and Specialized Surget)' Obslelncs Pechatflcs 
Coronar't Care HemodIalysIs Rehabllliatlon Operating Room Inten- 
s,,'" Care Emergency Practical Nurses (ehglble lor B C Llcensel 
also required Appty to AdmlOlstratlve Assistant Nursing Personnel. 
Royal Columbian Hospital. New Weslmrnster Bnllsh Columbia 
V3L 3W7 


Graduate Nurses lor 21-bed hospnal prelerably wnh obsletncal ex- 
penence Salary In accordance with RNASC Nurses residence 
Apol't to Matron Tofino General HosDltal. To',no Vancouver Island 
8n11511 Columbia 


New Brunswick 


PosItions avaltable July 1 1976 'or 'our leachers who can Qualify as 
AssIstant Or Associate Professors In a baccalaureate program with 
260 students One teacher needed with Master s degree and 
e){
 nence In community nursing and one with Master s degree ancJ 
exoenence In medical arid surgtcal nursmg Other teacherS needed to 
gUIde basIc and Post-R N students In c. meal experience In hospitals 
and community Modern new curriculum well equipped 
self-Instrucbonallaboratory new community hospital beautiful sman 
CI!\ Write Oean Faculty of Nursing The University of New 
Br mswlck Fredericton New Brunswick E3B 5A3 


Ontario 


Regis1ered Nurses for 34-bed General Hospllal Salary 5945 00 10 
S 1 14:. JO per month plus expeuence allowance Excellent personnel 
pohcles App1't to Director at Nursing Englehar1 & Dlstricr Hospda' 
Inc Englehart Ontano POJ 1 HO 


Cn jrens summer camps In sceniC areas 0' NortlJern OntariO reqUire 
Camp Nurses for July and Au .1 Each 'Ias resident M D Contact 
Harotd B Nashmé'" CalT'r\ Services CO-aD 821 Egllnlon Avenue 
Wesl Toronto. Ontèf c r...:J1\. 
t:.t 


"'VIII lõ;IIIU 


,,,, 


UNIVERSITY FACULTY: For basIc baccalaureate programme 
convnu",'y health nursing wnh special emphaSIs on parent/child, 
psychlatnc nursing and pnrnary care. slrong 10undatlOn desned In I"e 
sCiences. competence as chmclan required. master s degree 
reqUired prevIous expenence 10 university teaching preferred 
Academic rank and salary commensurate Wllh quallficallOns. Send 
resume and references - Dean, SchooJ 01 NurSing. Queen s 
University KlOgston Onlano K7L 3N6 


Registered Nurses are reqUired .mmed.<:lely lor the 43.bed Wadena 
Unron Hospttal TnlS IS a modern attractive acute care hospl1al 
s
ualed In Ihe 10wn 01 Wadena Saskatchewan a I"endly parkland 
coml'l11Jnlty wnh a pOpulation of 1500 AltraC1lve salary and I"nge 
benefits are provoded under the Saskalchewan Umon 01 Nurses ag- 
reement In eHect Please direct apptlcatlons to Adm., >Iralor 
Wadena UnIOn Hosp.lal. PO. Box 10. Wadena. Saskatchewan 


General Duly RegIstered Nurses lor 22-bed hospital snuated In 
South Eastern SaSkatchewan on the Trans Canada highway near 
lakes and Last Oal< Siu ReSOr1 Salary per SUN Agreement Please 
apply to. Director of Nursmg Broadv!ew Umon Hospital Broadvlew 
Saskatchewan. 


Saskatchewan 


Unfl/erslty 01 Saskalchewan - Faculty Posn,ons Term and regular 
appointments In Matemal-Chlld. pnmary Care. Community and Men. 
lal Health NurSing To teach In lour year basIC and Ihree year pOst- 
diploma programs and COn1nbute to curnculum revISIOn Quab'J(::a- 
tlons Master s or hlQher degree and expenence In clinical field for 
appointment at protesstQnal ranks: Baccalaureate degree and expen- 
ence lor appOIntment as lecturer Contact Dean. College 01 Nursing. 



"o

 of Saskalchewan Saskaloon, Saskalchewan. Canada 


United States 


Texas wants you! tf you are an RN. expenenced or a recent 
graduate come to Corpus Chnst,- Sparkling Qty by the Sea a oty 
bulkll ng tor a bener futl6e. where your opportlM1ltles for recreabon and 
studies are Ilmniess Memonal Medical Cenler 5CO-bed general 
leaching hospItal encourages career advancement and prollldes 
InserY1ce onentatlon_ Salary Irom $802 53 to $1,069 46 per month, 
commensurate with education and experience. Differential 'or 
evening shifts. available. Bene'lts mdude holidays. sick leave 
vacations. paid hospltahzatlon, health. life insurance. penSion 
program_ Become a volal pan 01 a modem up-to-date hospotal. wnteor 
call John W Gover Jr, o,re<:tor 01 Per.;onnel, Memona! MedIcal 
Cenler. P _0_ Box 5280, Corpus ChnsÞ Texas. 78405. 


Direc10r of NurSing: Immediate app11cahons are Inv"ed tor the POSI- 
lion of Director of NurSing m the 43-bed Wadena Union Hosp,1al 
Fringe benefJts Include Registered Pension Ran Group Life Insur- 
ance and Income Replacemenl Plan This IS a seven year otd wen- 
eq..pped hospnalln a town 01 1500 pOpulallon serving a large rural 
population Wadena IS centrally localed 130 ""Ies from each 01 Iwo 
major Saskatchewan centres SUperV1S0ry experience IS essential 
Nursing Administration course desirable Al1raC1lve salary seale 
w:

a 


I

sgp

"
c
los
:n
3x




 tos:




=:

 
SOA 4JO 


R.N:s needed Immediately lor a 31-bed aeule care hospnal ROIatlng 
shilts We will assISt In making arrangements to come to beautllul 
Wyomlng_ Call Collect o,rector 01 Nurses. Cheryl Karkheck - 307- 
682.8811 


REGISTERED NURSES: requlfed Immedlalely for the 22.bed Acule 
Care HosPlialln the Industnallown 01 Hudson Bay Saskalchewan. 
Hudson Bay IS slluated In a 10res1 regIOn wnh excellent fishing. hunÞng 
and recreational faCilities. Salary and fnnge benefits according to the 
SUN Agreement Please direct appftcallons 10. Mrs B Montgomery. 
o,rector 01 Nursing, Box 578 Hudson Bay Saskatchewan SOE OYO_ 


Two careers in one. 


. 


Have you ever thought 01 combinmg two 
careers in one? As a Canadian Forces nurse 
you could, because you would also be an officer 
eligible lor regular promotion, enjoying a mim- 
mum 01 lour weeks vacation your very hrst year, 
Iree transportation privileges to many parts 01 
the world. early retirement including a generous 
liletime pension and a number 01 other bene- 
hts The Canadian Forces will give you every 
opportunity to continue your nurse's training, 
while using the skills you already have in one 
01 the many military medical installations in 
Canada or overseas You might Quality lor flight 
nurse's training or even lor a complete doctorate 
study course 
II you're a graduate (Iemale or male I 01 a 
school 01 nursing accredited by a provincial 
nursing association and a registered member 
01 a provincial registered nurses' association, 
a Canadian citizen under 35 with two years' post- 
graduate expenence in nursing, you owe it to 
yours ell to enlOY two careers in one 
Contact your nearest Canadian Forces 
Recruiting Centre or write to: 
Director of Recruiting and SelectIOn 
National Defence Headquarters 
P.O. Box 8989 
Ottawa. 0 ntario ,.4..-.. 
K1A OK2 .

 

.
J! 

 

 

" , ß 
. ... 


-

 


....... 
t . 
1 " 
. . 
. , 
. . 
. I 


-- ---- 



 


- 


.> 


. 


. 


. 


. 


CET 
INVOLVED. 
WITH THE 
CANADIAN 
ARMED 
FORCES. 



56 


The CanadIan Nurse April 1976 


Georgian College 
of Applied Arts and 
Technology 
Health Sciences Division 


"Meeting Today's Challenge in Nursing" 


Queen Elizabeth Hospital of Montreal Centre 


Requires Faculty for Diploma 
Nursing Program in Owen Sound, 
Orillia and Barrie 


A Teaching Hospital of McGill University 


and Ambulance Attendant Program 
based in Orillia 


requires 


New, progressive, integrated 
curriculums. If you are a creative 
and innovative teacher, if you 
believe In seff-directed learning, 
we would like you on our staff. 


Registered Nurses 
and Registered Nursing Assistants 


Starting date August 17, 1976 with 2 
weeks orientation. 


. 255-bed General Hospital in the West of Montreal 
. Clinical areas include Progressive Coronary Care, Intensive Care, 
Medicine and Surgery, Psychiatry. 


Please write or telephone: 


Miss C,M. Brown 
Nursing Administrator 
Georgian College of Applied Arts & 
Technology 
43 Colborne Street West 
Orillia. Ontario. L3V 2YS 


Interested qualified applicants should apply in writing to: 


Téléphone: (705) 325-2705 


Queen Elizabeth Hospital of Montreal Centre 
Director of Personnel 
2100 Marlowe Ave., Montre
l, Quebec 
H4A 3L6 



 


Vancouver General Hospital 
Invites applications for 


Nursing positions in all clinical areas of an 
active teaching hospital, closely affiliated 
with the University of B.C. and the 
development of the B.C. Medical Centre. 


Regular and Relief 
General Duty 


For further information, please write to: 
Personnel Services 
Vancouver General Hospital 
855 West 12th Ave. 
Vancouver, B.C. 
V5Z 1 M9 


, 



Judy Hill Memorial Scolarship 
Applications are being received for this annual Scholarship. details of 
which are as follows: 
Value Up to $3.500.00 
Purpose To fund post"9raduate nursing training (with special 
emphasis on midwifery and nurse practitioner training) for a period of 
up to one year commencing July 1 st, 1976. 
Tenable In Canada, the United Kingdom, Australia, and New 
Zealand. 
Applicants should possess the following qualifications: 
. Fluency in English; 
. . R.N. Diploma, or equivalent; 
. A desire to wor\( for the Government of Canada or one of its 
Provinces at a fly-in nursing station in a remote area of Northern 
Canada for a minimum period of one year following completion of 
the scholarship year. (Details of this wor\( will be forwarded on 
request.) 
And should submit: 
. A resume of their academic and nursing career to date; 
. Copies of the educational qualifications submitted on entry to 
nursing school; 
. Verification of their R.N. Diploma, or equivalent: 
. Their proposed course of study; 
. Acceptances and/or preferences for place of study; 
. Two character reference letters. 
To: Philip G.C. Ketchum, 
Chairman, The Board of Trustees, 
Judy Hill Memorial Fund, 
829 Centennial Building, 
Edmonton, Alberta, 
Canada. 
BV: May 1st, 1976 
The Scholarship is conhngent on the successful applIcant s beIng regIStrable by a 
nurSIng assooatlOn on one 01 the Canadoan prOVInces and meehng current Canadian 
Immigration requirements for landed Imrngrant status. A successful appflcant from 
outSide Canada will be asSisted by the Trustees In meeting these requirements. 


University of Toronto 
Faculty of Nursing 


Bachelor of Science 
in Nursing: 


The Undergraduate Programme leading to a B-Sc.N. degree involves 
two curriculae: 
1. Four year course - the majority of students enrolled in !he course 
enter di rect from Grade 13, but a number with post-secondary education 
are also admitted. 
2. Three year course - for graduates of diploma schools of nursing. 
The first and second yearol this course are also available on a part-time 
basis. 
Bo!h courses proVIde a professIonal preparation which includes 
Qualification for nursing in both the hospital and pub
c health field. In 
bo!h cuniculae humanities and saences is assooa,ed with !he study of 
nursing. The four-year programme prepares the student for registration 
under the Nurses' Ad of the Province of Ontario. 


Master of Science 
in Nursing: 


Offered by the Faculty of Nursing through the School 01 Graduate 
Studies, this programme offers opportunity for the preparation of nurses 
to provide leadership in planning and giving high Quality care. Three 
areas of specialization are offered at present: medical-surgical, 
community health and mental health-psychiatric nursing Each 
candldate's programme is individually planned: electives in the 
functional areas of education and administration may be selected. A 
thesis is required and involves the investigation of a nursIng problem in 
!he area 01 !he student's clinical specializatIon. 


rne (;8n8018n Nurse April lV/I) 


,,, 


657 bed, accredited, modern, 
well equipped General Hospital, 
rapidly expanding... 
Saint John 
'i
j. 
General U \ \" 
GJfoÆPital 
ðaintGJohn,NH, 
CANADA 


,...- .-' 
. 41 



QUIRES: 
Genetãlðtaff N.yrses c;& 
Registered Nursing Assistants 


In a/l general areas: Medical, Surgical, 
Pediatrics, Obstetrics, Chronic and 
Convalescent, several Intensive Care 
areas and Psychiatry. 


. Active. progressive in-service education program, 
Speciat Attenlion 100rienlalion. 
Allowance lor Experience and Posl Basic Preparalion 
FOR FURTHtJR INFORMATION APPlY TO 

ERSONNEL DIRECTOR 

aintc:John General Hospital 
Po. BOX 1000 Saint John. New Brunswick ElL 4Ll 


m 


MEDICINE HAT COLLEGE 


INVITES APPLICA TrONS FOR 


PoslUon: NURSING INSTRUCTORS 


Qualifications: Master's degree preferred but not essential. 
Must have R.N. with a Bachelor's degree and previous 
teaching and nursing experience. Special preparation in 
Medical, Surgical, and Psychiatric Nursing will be an asset. 


Salary: Dependent on education and experience 
Range is from $11,000 to $23,000 


. 


Location: Medicine Hat College has about 80 students in the 
Two Year Nursing Diploma Program. The College is ten years 
old and enJoys a new campus in a rapidly expanding city of 
30,000 people. 


Starting date: July 1, 1976 


Send full details of training, expenence, plus references to: 
Mr. C.L Dick 
Academic Vice-President 
Medicine Hat College 
Medicine Hal, Alberta 



58 


Brandon General Hospital 
School of Nursing 


Nurse Teachers 
for Two Year Diploma Program 
Positions Available July, 1976 
in Nursing Content Areas of 
"Fundamentals" - "Maternal- Child" 
"Medical-Surgica1" - "Psychiatric 
Nursing" 


Qualifications 
Baccalaureate Degree in Nursing is required. 
Preference given to applicants with experience in 
Nursing and Teaching. 


Apply in writing stating qualifications, experience, 
references to: 


Personnel Director 
Brandon General Hospital 
150 McTavish Avenue East 
Brandon, Manitoba 
R7 A 2B3 


Registered Nurses 


1260 bed hospital adjacent to University of 
Alberta campus offers employment in 
medicine, surgery, pediatrics, obstetrics, 
psychiatry, rehabilitation and extended care 
including: 


. Intensive care 
. Coronary observation unit 
. Cardiovascular surgery 
. Burns and plastics 
. Neonatal intensive care 
. Renal dialysis 
. Neuro-surgery 


Planned Orientation and In-Service Education 
programs. Post Graduate clinical courses in 
Cardiovascular - Intensive Care Nursing and 
Operating Room Technique and Management 


I' 


Apply to: 
Recruitment Officer - Nursing 
University of Alberta Hospital 
112 Street and 84 Avenue 
Edmonton, Alberta T6G 2B7 


The Canadian Nurse April 1976 


The Registered Nurses' Association 
of Nova Scotia 


!nvites applications for the position of 


Executive Secretary 


The applicant should have a broad nursing background, 
administrative experience and university preparation, 
preferably at the Master's level. A background in 
professional association activities would be an asset. 


Applications for this position will be accepted until 
September 1, 1976. 


For complete information, including job description and salarv 
range, write to: 


President 
Registered Nurses' Association 
of Nova Scotia 
6035 Coburg Road 
Halifax, N,S, 83H 1 Y8 


[l]@ 


University of 
Alberta Hospital 


Edmonton, Alberta 


o 



Holy Cross Hospital 
Calgary 


The expansion of our Inservice 
Department has made it necessary for the 
creation of two new senior positions. The 
, positions are Instructor positions and are 
described as follows: 
Inservice Instructor - Acute Care 
The successful candidate will be 
responsible for the effective provision of 
inservice education in several clinical 
areas including Emergency, Acute 
Medical-Surgical, Intensive Infant Care, 
Orthopedics, Neurology, and 
Ophthamology. A B.Sc.N. is required with 
several years' progressive nursing 
experience with one year of teaching 
expertise. 
Inservice Instructor - Mental Health 
Candidates must provide documentation 
which indicates that they meet the 
profession I requirements of practice in the 
province of Alberta. A B.Sc. N. is required 
with major areas of concern in education 
and mental health. Applicants should 
have several years' progressive related 
experience with two years in the mental 
health field and one year of teaching 
experience. 
Interested qualified applicants should 
apply to: 
Hospital District No. 93 
Personnel Department 
940 Eighth Avenue SoW. 
Calgary, Alberta 
T2P 1 H8 


The Department of Continuing Education, 
Kelsey Institute of Applied Arts and 
Sciences, Saskatoon, requires: 


Diploma Nursing 
Instructors 


For the purpose of establishing an eligible 
list of qualified candidates for anticipated 
vacancies in Saskatoon, North Battleford 
and Prinæ Albert, the Public Service 
Commission invites applications from 
Registered Nurses with a Degree in 
Nursing and supplemented by experience 
in teaching preparation, nursing 
education and nursing practice. Duties 
will include classroom teaching and 
clinical guidance of students in the first 
and second year of the Diploma Nursing 
program. 


Salary is commensurate with education 
and experience. 


Competition number: 501010-6-485. 


Please quote position, department and 
competition number on all applications 
and/or enquiries. Forward all applications 
and/or resumes to: Public Service 
Commission, 1820 Albert Street, Regina, 
Saskatchewan. S4P 2S8. 


The Canadian Nurse April 1976 


S9 


:.\

 GENEIi-1l 


 [j !2 

 
 

 
 

 
 
<þ., 
 
 

 
 
'6 Ó 

 
 
-1'\t() C> ,,
 
llACH\
 


Quebec's Health Services are progressive! 


So 


. 


. 


IS 


nursing 


at 


The Montreal General Hospital 


a teaching hospifal of McGill University 


Come and nurse in exciting Montreal 


r-------------------------------- 


!ii
 
\UG 


The Monfreal General Hospital 
1650 Cedar Avenue, Mantreal, Quebec H3G IA4 


Please tell me about hospital nursing under Quebec's new concept of Social and 
Preventive Medicine. 


Name 


Address 


L_______________________________J 



60 


The Canadian Nurse April 1976 


':
: . 

 ;

; , 


. , 
f 


...... 


(( 


/;
 ;
y
"7: 
v-.......c..
/ 
. 


,
::T

 _ 
.'- "'To. 
 
..:.. 


.- 
,.
:f:' 
:-

f
::
';:" t.....,:- .
' 
,ø ';:/.y>1 
,... '!'- - 
-.i#/ 
 .... 

 .y)' " 
- 
\';I 
 
 


-- 


General Staff Nurses 


required for 
Regina General Hospital 


openings in all departments 


Recognition Given For Experience 
Progressive Personnel Policies 


Apply: 
Personnel Department 
Regina General Hospital 
Regina, Saskatchewan 
S4P OW5 


Apply to: 
Director of Nursing Ongoing staff education 
Montreal Neurological Hospital 
3801 University St. 
Montreal, P.O. H3A 284 


Individual orientation 


If Paris appeals to you 
. . . so will Montreal 


. Modern 700 bed non-sectarian hospital 
. Excellent personnel policies 
. Registered Nurses and Nursing Assistants 
are asked to apply 


. Active In-Service Education program 
. Bursaries available 
, . Quebec language requirements do not 
apply to Canadian applicants 


, 


Director, Nursing Service 
Jewish General Hospital 
3755 cote ste. Catherine Road 
Montréal, Québec 
H3T 1 E2 



North Newfoundland & Labrador 
requires 
Registered Nurses 
Public Health Nurses 
International Grentell AssociatIOn provides 
medical services for Northern Newfoundland 
and Labrador. We staff four hosprtals. eleven 
nursing statlOf1s. eleven Public Health unrts. Our 
main 180-bed accredited hospital is situated at 
St. Anthony Newfoundland. Active treatment is 
carned on in Surgery, Medicine, Paediatrics, 
Obstetrics, Psychiatry. Also, Intensive Care 
Unit. Onentation and In-Service programs. 
40-hour week rotating shifts. Living 
accommodations supplied at low cost Public 
health has challenge of large remote areas 
Excel/ent personnel benefits include liberal 
vacalron and sic!< leave. Union approved 
salaries start at $810.00. 
Apply to: 
International Grenfell Association 
Assistant Administrator of 
Nursing Services 
St, Anthony. Newfoundland 
AOK 4S0 


DONO 
 RS 
BLOOD 
I 
. LIFE 



 


y.. 

 - 


Sea 
RED 
CROSS 
BLOOD DONOR 


. 
.' 


University Nursing 
Faculty Positions 


Maternity, Paediatric, 
Medical-Surgical, 
Psychiatric 


Masters degree and teaching 
experience required. Excellent 
personnel policies and fringe 
benefits, Rank and salary 
commensurate with education and 
experience. Positions available' 
Fall, 1976. 


Write to: 
Dean 
Faculty of Nursing 
University of Toronto 
Toronto, Canada 
M5S 1A1 


The Canadian Nurse April 1976 


Canton Hospital 
Winterthur Switzerland 
(Near Zurich) 


For our modem well organized Physical 
Therapy Unit and for the Rheumatic Clinic 
we need Physiotherapists for various 
dulies associated with Rheumatological 
Surgery, Internal Medicine, Paediatrics 
and Gynaecology. We offer pleasant 
working conditions equitable hours of 
work and leisure, Salary in keeping with 
qualifications, living quarters provided. 


Applicants should apply directly to: 
Kantonsspital Winterthur, 
Personalburo, 
CH 8401 
Winterthur, Switzerland 


Senior Public Health 
Nurse 


The Department of Health & Social 
Development, Community Operations, 
Portage la Prairie, requires a person who 
in a multi-disciplinary setting, 
co-ordinates area public health nursing. 
Plans and evaluates programs to fill 
community needs. Orients and develops 
new nursing personnel to provide quality 
service. Acts as guide and resource to 
own staff, plus learns in allied disciplines, 
outside agencies and community. 
B.N. plus four years related experience. 
SALARY: $13,680 - $19,836 per annum 
This position is open to both men & 
women. 
Apply in writing referring to#1128 on 
or before April 22, 1976: 
CIVIL SERVICE COMMISSION 
Recruitment & Selection 
Room 904 - 155 Carlton St., 
Winnipeg, Manitoba 


Registered Nurses and 
Nurses Assistants 
required for 110-bed hospital for 
chest diseases situated in the 
Laurentians, 55 miles north of 
Montreal. 
Salaries are now being updated 
Excellent fringe benefits. 
Quebec language requirements 
do not apply for Canadian 
applicants if registered in Quebec 
before July 1976. 
Apply: 
Director of Nursing 
Mount Sinai Hospital 
P.O. Box 1000 
Ste-Agathe des Monts, Quebec 
J8C 3A4 


61 


OPERATING ROOM 
TECHNICIAN 


required for small, general hospital. 
Cast room experience preferred. Will 
also be required to care for 
anaesthetic and other equipment. 


Apply in writing to: 


Miss Catherine McFarlane 
Paddon Memorial Hospital 
International Grenfell Association 
Happy Valley, Labrador 
AOP 1 EO 


Nursing Co-ordinator 


Operating Room and Recovery Room 
Leadership and adrninislrative qualities 
desirable. B.Sc.N. preferred. Previous 
Operating Room experience essentiaJ 


Salary commensurate with qualifications 
and experience. The Thunder Bay area is 
well renowned for its many summer and 
winter recreational facilities all within 
minutes of the city. 


Apply sending complete resume to: 
Personnel Director 
St. Joseph's General Hospital 
Thunder Bay, Ontario. 


SOFRA.TULL.' Rouaa-' 
Fr.m1'cetln Sulphate BoP. Antibiotic 
Inclcat_, Treatment 01 ,ntec1ed or polentoaby .,Iecled 
burns. crush I"Ilures. &acerahons Also vancose ulcers. bed- 
9:)res and ulcerated wounc::!i 
Conlratncllcatl_a: Known allergy to Ianoion or Iramyce- 
tm Cross-sensitization may occur among the group'OI 
slreplomyces-deo....d anllbtohCS (neomycin. paromomyc". 
kanamycin) of whICh framycetJn IS a member but ttus IS 
not lI'vðfl3b1e 
Pr__ut_, In mpsl cases absorpbon 01 the anhboot", IS 
so Shgnt 1I1al n can be dISCounted Where....'Y large body 
areas are "volved (e 9 30'16 or """e boóy bum) Ihe I>OSS' 
DIIny of O'OIO>'CI!y be.,g eventually prOduced Should be 
conS<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 
. 
} í 
 


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 


.;.
 -.,'
. 
. ' 
 .j....
:
.. I 
! 'l

'1'. .
. ". ....
 
l',":::" . 

-

 . 
: :::: . .....' f'''; ... 
(
f...:..,..:. .',.";....j..,,, 

 ir,
;

i
1
E}> 

" ::';:: . .': 
\ '
. ',\ 
I -""',," ..,., 
" 


warth 
looking 
inta... 


\ 


,
.- 
.. ..1.. 
!.:
/ 
'ir.,/ :
\ :>-.:::. 
:" ;'1'::::':>' ::{ 
'
rJ.;.' ":;:;", 
. 
.-::
 1-' r. 
(.. . 
,/ ..... . '>_ 
 .Ji' I ' ' ' , 
''-rif' ': . :.' 
, ".1.',. Y I 6. r j . ".- -to: ." .' 

 ; J '. ,:!!:



. -':'. 
--J "',".:
.
 .' . .: . 
........ It.. :"'-. ""-. ',. 
/ ,ir;

 
I \/'. 


.-.. .":
: ". . 


. .... ..
; 


</ 
\ 
l 


I 
\ 


/ 


I 


O[[upotionol 
health 
. 
nursing 
with Canada's 
federal public 
servants. 


. * Health and Welfare Sante eI Blen-etre social 
Canada Canada 


t 


,---------------
 
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.;] 



) 76 


The Canadian Nurse 


Eco r n57 l.. 


L 


6 n )-111 ..( TE
BURG 
CfT \
A oL. { .T 


r r - 
-.- , -- - . 
- \ , 
.\ 
- I 7]] 

""'" 
'"'- ] . 

 I 
.... ... 
- -=-...--- - 
-- . -= - 
... 1 
1, , .... 
1 - . 


" 


-- ,,/' 


Î
 



 


-------' 



THE 


BEST 


OF 


NOW 


BY 


1 
\ 
J:
 
l
 
l
i' 
"'I .<
 
::j 



::
:.. "
'.. 
 t....
 
.; "'
.. 
 ç. -, 
 

...."" "" 
· .. .-" . .:", i . " 
 - ,,,, 
. .h .-.. 
 1 
..
.::t_ 
-::. 
 .
iz. - 
.. .
 ,,- 
 
 
-.


,\ 
l -

;
 t

 

 

. 
---,. 



 
.'. 
...! 
t" 
;: , ;. 
..
 


.. 
- 
.l 
,;: .:

 
_
 
 Ñ .- 

. 
:_
 ç 
,,-.
t 
:.:
 1 -<: 
 
: 
ifli 
t 
 
K}. 
 
.,-. 
1 


\ \\ 
\ \ . .- 
.- 
\\ ;- 
,- 
,. 
- 

 
II 


A & B) Style 46411 
Sizes 7 - 15 
Royale Corded Tricot 
White, Mint, 3-piece. . . . . .about $32 


B 


/ 
J 


t/ 


C) Style 6836 
Sizes 1 0 - 18 
Royale Seersucker 
100% Woven Polyester 
White, Mint. . . . . . . . . . . . .about $2! 


1) IG 



 


\NHITE 
SISTER 


See our new line of Whites and Water Colours at fine stores across Cana 



New 


- 


@ 


The shampoo that guards against dandruff! 


Oan-Gard is really two preparations 
in one - an effective dandruff control 
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. 


...
 


125m! 



 125
 
éIOt'-pellicuies 
dan- 
 
garä. da n - 

 9arä. 



 

......

 
-
 ""-- ........ 


é\r1!j,danåuff 

 

 
'"'- -'--.. 
'::

 c-... 


88là __guards against dandruff! 


130517026'( 



f 


E 


IFFE 


\.... t-r:. r' 
((.I" 

 


\. 



 I Burroughs We II come Ltd. 

 LaSalle, Que. 
For full product information, see page 55 


- 


rn 


. 



 


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 


" 


. Trade Mark 



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 


. 
--- 
 --r;- 
"" I]}
.. 


-t 


. 

 


..' 


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 


'f 
J 


.. 

 


--v.- 



 


,( , 
. \ 


J ' 



 


.. 


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 . . . 


.. , 


'- 


t 


\0- 


, 


" 


'-- 


- 



 --- 


, 


.. 


-.... 


.... 


. 
{ 


1___ 
- 


, " 


, , \ , A 

 "- 

. .,
 '
. 
so will retelast ,
,,:
 
I 
Your patients will be back to normal in no \'",
 \ I. 
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 
RETAIL PRICES 


NURSES ARE PRIVILEGED TO BUY DIRECT 
FROM FACTORY AT SENSATIONAL SAVINGS. 


Cut down the high cost, avoid 
the middle-man profits. Buy 
direct from the manufacturer at 
lower costs. 


BUDGET if you wish at no 
extra charge. 


LEATHER COAT DEPARTMENT 
Famous brand of genuine leather 
coats in latest styles æd 
colours - plain - fur trimmed - 
zip-in lining. 


t 


1IoUSB OF- 
APPBL 
FU R CO. LTD. 


Manufacturers of 
FINE FURS 
119 Spadina Avenue 
Toronto, Onto 
M5V 2L 1 
Tel.: 363-7209 


-. 


.. 


, 


1 


_r . 
IH"}((.t'\ 
- 


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 


The author's text considers pediatric disorders from both psychological and 
cbnical viewpoints. Organized by chron01ogic stages from fetal Me through 
adolescence. this book deals with common pediatric disorders. their 
impending emotional impact on both the chiJd and the nurse, and helping 
the child adjust to a hospital environment (A Teacher s Guide is available) 
By Eleanor Dumont Thompson, RN. St Joseph's Hospital School of Practical 
Nursmg. Nashua. N H About 380 pp.. 165 ill About $6 70 Ready June 1976 
Order #8842-X. 


Jacob & Francone: ELEMENTS OF ANATOMY 
AND PHYSIOLOGY 


This beautifully illustrated new text by the respected author artist team of 
Stanley Jacob and Clarice Francone reveals current concepts of cellular 
physiology and the role of DNA and RNA In heredity and life-functions. 
Tissue structure. appearanæ and function are described: each of the 
body's primary functional systems is examined separately. Text headings 
such as. What Does a Neuron Look Like') focus attention on the concepts. 
By Stanley W. Jacob. MD, FACS. School 01 Mediane. University 01 Oregon Health 
Sc1ences Center. and Clarice Ashworth Francone. Medical Illustrator About 260 
pp. 240 dl. 65 10 color Solt cover Aboul $7 75 Just Ready Order #5088-0. 


Simmons: THE NURSE-CLIENT RELATIONSHIP 
IN PSYCHIATRIC NURSING: Workbook Guides to 
Understanding and Management. New 2nd Edition 
This practical workbook shows you how to estabhsh a therapeutic relation- 
ship with the mentally ill patient This revised edition mcludes new guides 
on observation oj anxiety. assessing the miheu. theoretical approach. crisis 
interoention descriptive data. assessment oj the client's learning. and 
assessing oj the nurse's learning. 
By Janet A. Simmons. RN. MS. Filchburg Slale College About 240 pp Solt cover 
About $700 Jusl Ready Order #8286-3. 


Kron: THE MANAGEMENT OF PATIENT 
CARE: Putting Leadership Skills to Work. New 4th 
Edition 


Here's a modem look at the challenges of nursing leadership in the rapidly 
changing health care field It examines the responsibihties of the profes- 
sional nurse. the legal aspects of practice. ways to improve communication 
and understanding. the administrative and managerial responsibilities of 
nurses. methods of work improvement and leadership skills Particular 
attention is paid to defining the role of each mc"nber of the nursing team. 
By Thora Kron. RN. BS Aboul290 pp llIustd Solt cover Aboul $5.15 JUSI Ready 
Order #5528-9. 


Gillies & Alyn: PATIENT ASSESSMENT AND 
MANAGEMENT BY THE NURSE 
PRACTITIONER 


This brand new text is ideal for developing your skills in interviewing, 
physical examination. laboratory test interpretation. and protocol m the 
management of patients with chronic tllnesses such as hypertension. 
diabetes. osteoarthritis. arteriose/erotic heart disease. obesity. alcoholism. 
and chromc obstructive lung disease 
By Dee Ann Gillies. RN, EdD. Asst Dlreclor 01 the Dept 01 Educabon Health and 
Hospitals Governing CommissIOn 01 Cook County. IIbnois. and Irene B. Alyn. RN. 
PhD. Assoc Prol 01 Medical Surgical Nursing. Univ. 01111 College 01 Nursing 236 pp 
lIIustd Aboul $11 35 JUSI Ready Order #4133-4. 


Falconer. Patterson & Gustafson: CURRENT DRUG 
HANDBOOK 1976-78 


You'li find the most recent clinical information on about 1.500 drugs in 
common use in the Current Drug Handbook. Its tabular format lets you 
grasp pertinent facts at a glance. and it's fully indexed by both proprietary 
and generic names. The drugs are grouped under 16 categories. such as 
Antiseptics and Disinjectives. Antihistlmmes. and-new to the 1976-78 
handbook
hemotherapy oj Neoplastic Diseases. 
By Mary W. Falconer. RN. MA, lormerly ollhe O'Connor Hospilal School 01 
NursIng. H. Robert Panerson. PharmD. Prof. of Bactenology and Biology. San Jose 
Slale Umv . and Edward A. Guslafson, PharmD, Pharmacist Valley Medical Center 
279 pp Solt cover About $6.70. Just Ready Order #3567-9 


Howe: BASIC NUTRITION IN HEALTH AND 
DISEASE, New 6th Edition 
From chemical conversion of food-to modem diet planning. purchasing 
and storage-this text covers all the material necessary for a better 
understanding of basic nutrition. There's plenty of information on diet 
therapy. common misconceptions about food. and weight control: and the 
appendix includes an alphabetical listing of modified diets (A Teacher's 
Guide is available ) 
By Phyllis S. Howe, RD. BS ME. Nutnlional Instructor. Contra Costa and Diablo 
Valley Commumty Colleges. Catilorn.a Aboul 465 pp llIustd Solt cover. About 
$775 Jusr Ready. Order #4788-X. 


Mayes: NURSE'S AIDE STUDY MANUAL. 
New 3rd Edition 
Designed to equip the student aide with a working knowledge of good 
patient care. this book covers: basic nursing arts procedures. her ethical 
and legal responsibilities and limitatIons. what to do in emergencies. and 
basic anatomy and physiology (An Instructor's Guide is available.) 
By Mary E. Mayes. RN. lormerly Supervisor. Emergency Room. Ventura General 
Hospital Calilornia About 285 pp. 130 ill Solt cover About $620 Jusl Ready. 
Order #6191-2. 


_it 
.o

r
s


o

!'
t




NY CANADA LTD. Pncessublecl 10 change 
'- TO orde't;Ue s
 30-d8rapprova' ,

 'der ::ber 
::; hor: - - - - -;'
 e Pn 
 - - - - - - - - - - - - ;;;1;;- - - --I 
I I 
I I 
I FULL NAME I 
I I 
I AU AU AU: POSITION & AFFILIATION (IF APPLICABLE) I 
I HOME ADDRESS I 
I I 
1_ 
 heck 

" d-Saunder s
 
.ta
 _ 
nd C . O.D ._ _bill m 
 _ 

 _ _ __ _ _ _ _ _ PROVIN 
 _ _ __ 
'=- __I 



r- 


8 


The Canadian Nurse May 1976 


I II I) lIt 


Editor's note: The followmg open letter 
was submitted simultaneously to both 
the RNABC News and The Canadian 
Nurse. The author asks that it be 
published in this journal "since it is a 
topic which affects the membership 
[of the nursing profession) as a 
whole." 


t 


Handmaidens protest 
Yes, nurses must be 
accountable, not only as individuals, 
but as the Canadian Nurses 
Association. As a member 01 the 
Association, I am ashamed that we 
haven't taken a stand on abortion. 
I am not against abortion, 
providing it IS done in the first 2 - 3 
months, before there is an audible 
fetal heart. What I am against, are 
abortions at four months gestation by 
means of instilling a hypertonic saline 
solution into the woman's uterus. 
Charting consists of 'fetal heart heard 
per doptone" - and then the 
procedure is charted - and we walt 
for that fetus to die and be aborted - 
hopefully it will be dead and not 
gasping for breath as it is expelled. 
Is this nursing as we pledged to 
carry it out - being "handmaidens'- to 
doctors that continue to do these 
''fetacide-abortions?'' How can we 
justify this, when on the other end of 
the spectrum we hear a cardiac arrest 
call and we rush to breathe air into the 
lungs and massage the heart of a 
person that is dying? It doesn t make 
sense. In other words - are we being 
accountable? 
What suggestions have I got for 
this horrendous problem in today s 
society? 
First, we must through our 
Canadian Nurses Association bring 
pressure on the Canadian Medical 
Association to stop doing abortions 
when there is an audible fetal heart. I 
am sure there are many doctors that 
feel this practice is wrong and only 
require some stimulus to get them to 
stand up and be heard. 
Next, let's stop using valuable 
hospital beds for abortions and 
establish properly run abortion clinics. 
Thirdly, and I feel most important, 
let's press for well publicized, family 
planning and sex education clinics. 
Now I know there are those 
among you that will say - this is all 


very good, but if a woman can't get an 
abortion 'legally" (because there is a 
fetal heart) she will go to some back 
street abortionist often with sad 
results. It IS this rationalization, that 
has made these late abortions seem 
acceptable. 
It would be my hope that through 
Improved contraception education 
and abortion facilities that these 
advanced abortions would be 
eliminated. As it now stands, I feel 
every time there IS an abortion done on 
a woman with an audible fetal heart- 
the doctor and nurse who initiate the 
abortion are being used - used 
because society as a whole is no 
longer accountable. Let's try to alter 
this now, and we as nurses stand up In 
force through our Assoaation, and say 
we will no longer perpetuate an 
intolerable situation. Stop being 
"handmaidens' and show that you do 
have an opinion. Let's be accountable! 
- Marjorie P. Shier, North Vancouver, 
Be. 


Professional challenge 
h was with considerable interest 
and relief that I read the article by Dr. 
Adamkiewicz, "What Are the Bonds 
Between the Fetus and the Uterus?" 
There is currently a very blasé attitude 
amongst heahh professionals and 
educators concerning abortion - the 
opinion that it IS not a criminal act to 
destroy the life of the unborn fetus, a 
life which has the full potential of a 
human being. Under the rather weak 
excuse 01 wanting "to help women in 
trouble." we as nurses are 
contradicting a basIc, deep principle in 
in our philosophy of care, which is to 
preserve life 
As a concerned citizen and a 
teacher of future nurses, I agree with 
Dr Adamkiewicz that we must bring 
our skills, high ideals and Influence 
together to fight the current 
pro-abortion trend and provide the 
fetus with that community protection to 
which he is justly entitled - 
Carol Lawson, Pediatric Nursmg 
Instructor, Vanier College, Ste-Crolx 
Campus, Montreal. 


Demeaning viewpoint 
I found Viewpoint (The CanadIan 
Nurse, February 1976) inappropriate 
and objectionable for a professional 
journal. Dr. Adamkiewicz rambles in 


Irrelevanaes and reiteration of 
patently obvious factual data on a 
subject which he purports to 
understand. 
The title "What Are the Bonds 
Between the Fetus and the Uterus?" 
clearly Indicates evasion of the real 
issue in abortion debates. It is not the 
uterus which demands 
decision-making nghts, but the 
woman who happens to possess that 
organ Suggesting extraterritOllal 
status for the pregnant uterus is the 
height of conceptualization without 
reason. 
Publication of this demeaning and 
poorly "conceived" article coupled 
with an editorial challenge to nurses as 
health care providers seems 
unwarranted. Surely our editors could 
solicit a more objective and Informed 
viewpoint. - 
Bettie J. Scheffer, RN, Vancouver, 
B.C. 


Peripatetic profession 
I wish to add some weight to the 
side of the nurses who are unhappy 
with different provincial registrations 
across Canada. (The Canadian 
Nurse, January 1976) I feel there are 
two things which make this situation 
difficuh to work with. 
The first IS that people are in 
general more peripatetic. Not only 
nurses move about but also husbands 
and other family members. I find 
myself changing provinces to look 
after a Mom with lung cancer. This was 
not planned to suit registration times 
This brings me to my second 
consideration, which is fmancial. 
Since I have just paid $70.00 
registration fees in Manitoba, $22.50 
PHA fees. and $12.00 Associate fees 
to my home school (the AARN), my 
total registration fees this year will be 
over $200.00 if I pay $110.00 to the 
RNABC !!! Whew! 
-B.E. Gunn, R.N., B.Sc. P.H.N., West 
Vancouver, B. e. 


Gypsy in our soul 
I have always looked forward to 
The Canadian Nurse and have often 
received useful, practical, information 
from this journal. I am writing now to 
bring your attention to a problem that I 
share with a lot of nurses in our mobile 
society. I've just spent three hours 


completing forms, wntlng cheques 
and letters, and hunting for every thin, 
from school marks to mamage 
certificates. II IS an experience that WE 
all must face each time we change OUI 
province of residence and It doesn't 
make much sense. 
Why, in a country where each 
province has Identical registration 
requirements, don't we have a slngl 
Canadian RegistrallOn? It would sav 
the "gypsies' among us, and our 
vanous provincial associations a gre
 
deal of time, money and frustration. 
I truly hope that a lime will COrT1l 
when I am a "Canadian Nurse' anc 
please let it be before I move again 
Dona M Penkala, Pasadena Nfld. 


Prisoners of conscience 
Thousands of men and women 
are being detained in Soviet pnson
 
corrective labor colonies and 
psychiatric hospitals because of the 
religious or political beliefs. In 
contemporary Soviet law (penal) thf 
"infliction 01 suffering' is regarded a 
permissible and necessary. 
In more than 14 years of work or 
violations of human nghts throughol 
the world, Amnesty IntemallOnal ha 
accumulated a great deal of 
information on the treatment and 
conditions of prisoners of consclenc 
in the USSR. This Information IS nOl 
available with the release in five 
languages of "Prisoners of 
Conscience In the USSR: Their 
treatment and conditions. 
The documented evidence of 
maltreatmem by Soviet physlaans, 
psychiatrists, and paramedical 
personnel will be of particular intere 
to nurses. The report IS available frol 
Amnesty International for $2.50. 
- Mary J. Beattie, Amnesty 
InternatIOnal, 2101 Algonqum 
Avenue, Ottawa, Ont., K2A 1T2 


New horizons 
I am writing this letter to ask you 
favor. I am 26 years old and would lik 
to correspond with someone 
interested in nursing. So. please bE 
kind enough to publish my address 
one of your nursing journals. 
-(Miss) Ramya Nancyakkara. No. 
121/3, Lady McCallum's OrNe, 
Kandy. Sri Lanka. (Ceylon). 
(Continued on p. 11 



L'eggs@ Nurse White Pantyhose 
available only by mail. 


Here's something specially for you, Famous 
L'eggs Panty hose in Nurse White. And 
they're available in Sheer Energy" Panty- 
hose to give your legs all-day support, or 
regular L'eggs Pantyhose. with their super- 
stretch, super-fit. 




 

 



 


As Nurse White panty hose is made espe- 
cially for nurses, it's available only through a 
mail order program. On larger quantities. we 
offer bonus savings-six for the price of five 
12 pair for the price of 10. And we pay the 
postage. It's economical, prompt. and con- 
venient. And your satisfaction is guaranteed, 
If you're unhappy with the product for any 
reason, we'll refund your money or send you 
a replacement pair of L'eggs, whichever you 
prefer. All you do is return it to: L'eggs 
Guarantee, 1775 Sismet Road, Mississauga, 
Ontario L4W 1P9. 


How 10 order your Nurse White Pantyhose. 
Check your s'ze on the size chart, flll,n the order form enclose a 
cheque or money order and mall to thIS address 
L'eggs Nurse White. POBox 8116, Toronto. Ontano M5W 1S8 


for best fit, find yo
r height and ..e,gIIt below and choose Ihe appropnate size 
R ep lar hn ty ho5e Sheer Enern' 
He, r
t Avera
e Size Oueen size S,zeA SlZeB Oueenslze 
4'10
 11 0 130 Ibs. 
4'11" 105 135lbs 
5'O
 100 130lbs l3l-180Ibs 1001401bs. 145 180lbs 
5'1
 95-1351bs 136-1851bs 95-1451bs 150 1851bs_ 
52" 90.1401bs 141-1901bs 90-140 Ibs. 141-1501bs 155 1901bs 
5'3
 90-1451bs 146-195Ibs. 90-135Ibs. 136-155Ibs. 160 1951bs 
5'4
 90.1451bs 146 200 Ibs 95 130Ibs. 131-160Ibs. 165-1951bs 
5 5
 90-1451bs 146200lbs 1001251bs 1261651bs_ 170-1951bs 
56
 90 1451bs 146-200Ibs. 105 120 Ibs 121.165Ibs_ 170-190Ibs 
5']" 95-145Ibs_ 146-195Ibs. 1I0-115Ibs. 1I6-1651bs 170-185Ibs 
5'8
 100.145Ibs. 146-190 Ibs lIS. 160 Ibs 165180lbs 
5'9
 105-1401bs 141-1851bs 120-1501bs 155-175Ibs. 
5'10
 115 135lbs. 136-180Ibs 125-1451bs 150.170Ibs 
5'11" 130.140Ibs 145 170lbs 
6'0
 145-1601bs 


Determine the price 'or Your Order 
3 pairs 6 pairs for 
pnce of 5 
$ 745 
$ 7.95 
$1995 
$1995 
$19 95 


12 pairs for 
pnce 0110 
$1490 
$1590 
$39 90 
$39 90 
$3990 


Available Styles and Siles 


$ 447 
$ 4.77 
$1197 
$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- 

 I 
. . 
'a 
, 
::Þ 

 
.... "'" 
'- 


Nurse White only color available-See size chart 


Available Styles and SIZes 3 pairs 6 Pairs lor 12 Pairs tor TOTAL 
pnceof5 pnceoll0 
l'eggs- Regular $ 4.47 $ 745 $1490 
l'eggs-Queen5lze $ 4.77 $ 795 $1590 
Sheer Energy -Size A $1197 $1995 $39_90 
Sheer Energy' -Size B $1197 $19_95 $39 90 
Sheer Energ -Queen5lze $1197 $19.95 $3990 
(Chec
 tI' nght box) TOTAL PURCHASE 
Ontanoresidents add 7
sales tax SAl ES TAX 
CON N 576 TOTAL AMOUNT 


NAM F 


ADDRESS 


CITY 


PROVINCE-POSTAL COD F 



-----------------------------------------------
 



10 


The Canadian Nurse May 1976 


Xe\ys 


Belt-tightening hits nurses, 
national outlook bleak 


When the federal government 
officIally put the lid on health care 
costs by Introducing Bill C-68, closely 
followed by announcement of a 
national anti-inflation program, most 
provinces reacted by initiating 
cutbacks and curtailments in their 
health services. 
Under Bill C-68, the federal 
government would limit future 
increases in contributions to 
medicare to 13 percent in 1976-77 
and 10.5 percent in 1977-78. At the 
same time, the government served 
notice of its intention to end existing 
agreements under the Hospital 
Insurance and Diagnostic Care Act, 
through which each province 
recovers about half of its hospital 
expenditures. 
"Hold-the-line" budgets are fast 
becoming a fact of life in most 
provinces, with varying effects on the 
level of health services available and 
the personnel who provide them. 
Representatives of provincial nurses' 
associations were contacted recently 
by The Canadian Nurse in an attempt 
to obtain a national picture of the effect 
of these austerity measures on 
nursing manpower in their 
jurisdictions. 
Although the situation varies from 
province to province, and from one 
area to another in the same province, 
as well as seasonally, the general 
impression provided by these 
spokesmen, was that of a general 
tightening up in employment 
prospects, with pockets of serious 
unemployment becoming apparent in 
seve.-al centres. Short-term prospects 
are not generally encouraging for the 
recent graduate or for nurses with a 
definite preference for working in a 
particular city or hospital. 
Some of the comments follow: 


British Columbia 
Although jobs for registered nurses in 
British Columbia were in relatively 
short supply in late Winter, the 
situation was expected to improve by 
Spring, according to Registered 
Nurses Association of British 
Columbia Employment Referral 
Director, Marilyn Carmack. 


"The number of nursing jobs 
listed with us drops every year at this 
time," she says. "Things are tighter 
than usual, but the situation should 
change - despite budget cutbacks at 
some hospitals." A similar situation 
existed in 1970 and rumors then of a 
lack of jobs created a critical shortage 
of nurses in British Columbia that 
lasted nearly five years. 
The association's employment 
referral service listed nearly 100 job 
vacancies and about 65 new enrollees 
looking for work early in 1976. 
Comparable figures for 1975 show 
about 200 vacancies and 50 new 
enrollees. Many of the jobs go unfilled 
because they are outside the Lower 
Mainland, according to Carmack, and 
others may require nurses with 
hard-to-find clinical specialties. "The 
apparent lack of jobs should 
disappear," said Carmack. "Any other 
view of the situation is unrealistic." 
She notes that British Columbia trains 
only about 30 percent of its new 
registered nurses and must import the 
rest from other provinces and outside 
Canada. 


Alberta 
The registrar of the Alberta 
Association of Registered Nurses 
indicates that the supply of nurses 
appears "generally equal to the 
demand" although in certain sections 
of the province, some levels of 
unemployment are being 
experienced. A few vacancies still 
exist in northern areas. 
As of February 2, 1976, all 
graduates seeking registration in 
Alberta whose credentials meet the 
requirements for registration must 
pass either the Canadian Nurses 
Association Testing Service or the 
National League of Nursing 
examinations In medical nursing, 
surgical nursing, obstetrical nursing, 
and the nursing of children. Graduates 
of 1972 or later must also pass the 
registration examination in psychiatric 
nursing. 


c! . 
. ,- " 
J r 
. 
I 
. l , it 
. . "" 
.. 
 

 
..'"J.. 1 J 
-
 . 


\ 


- .. 

 


.... 


. 
... 


i 
. 


--1r. ..... 
..' -4 


" 


.... 


'\ 


Close to 750 Eastern Ontario nurses at a mass meeting in Ottawa heard 
Anne Gribben, chief executive officer of the Ontario Nurses' Association, 
warn that provincial health-care cutbacks threaten public safety as well as 
the jobs of hospital employees. Above, a member of the audience 
comments on the situation from her perspective. 


Saskatchewan 
A spokesman for the Saskatchewan 
Registered Nurses' Association 
indicates that the association is 
currently receiving "few requests 
for assistance in finding nurses for 
the city hospitals - i.e. Regina, 
Saskatoon, Moose Jaw. Many new 
graduates from Ontario have been 
employed in this province. Small 
hospitals are not requesting 
assistance as often as they were a 
year ago. There are fewer requests 
that we expedite the admission of 
foreign applicants. An official from 
Manpower and Immigration has also 
noted that there seems to be a fairly 
generous supply of nurses. The small 
hospitals are always short of nursing 
staff unless they have a "captive" 
supply living in their area. There is little 
to induce nurses to go to small towns 
even when the number of job 
opportunities is small." 


Manitoba 
In Manitoba, according to the registrar 
of the provincial association, "things 
are tight. .. and likely to stay that way for 
some time. She sees little chance for a 
change for the better in the near future 
and reports that new graduates are 
expressing a good deal of concern 
over the possibility that more positions 
will be cut. 
Officials of outlying hospitals In 
the province say that they are enjoying 
an unwonted bonanza, with more 
applications than ever before. 


Ontario 
The province hardest hit by the 
austerity program, at least in terms of 
the number of nurses affected, is 
undoubtedly Ontario. A mid-Winter 
government announcement heralding 
limitations on increases in some 
areas, freezing of costs in others and 
actual cutbacks in other areas, was 
followed by the forced closing of up to 
3,000 hospital beds. Estimates of the 
number of hospital personnel - the 
bulk of them nurses - who will be laic 
off range up to 5,000. 



The CanadIan Nurse May 1976 


11 


Both the Registered Nurses 
ssociation of Ontario and Ontario 
urses Association have reacted to 
e situation with public statements 
dicating their dissatisfaction with 
,wholesale and arbitrary reduction of 
Il edS and staffing' as a means of 
utting health care costs and offering 
) co-operate with the government in 
etermining means of providing less 
xpensive primary care and 
'Iiminating duplication and waste in 
"xisting services. 
Approximately 4,300 persons are 

 xpected to qualify for Registered 
urses' certificates in Ontario this 
'pring. They will compete for fewer 
han 200 job openings. An overall 
eduction of 15 percent in admissions 
o schools of nursing in the province's 
ommunity colleges in 1976 has been 
nnounced by the ministry of colleges 
nd universities In the meantime, 
oris Gibney. assistant executive 
irector of the Registered Nurses 
o.ssociation of Ontario says, .'the 

 'ituatlon is really quite acute. Any 
penlngs that do exist are for highly 
ualified nurses.' She sees little hope 
Jf improvement in the sltuallon in the 
'lear future. 


Juebec 
Jobs are a httle easier to find in 
Juebec than in some other provinces. 

ccording to an Order of Nurses of 
Juebec spokesman. who says that 
;hortages still exist in some specific 
ueas - for example, long-term care 

nd positions in outlying areas. Some 

xodus of nurses from the province 
las been noted in the past year, owing 
Jartly to concern over provincial 
anguage requirements and salary 
:lifferential. Quebec nurses, whose 
;alaries have been under official 
evew for the past year, anticipate a 
TIajor Increase soon to bring them 
:Ioser to the national average. 
lIew Brunswick 
\lew Brunswick Association of 

egístered Nurses president, Simone 
:ormier, reports: "In recent months 
he employment picture 10 New 
3runswick has changed from one of 

eographic pockets of shortage to the 
)resent sltuallon of no extreme 
;hortage. This can be mainly 

ttributed to the Immigration of Ontario 


nurses who cannot find positions 10 
their own province. In filling our 
vacancies with Canadian nurses, we 
presently do not have a need for 
out-of-country nurses. 
The closing of 300 hospital beds 
In New Brunswick will have some 
impact on the nursing manpower 
situation. although many nurses will 
be absorbed into other units or 
hospitals. As an association, we do 
have some concern regarding 
employment opportunities for the 
upcoming graduates of our nursing 
schools. " 


Nova Scotia 
Registered Nurses Association of 
Nova Scotia personnel service 
consultant, Margaret Bentley, points 
to several factors affecting the current 
situation in that province. The number 
of positions available has dropped 
sharply under a system of restraints 
that includes the freezing of staff as of 
December 31 last year. By late Winter 
there were only 16 vacancies 10 the 
entire province, all but three of these at 
one hospital. Unemployment 
Insurance Commission benefits were 
being collected by close to 200 nurses 
(not including those on sick or 
maternity leave) oul of the total work 
force of 5,723 registered nurses in the 
province. 
In early spring, directors of 
nursing were being swamped with 
applications from outside the province 
- (chiefly Ontario). "If restrictions are 
lifted" according to the RNANS 
personnel services consultant. ..these 
nurses may get jobs before our 
students graduate in August. Our fear 
at the moment is that when these 
students graduate they will not get 
employment in N.S'- 


Prince Edward Island 
The Executive Secretary of the 
Association of Nurses of Prince 
Edward Island, Laurie Fraser, 
comments, "it looks as though there 
will be a few vacancies for nurses this 
summer. With the relatively small 
number of staff positions here to start 
with, and a small turnover rate, there 
really have never been a large number 
of positions vacant. and so far here, 
there have been no bed or staff 
cutbacks. 


I would suggest though that there 
will be no employment opportunities 
come Fall, as any summer vacationing 
staff will have returned and 
approximately 50 graduates of the PEl 
School of Nursing will enter the job 
market. Many will seek jobs in other 
provinces. " 


Newfoundland 
Newfoundland, which has traditionally 
been faced with severe shortages of 
health care workers, is now 
undergoing a complete reversal of this 
manpower situation, according to a 
senior official of the province's 
department of health. Although 
temporary shortages may be 
experienced in some areas during the 
summer months, he expects that by 
September there will be sufficient 
nurses available to staff all of the 
province's hospital and health 
services. 
In recent months there has been 
a noticeable increase in applications 
from nurses in other provinces and 
most hospitals report a record number 
of applications now on file. The recent 
announcement of plans to close 200 
beds in 1976 (out of a total of 3,000 in 
the province) will also obviously affect 
employment opportunities in the 
coming year. 


Northwest Territories 
One cheerful note to end on: the 
registrar of CNA s newest member 
association, the Northwest Territories 
Registered Nurses' Association, 
points out that there is still a serious 
shortage of nursing manpower in the 
North. Canada's last frontier needs 
experienced nurses, capable of 
working with a minimum of 
supervision. A word of warning 
though. Accommodation is tight, 
unless you're single and willing to live 
in residence 
If you're interested, contact 
NWTRNA Registrar, Mary Lou Pilling, 
Box 2757, Yellowknife, NWT. 


Canadian nurses 
to partici pate in 
international seminar 


Six Canadian nurses will join seven 
colleagues from the United States and 
ten from the United Kingdom at an 
International seminar in London, 
England, this summer to compare 
professional developments and 
experiences in the three countries. 
The event is the third King's Fund 
Seminar of Nurses, organized by 
King's Fund College and held in 
London, July 19 to 23, Inclusive. Its 
purpose is to contribute to the 
personal and professional 
development of members of the 
seminar and, indirectly, to the nursing 
services in the countries they 
represent. A report of seminar 
discussions is also published. 
Canada will be represented at the 
meeting by: Lorine Besel, director of 
nursing, Royal Victoria Hospital, 
Montreal; Dorothy Kergin, associate 
dean of health sciences (nursing) 
Faculty of Health Sciences, McMaster 
Health Sciences Centre; Huguette 
Labelle, principal nursing officer, 
Health and Welfare Canada; Ada 
McEwen, national director, Victorian 
Order of Nurses for Canada; Helen 
Mussallem, executive director 
Canadian Nurses Association
 and 
Shirley StlOson, professor, school of 
nursing, and division of health 
sciences administration, University of 
Alberta. 
The central focus of the 1976 
King's Fund Seminar will be on 
leadership. John Garnett, CBE, 
director of. the Industnal Society, will 
make the Introductory address on 
'The Nature of Leadership." 
Three other related areas will be 
explored during the discussIOns and 
speeches that follow. These are: the 
definition of the role and responSibility 
of nurses for leadership in a health 
care delivery system; the emergence 
of leaders and the evaluation of 
leadership performance. 
The first King's Fund Seminar of 
Nurses was held in 1972. It was 
o
ganlzed by King's Fund College as a 
direct result of its activities in the area 
of international exchange of health 
service personnel. Five Canadian 
delegales participated in the last 
seminar, held in London in July,1974. 



12 


The Canadian Nurse May 1976 


Xe\\-s 


Ontario nurse-midwives 
hold annual workshop 


The many faces of the nurse-midwife 
in Canada today were the subject of a 
recent day-long meeting in London, 
Ontario. The meeting, which was 
attended by approx imately 100 nurses 
from southwestern Ontario, was 
organized by the London and Windsor 
chapter of the Ontario 
Nurse-Midwives Association. 
A highlight of the day was a panel 
presentation by seven nurses, each of 
whom is involved in a different aspect 
of the maternity cycle. Participants 
included a family practice nurse from a 
local medical center, a perinatal nurse 
from a hospital high risk center, a 
postpartum nurse, an OB nurse 
practitioner working in a doctor's 
office, an inservice coordinator in 
Obstetrics and Gynecology, a prenatal 
coordinator in a local health unit and a 
nurse who had worked in a northern 
nursing station. 
The coordinator of the panel was 
Mary Cameron of Women's College 
Hospital, member of the RNAO 
committee forthe expanded role of the 
nurse, and one ofthe organizers of the 
National Committee of 
Nurse-Midwives. 
The activities. roles and functions 
of the seven nurse-midwives as they 
described them for the audience, 
ranged from teaching and support 
programs for the mother and family 
before birth, through the actual 
delivery, up to and including care and 
support of the mother, baby and family 
after birth. 
Panelists stressed the need for 
increased continuity of care 
throughout the maternity cycle and 
greater involvement of the patient in 
the health team. Speakers also 
criticized the tendency in North 
American society to place undue 
emphasis on the relatively short time 
span involved in pregnancy and 
delivery, compared to the need to 
provide professional assistance and 
support throughout parenthood. 
Two speakers from St. Joseph's 
Hospital in London addressed the 
annual workshop: Dr. Paul Harding, 
chief of obstetrics and gynecology, 
discussed "Current Advances in 
Perinatal Medicine" and Dr. Michael 


Hardie spoke on "Infection in the 
Newborn. .. 
Coordinator of a panel discussion 
on Coping with Parenthood was Karen 
Kaufman, clinical specialist in 
maternal child health, McMaster 
University Medical Centre. Members 
of the planning committee included 
Ontario Nurse-Midwives Association 
members Gaie Haydon, Jan Archer, 
Mary Mansell, Kay McDonald, and 
Mary Monoghan. 


RNASC members 
to explore 
professional attitudes 
The Idea that the nursing profession 
acts as "the oppressed majority" will 
be explored in general sessions of the 
64th annual meeting of the Registered 
Nurses' Association of British 
Columbia, May 12-14 in Vancouver. 
The concept being developed is that, 
while nurses make up a majority of the 
health care work force, they are 
dominated by smaller groups and 
exhibit behavior patterns similar to 
those of oppressed minorities. 
Committee chairman Jo Ann 
Perry of Vancouver emphasized that 
the situation could be affecting nursing 
care, since "our attitudes towards 
ourselves and others in the profession 
ultimately influence how we deal with 
our patients. If we are becoming 
alienated by the process, our delivery 
of care can suffer." 
The committee's object is to 
provide a "consciousness-raising" 
situation to focus members' attention 
on the problem. Plans for the general 
sessions include group discussions, a 
panel presentation and a short talk by 
a sociologist-anthropologist who 
would relate typical nursing behaviors 
to those of minority groups. 
Elections will be conducted for 
new chairmen of RNABC standing 
committees. Voting delegates will also 
consider resolutions submitted by 
districts and chapters, as well as a 
series of major constitution and by-law 
amendments. The proposed 
amendments would restructure the 
association by establishing a new 
Labour Relations Division, allow 
student memberships and change 
voting representation at future annual 
meetings. 


Edmonton group 
receives charter 


A Pediatnc Interest Group that has 
been active in Edmonton for the past 
two years recently became chartered 
as the first affiliate group in Canada of 
the Association for the Care of 
Children in Hospitals. 
The Association for the Care of 
Children in Hospitals is an , 
interdisciplinary group that focuses on 
the psychological and social aspects 
of the care of hospitalized children and 
their families. Their objectives are: 
. to seek better understanding of 
the emotional needs of children in 
medical settings, to foster their 
well-being, and to develop sound 
programs of comprehensive care 
which will support these children and 
their families; 
. to provide a common meeting 
ground for all those who are 
concerned with children and their 
families in such settings; 
. to foster high standards of training 
and competence in all professions 
working within the pediatric setting; 
. to focus the attention of all health 
workers and the community at large on 
comprehensive pediatric care; 
. to cooperate with other 
organizations and agencies having 
related purposes; 
. to stimulate and support research 
related to these purposes. 
Membership is open to all those 
whose professional training and/or 
professional position is related to the 
above objectives, 



". 
" 
 I 
, .... 
 
.. 
 
I i 



 



 


\\ 


lavoie Photo Enrg. 


For more information, write M. 
Culp (President), Royal Alexandra 
Hospital, Edmonton, or Barbara 
Geyer (Secretary), Charles Camsell 
Hospital, Edmonton. 


ICN asks nurses 
to describe conflicts 


The International Council of Nurses is 
calling for nurses around the world tc 
submit written contributions for its 
forthcoming book related to the ICN 
Code for Nurses. The contributions 
should be real-life descriptions of 
ethical conflicts they have 
experienced or observed. 
According to Adele Herwitz, 
executive director of ICN, "as we 
approach the 21st century, ethical 
conflicts are of ever increasing 
concern for the nurse. There is an 
urgent need for nurses to be strong in 
their beliefs basic to nursing as 
expressed in the ICN Code for Nurses 
This book will provide a unique 
opportunity for nurses of different 
languages, cultures and beliefs to 
share their experiences. Nurses neec 
to know they are not alone in the 
problems they face and by providinç 
ICN with real-life stories we can hell 
each other." 
Nurses are asked to describe ar 
event which illustrates an actual 
problem situation. The anecdotes 
should pertain to ethical issues, not 
legal problems which may be specifi, 
only to the laws in one country. The 
setting and activity may be with 
patients, with other nurses, with othel 
health professionals or assistants, 0 
with organizations or societies eithe 
professional or nonprofessional. ThE 
nursing action may be direct patient 
care, or other activities involving 
interpersonal relations, teaching, 
administration or community or 
professional organization activities. 
Nurses should submit the 
descriptions to the Nurse Project 
Director, FNIFIICN Publication 
related to the Code for Nurses, 
International Council of Nurses, P.O 
Box 42, 1211 Geneva 20, Switzerland 
before 15 August, 1976. Writers of 
descriptions will not be identified in thE 
publication but names and addresse 
should be included in case 
correspondence is needed for 
clarification. 



I 
I 
J 


ight ... 


whenever 
the potential 
for infection 
i evident or where 
inhction is present 


[iìsofra-tuIIEf 


Bactericidal 
Dressing 
effective against 
both Gram-positive 
and Gram-negative 
infections of the 
skin-including 
pseudomonas 


Remai ns 
Active 
even 
in the presence 
of blood, pus 
and serum 


Soft 
pliable 
Not Messy 
the significantly 
increased 
lane-paraffin bas- 
is Just Right 
Indicated 
In 
burns 
ulcers 
wounds 


ROUSSEL Â 


Roussel (Canada) LId ILlée 
1 '\3 Gr"vAlrne 


ÆiillIi1 



14 


The Canadian Nurse May 1976 


Xf!\YH 


Smallpox eradication program 
almost certain to succeed 


Laboratories around the world are 
beginning to destroy their stocks of 
smallpox virus as the World Health 
Organization concentrates its 
campaign to eradicate the disease in 
the one remaining infected country, 
Ethiopia. 
Some months have passed since 
the last known cases of variola major, 
the most virulent form of smallpox, 
were reported, and the milder strain 
that is still found in Ethiopia exists in 
fewer than 60 remote villages. WHO 
officials hope these foci will be 
eliminated within six months. If they 
succeed in their goal of wiping out the 
disease by 1976, it will be the first time 
man has made a disease extinct. 
WHO began its eradication 
program in west Africa a decade ago 
Officials hoped to conquer the disease 
with a mass vaccination program 
aimed at immunizing 80 percent of the 
population of affected countries using 
jet immunization guns. This strategy 
was limited by the number of experts 
required to supervise such a massive 
campaign, and by some problems with 
the immunization technique. 
The guns frequently broke down 
and spare parts had to be sent to 
vaccinating teams, in addition, they 
were difficult for untrained vaccinalors 
to use. WHO simplified the technique 
by adapting a short, two-pronged 
needle originally used to immunize 
fowl against viral diseases. Then, 
while working in eastern Nigeria it was 
discovered, by accident, that the 
smallpox cycle could be stopped by 
immunizing only half the population if 
vaccinating teams concentrated on 
areas where the disease was most 
rampant. 
By emploYing a new strategy of 
detecting and concentrating on 
outbreaks and following up with a 
surveillance system to take care of 
isolated cases, WHO was able to wipe 
out the disease in South America, 
Indonesia, Pakistan, Afghanistan and 
15 countries in western Africa by 
October 1974_ With this strategy, 
when an outbreak was detected, 
infected cases were quaran1ined 


immediately and individuals who had 
been exposed to smallpox were 
quickly vaccinated. 
The countries most recently 
infected with smallpox were Nepal, 
India and Bangladesh. But since 
October 1975, no new cases have 
been reported in any of these 
countries, and WHO officials believe 
that the disease has finally been 
stamped out in Asia. 
Now the only country left to 
control is Ethiopia, and the 202 cases 
that were reported in December 1975 
were of a much milder strain. Death 
rates are only 1 - 2 percent compared 
with 20 - 40 percent fatality rates for 
variola malor. 
Confirmation that smallpox has 
been eradicated requires two years of 
active surveillance after the last known 
case. After this period, WHO 
convenes a special International 
Commission to visit the country and 
carry out on-the-spot investigations, 
before they declare the country 
officially free of disease. 
Dr. Halfdan Mahler, WHO 
Director-General. has said that if 
eradication of smallpox can be 
confirmed by 1978, new global 
agreements could then be reached 
concerning vaccination for 
international travel. 
It is estimated that world 
governments have contributed $85 
million to WHO over the last decade 
for its smallpox program. 


Clarke Institute creates 
widows' self-help agency 


An outreach program 10 help the 
recently widowed cope with this crisis 
stage in their lives has been 
established in southern Ontano. The 
self-help program, called Community 
Contacts for the Widowed. was 
developed by the Community 
Resource Service of the Clarke 
Institute of Psychiatry in Toronto, as 
the result of studies indicating that the 
needs of the newly bereaved were not 
being met by professionals or the 
community. 


Research by the Clarke Institute 
and other agencies indicates that 
widows are a "high-risk" population, 
particularly vulnerable to 
psychological, physical and social 
problems. Young widows. for 
example, experience three times as 
many hospital admissions in the year 
following bereavement as other 
women of similar age. In one study, 36 
percent of suicide victims had been 
bereaved within five years of thèir 
death, and, in another, widows 
experienced a 12 percent increase in 
mortality during the first year of 
bereavement. 
Statistics indiC'ate that one in ten 
Canadian women over 14 are 
widowed (there are 96,000 in the 
Toronto area). That their special 
needs are not being met by other 
community resources was 
demonstrated by the overwhelming 
acceptance rate (88 percent) when 
widows were approached and offered 
assistance in the Clarke Institute 
project_ 
Community Contacts for the 
Widowed, fashioned after the 
Institute's initial pilot project, will be an 
autonomous incorporated agency 
based in the community, and will serve 
Metro Toronto with a central office and 
four satellite clinics. Through the 
agency, the newly bereaved will come 
in contact with widowed people of 
similar ages who have resolved their 
own grief. The staff can offer advice for 
concrete needs (legal, financial, 
medical, etc.) and are prepared to 
provide ongoing emotional support. 
Discussion groups on problems 
encountered by the widowed, and 
opportunities for socializing are also 
offered. 
The program is staffed largely by 
volunteers who have come through a 
similar crisis and wish to help others In 
need. However, a small core staff, also 
widows, will be paid to organize and 
maintain services in the five offices. All 
staff, paid and volunteer, are trained 
by a team at the Clarke Institute. 
Enough money has been raised 
within the community to cover the first 
nine months of operation. 
Contributions have been received 
from a broad range of sources within 
the community. including major 
religious denominations, the 
insurance industry, trust companies, 
private corporations and Red Cross. 


IORC investigates role of 
traditional healers 


An In-depth study that will attempt to 
uncover the secrets of African 
traditional healers In Zaire and 
possibly integrate them into the 
country's health services has been 
announced by the International 
Development Research Centre In 
Ottawa. 
Traditional medicine in Zaire and, 
in fact, all of Africa continues to serve a 
far greater percentage of the 
population than does modern 
medicine. In spite of this fact, little is 
known about traditional healers - 
their methods, medicines or 
effectiveness. 
The research will take Into 
consideration all aspects of traditional 
medicine, from medication and 
anatomy to etiology and therapy. Data 
on some 250 healers will be gathered 
through interviews and direct 
observation for a period of one year 
Patients will also be interviewed and 
samples of the herbs used for 
treatment will be collected 
systematically and stored in an 
herbarium. 
Ritual groups function on the 
basis that the patient is possessed by 
a spirit, and all of them have in 
common the fact that a permanent 
relationship exists between healer and 
patient. The majority of patients are 
people who suffer from psychic 
problems. In each of the groups the 
patient can proceed through a series 
of initiations and experiences that 
eventually leads to graduation as a 
healer. Groups are largely run for and 
by women. 
The IDRC grant of $133,200 over 
18 months provides for training of 
personnel, compensation fees for the 
healers, one-day study sessions, 
production of two films and the 
services of two consultants in the 
fields of anthropology and information 
sciences. 
Another $162,325 is being 
contributed by the National Research 
and Development Board of Zaire, 
which will carry out the work, Including 
a survey of all aspects of traditional 
medicine among specific ethnic 
groups in rural and urban settings and 
an analysis of three major therapeutic 
rites. 



GENEROUS NEW GROUP DISCOUNTS on all 
items Sh01NT1, f
r group purchases. graduation f",. favors. etc. 
6-11 Same Items, Deduct 10%; 12-24 Same Items, Deduct 15% 
25 or More Same Items, Deduct 20% G 


Me
 


r-------------------------------------. 
I IT'S EASY TO ORDER REEVES NAME PINS FOR YOURSELF OR FRIENDS! I 
I Choose style you want. shown rlpt. Print name (and 2nd bottom Igl'tt Attach e.-fr. .shter 'Of addibona1 pins I 
I :::
' :S:

tl:"::sb=t:Jo:nclC


:t
:r:
 :
 
=SJ
.

DENTICAl PINS... .Drl cOIIY'nlent. I 
I I 
I LETTERING,______________________ 2nd lINE._______________ I 
I S1.,p I I IffiAl I MrTAl I BAtlgOUND I LEmRIN; I PRICES I 
I n DESCRIPTION COLOR FINISH 
:I COLOR E.,.....I LiltIÚl......2
 I 
A
T
=;




 or DGoId B 
== Does D8lack 01 Pin 2.49 0 1 Pin 3.25 
DootOM' combmlnø satin 0 Silver 0 Satin not D o 
u

ue 0 2 PinS 3.99 0 2 Pins 4.95 
oackground with pohshed edges. apply (yme narnr (wme nM'Ie, 
. PlASTIC LAMINATE.__sllrnmer Does 
. =
I


c:,
 &'ve
 to not 
Dof'der matche$ lettenne- apply 
IIII!a. METAL FRAMED ..ClaSSIC o Gold 
IIiir n
th. ==t

tCf;::e DSlfvrer 
aD MOLDED PLASTIC.. - Simple. smart. Does 
. . ono.n-Uf. win never discolor not 
Smooth rounded comers aoo edaes. appty 


Does DWhltl! +-E Black 0 I Pin 1.25 DIPI" J.85 
no! D Gr
r'J DtI Blue 
apply DBlue White D2Plns195 D2Plns290 
OCoc
 Letters ani)' 1..-.,.,.1 I

) 
Pohsned Wh,'" o BLack o ) Pm 2.49 o 1 Pin 3.25 
'..me only o Dk Blue D 2 Pins 399 D 2 Pins 4.95 
.

 
Does Wh,'" o BLack o [Pin 1.25 D I Pin J.85 
not only o Dk Blue D 2 Pins 1.95 D2Plns290 
apply (yme......, IYme name] 


....... . 


.... . 


finest Forged Steel. 
Guaranteed 2 years. 


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 
 _ - 
No. 705 Sharp/Blunt points,., 2.95 ""! 
No. 706 Sharpl Sharp points. . . 2.95 '
 
No, 71041'2" IRIS Scis., StraiBht. . . 3.75 
For enenved initials aIJd 50, per instrument 


3V,- 
t'lh" 
5"'- 
7%:" 


KELLY FDRCEPS 
So handy for every nurse! Ideal for clamping 
NO.o

:
n
't:.ryl
t'
:s Ls

I.. 


. 4.49 
No. 725 Curved, Box Lock. . . . . . . . 4,49 
No. 741 Thumb D",sSonl Fon:ep, 
Serrated, Slrailht, 5'''- . .3.75 
FDr enaraved initials add 50, per instrument 


MEDI-CARD SET Handiest reler 
ellce ever' 6 smooth plastic Cirds l3\-í" r 
5'n") crlmmed With information: E
IYa- 
loneies of Apothet11] to Metnc to Household 
Meas, Temp. oC to "F, Prescrip. Abbr., Unn- 
alysos. Body Chem, Blood Chem. L,ver Tests, 
Bone ..,,'OW. Disease Incub Ptr
. Adult 
wgts. etc. In white vinyl holdl!r. 
No. 289 Card Set . . . 1.50 ea. 


\
:r
sa:3':õ:
amped on back of 


POCKET SAVERS 


Prewent stains InCI "Nr! Smooth. ph. 
able pure whita vinyl. Ideal Jow-cost 
I'OUp IIlIs or ''''''''' 
NI. 210-E <<.r left), two compartmenls 


:'f;,,

:a$T.
 caduceus 
III. 191 110ft) Deluxe Saver, 3 campi, 
chanle pocket & key chain. . . 
Plcklt of 6 for $2.9B 
Nurses' POCKET PAL KIT 
.A 
Handiest for busy nurses. InGludl!s white I 
Deluxe Pocket Saller. With 5'n" Lister SciSSOrs 
(both shown abovel, Tn-Colof ballpcnnt pen. 
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 
I. bck Free. 
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 _ - 
ufety catch. Or replace either with class pin Gold 
 .ßJJ 
finISh, lIlt boxed Choose RN. LPN or LVN. .... 
No. 3420 Pin Guard. . 2.95 ea, 


'- 



J 


ENAMELED PINS Beaul,lully sculplured ,tatus 



Iôim

:
 



c:as
.

 :::
T
. oL

o

 
"r\ NA on coupon 
1
t1 No. 205 Enam. Pin 1.95 ea. 


8zzz MEMO-TIMER Time hot packs. 
W 
h
it lamps. p.a(
 meters Remember to check .Ital ...... 
SignS IJlve medlCitlOn. etc. lightweight, compact 


 :I:.!ë sets to buzz 5 to 60 mln KI!Y"", \
 
No. M-22 TImer. . . 6.95 


.'. 
 
- 
c ... ;;;:;. 

Q 
.
 
:
 
'- 


"- 
Free Initials and 
Free Scope Sac_k with your own 
LittmaUD Nursescopef 
Famous Littmann nurses' 
diaphragm stethoscope . . . 
a fine precision instrument. 
with high sensitivity for 
blood pressures, apical pulse 
rate. Only 2 OlS., fits in 
pocket, with gray vinyl anti- 
collapse tubing, I10lKhilling 
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.llke colors: Goldtone, Initials and Sack 
SI'vertone, Blue, Green, Pink. Duty Free 16,95 ea, 
.'''PORTAHJ: New "Medallion' styling Includes bJbing in colors to match 
meLt) D -ts If desired. add $1. ea. to prICe above; add 'M to Order 
No. 21&.!!!: on C<lUpCln. 


FREE INITIALS AND SACK! 
Your intials engraved FREE on 
chest piece; lend individual 
distinction and help prevent 
loss. FREE SCOPE SACK neatly 
carries and protects Nurse- 
scope. Heavy frosted vinyl, with 
dust proof press-type closure. 


LITTMANN COMBINATION STETHOSCOPE 
MaIlroom sens,t,.."y from this fine professiOnal instrument Con- 
vement 22'" overall length. weiRfts only 3'n oz. Ct1rome bJn,aurlls 
fixed at correct angle. Inlernal spring, stainless. chest piece. 1 
. 
dlaptlragm. 1 Y4 Of bell. RelT1O"iable non-chdl sleeve. Gray vinyl tubing 
Two ;",t,als en, on chest p,ece IR[[ SCOPE SACK INClUDED 
No. 2100 Combo Steth... 29.95 el. Duty Free 


CLAYTON DUAL STETHOSCOPE 
Lilhtwe,ght dual scope Imported Irom Japan, h'pest 
sensltlYlty for apical pulse rite. Chromed bmaurals. 
chest piece With 11,1;- bell and 1 'Ja" diaphragm, 
grey antl-collapse tubing t 01 . 29" long. Extrl 
elr plugs and diaphragm Included TWllmtials 
engraved Iree FR[E SCOPE SACK INCLUVI 
No. 413 Dual Steth . . . 17.95 ea. 
Duty Free 
LOW-COST STETHOSCOPE 
Our lowest cost precision stethoscope! Slnlle daaphragm II 7/," daa) 
Choose Blue. Green. RelL Silver or Gold tubing and chestplec:e. silver 
bmaurals. onl, 3 0' Ihr.. initi.1s e..raved Iree FREE SCuPE SACK 
No. 4140 Cia,. Steth ., 11.95 ea. Duty Free 



 


\- 


, 
-"'" 


No. 149 Shouldlr 
Bal... 32.95 el. 



 


.1 


NURSES SHOULDER BAG 
Perfect fOl .be ,,!Siting nurse' Combine-s 
convenience 100 smart styling, while 
avo,d,nl the risk, 'docl""s bag' lock. 
AdJustable shoulder strap, Of carry in 
hand Generous inSIde and outside poc.eh 
lor retards adlustable and fi.ed loops 
Inside to hold bottles. tubes. instruments, 
etc. 'n nth water-repellent vinyl sim 
black leather. sturdy stitching, gokl fin- 
ished "',dware, Jock eI.sp wIth key. ()pens 
widely for easy access ID card holder on 
end IREE ,nillals lold embossed 12"'" 
. 9"'" . 5'1." Dutstand'III ..Iue' 



 


7k,...fu-
 


MRS. R. F. JOHNSON 
SUPERVISOR 


IN 


.1. 


.=- 


CHARLENE HAYNES 


. 


a-" 
,
- 
. " OHN. L.PN. 


.1. 


..... 


51. 
........ WIllI ..,., __ 
NURSES PERSONALIZED SPHYG 
Now in Fashion Colors! 
A superb aneroid sphYK especlilly dnlgn
d 
'Of nursrs by ReIster precIsIOn craftsmen 
In W GerlTUlny bsy to attach Velcro. cuft. 
hp'
lpt. compMl fits Ifttc soft slm / 
leather zipper c
e 2'n" I .... I 1". Dill. 
calibrated to 320mn1. IO-yell <<curaer 
1
:


I
e:

 ;

 S


I:
fS - , ( 
engraved on manometer and gold 
stamped on tise FREE Choose BLACK 
witt! chrome metal manometer or 
BLUE, GREEN or BEIGE w,th pl"'t", 
m,"",. houSing tubing. cuH and C
 
all color-coordm,ated (s
lfy on coupon1- 
No. 106 Sphn. . . .39.95... 
Duty Free 


(NJO 


.... 
--- 



 


, 


, 


/' 


BLOOD PRESSURE SET 
An outstanclml ._ sp/lyg. made 

 In Japan especially 'Of Reeves. Meets 
an u.s. Gov. specs, :<o3mm accuracy, 
D gua""teed 10 yoars. Black and 
chrome manometar, al to 300mm. 
Velcro" I'ey cull, blp tubinB. soft 
leatherette zipper case measuring 
2'n'" I" t" I" 1". StfYlCed in USA I' 
ever needed Clayto" No. 4140 

 Stelhoscope Is,lver) and Scope Sack 
G included Isee photo left) FREE lold 
initials on case. Here IS . smsible. 
pract,cal, dependable 
,t just "pt 
for every oorse! 
. No. 41-100 B.P. Set... 
--" Duty Free 33.95 set complete 
SphYI onl, No. 108 .26.95 with case 

... 
 "" 

 
 ..=-.......
 
CAP TOTE keeps your caps c",plOll clean. 
Flexible cle.ar plastic, white trim, zipper, carrying 
 - 
 !I 
slr2ll, "'ng lOop. Stores llat. Also tor w'llets, 
curlers. ete 8'n" dil. 6" hip 
No. 333 Tote. . . 2.95 ea. r, 

 Gold init. add 50.. 
_ WHITE CAP CLIPS Holds caps 
.....,. 
 firmly in place' Hard-to-fincl wh,le bobbie pins, 

..'-\ ..
 el\a(l1el on lìne sprang steel. Seven r InCI tour 
. > 3" clops included 'n plastIC snap boL 

 No. 529 Clips 85. per box (min. 3 boxes) 
"-.. MOLDED CAP TACS 
-, 
Repllce cap band instantly. Tiny plastic tac, dainty -- ./ T 
ca&iceus. Choose Black. Blue. White or Cryster wit 
 
Gold Caduceus. The neater way to flsten bands 
 
r::;-r.n No. 200 - Set 01 6 Tau -:; - 
W Øi ...1.25perset , 
;:- METAL CAP TACS Plir of daint, 

 JewelJ}'-quahty Tacs with griþpers. h
lds cap 
... bM1ds secure',. Sculptured metal, gole! finish, 
appro. W' wide Choose RN, LPN, LVN, RN 
D.\JlI Caduceus or PIIIR c.tuceus. Gift bo1ed. 
No. CT-l (Specify Init.)..... No. CT.3 (RN 
Cad.) . . No. CT-2 (Pilon Cld.l. . . 2.95 pr, 


TO: REEVES CO" Box 719, C, Attleboro, Mass. 02703 
ORDER NO. ITEM COLOR QUANT. PRICE 


---I 
Use extra sheet for additional items or orders. 
. 
I 


I 
. INITIALS IS desired: _ _ _ 
I TO ORDER NAME PINS, '''' out øll information in box,top 
'efl. clip out and attach to this coupon. 



 Please add 50C handlinl/posta.. 
I enclose S , on Drders totallinl under $5.00 
No COD's or billinl to individuals. Mass re..dents add 3% S. T. I 
Sendto. .. 
Street .. 
. 
C,ty . State. ZIp. 



r 


16 


The Canadian Nurse May 1976 


f
alell(lal. 


May 26 - 28, 1976 
Annual Meeting of the Saskatchewan 
Registered Nurses' Association to be 
held at the Coronet Motor Hotel, 
Prince Albert, Saskatchewan. Theme: 
"Expectations - Yours and Others." 
Guest speaker: Dr. Jerome Lysaught, 
Professor of Education, University of 
Rochester, Rochester, New York. 


May 31 - June 1, 1976 
Sixth annual nursing alumni 
conference at University of Western 
Ontario, London, Ontario. Theme: 
Quality of living. Contact: Alumni 
Committee, Faculty of Nursing, Health 
Sciences Centre, The University of 
Western Ontario, London, Ontario 
N6A 5B7. 


May 31 - June 4, 1976 
Bilingual Health Care Evaluation 
Seminar to be held at the University of 
Montreal, Montreal. All participants 
are expected to be able to understand 
both spoken French and English. 
Information from: Hélène Chauveau, 
Coordonnatrice du séminaire, 
Département d' administration de la 
santé, 2375, Côte Sainte- Catherine, 
Montréal, P. Qué. 


May 31 - June 11,1976 
Habitat, United Nations Conference 
on Human Settlements to be held in 
Vancouver, British Columbia. For 
information, write: Enrique PenaJosa, 
Secretary General, Habitat, 485 
Lexington Ave., New York, N. Y. 
10017, U.S.A 


May 31 - June 11, 1976 
Course in "Organization and 
Techniques of Rehabilitation 
Medicine" at the Calgary General 
Hospital offered by the Department of 
Physical Medicine and Rehabilitation 
and the Department of NurSing 
Service. Information from Director of 
Physical Medicine and Rehabilitation, 
Calgary General Hospital, 841 Centre 
Avenue East, Calgary, Alberta. 


May 31 - June 4, 1976 
Multi-Disciplinary Pediatric 
Rehabilitation Course to be held at 
Ontario Crippled Children's Centre, 
Toronto. Information from: Norma 
Geddes, Education Department, 
Ontario Crippled Children's Centre, 
350 Rumsey Road, Toronto, Ontario. 


June 2 - 3, 1976 
Seminar: Health Administration 
Forum. To be held in Ottawa. 
Information from: Coordinator, 
Continuing Education Program, 
School of Health Administration, 
University of Ottawa, 545 King Edward 
Avenue, Ottawa, Ont., K1N 6N5. 


June 2 - 4,1976 
Canadian Association of University 
Schools of Nursing annual spring 
conference with Learned Societies is 
to be held at Laval University, Quebec, 
Que. Theme: a creative approach to 
aging. Contact: Colette Gendron, 
Program Chairman, School of 
Nursing, Laval University, Pavilion 
Comtois, Quebec P.Q. G1 K 7P4. 


June 3 - 4, 1976 
Fourth Nursing Pharmacy Workshop 
to be held at Red Deer, Alta. Theme: 
Cardiovascular Disease and Patient 
Management. Information from: 
Continuing Nursing Education 
Division of Continuing Medical 
Education. Clinical Sciences Bldg.. 
University of Alberta, Edmonton, Alia. 
T6G 2G3. 


June 14 - 17, 1976 
Workshop on the borderline student 
nurse to be held at University of 
Western Ontario, London, Ontario. 
Information from: Summer School and 
Extension Department, University of 
Western Ontario, London, Ontario 
N6A 5B8. 


June 16 - 18, 1976 
Annual convention of the Canadian 
Hospital Association to be held at the 
Chateau Laurier, Ottawa, Ontario. 
Information from: Canadian Hospital 
Association. 25 Imperial Street, 
Toronto, Ontario, M5P 1C1. 


June 19, 1976 
Kitchener-Waterloo Hospital reunion 
for Class of 1966 Information, from 
Hilary Bowers 196 Lyndhurst Drive, 
Kitchener, Ontario, N2B 1 C1. 


October 27 - 29, 1976 
Annual general meeting of the Order 
of Nurses of Quebec to be held at the 
Queen Elizabeth Hotel, Montreal. 


11I1)tlt continued.. 
Slip in time... 
There is one mistake in the article 
on Halifax (February, 1976) which I 
rather object to as it was not written 
this way in my copy. It is not "The 
Order of Good Cheer" - it is ''The 
Order of the Good Time" - this is the 
official name. 
I like the new format 
 it's quite 
exciting and immensely different - 
almost takes a bit of getting used to. I 
particularly liked your January 
editorial! and I do hope you're having 
fun. 
- Dorothy Miller, Public Relations 
Officer, Registered Nurses' 
Association of Nova ScOtIa. 


Death with dignity 
Much has been heard recently, on 
T.V. and in the newspapers, about an 
individual's right to "die with dignity" 
There is a great difference 
between positive euthanasia and 
passive euthanasia; the latter is simply 
the withdrawal of extraordinary 
treatment, without which the patient 
would die a natural death with nature 
taking its normal course. 
The answer may be to have those 
who wish to do so write out a 
statement to the effect that if ever their 
life reached a point where it must be 
artificially sustained by extraneous 
mechanical means then they would 
wish to be allowed to die with dignity 
and peacefully.... 
- Alice Tester, R.N., White Rock, 
B.C. 


Moving, being married? 
Be sure to notify us in advance. 


. 


Attach label from 
your last issue or 
copy address and 
code number from it here 


New (Name)/Address 


Street 


City 


Prov./State 


Please complete appropriate category 


Postal Code/Zip 


o I hold active membership in provincial nurses assoc 


reg. no./perm. cert./lic. no. 


o I am a personal subscnber 
Mail to: The Canadian Nurse, 50 The Drivewav, Ottawa K2P 1 E2 



PROTECTIVELY! 



 


.. 
 
, 
-.. 
. ... 
'\.-- 
, toe; 
, "-- ..... 


IVAC 230 Controllers Detect Most Infiltrations 
and Provide the Best Possible Patient Protection 


All medical-surgical LV.'s can be made safer, more accurately. 
New IVAC 230 Controllers provide unexcelled protection to any patient 
receiving an LV. Ideal for med-surgical floors where nurses cannot be 
with patients every moment. 
Protection is constant. Even when the patient is being transported, 
battery power provides uninterrupted coverage. This eliminates the 
fear of runaway LV.'s and the time consuming re-adjustments neces- 
sary when using only the LV. set clamp. Compact new IVAC 230 Con- 
trollers make it easier than ever to insure correct medication.,. not 
underdose or overdose. . drop rate selected is maintained. 
COST JUSTIFIABLE! 
Because tissue infiltrations are detected and most re-starts eliminated, 
the patient receives better medical care and at lower cost. Most hos- 
pitals find that the cost of additional sets used in re-starts alone, pays 
for the modest investment in the IVAC Controllers. 
Give your patients this reliable protection soon. Ask to see the new 
IVAC 230 Controller with built-in battery for uninterrupted protection. 


.Coggin, S Modern I.V. Technology Modern HospItal. March. 1973 


IVAC 


DJ;;;;
 ;
S TE
;

:." 
47 Baywood Road, Rexdale (Toronto) Ontario M9V 3Y9 
IAi1
\ 7Aa_
111 ... T......I........... 
 
,c:,c:1., 


111 


, 
\ 


.. 


= 


- 


. 


J 


2 0 



 



. 
, 



 
\ 


'# 


. 


) 


" 


-- ./' 


\.. 


7 


" 


, 


..... 



 


-....... 
"-- 


--... 


I 


0) 



. 
) 



l) 


The 'Littmann' Series Portfolio of 
A. Y. Jackson drawings 
Free with your order 


Reproduction of 
A. y. Jackson 
drawings by 
special permission 
of the McMichael 
collection. 


Littman @ 
STETHOSCOPES 
· · · tru Iy the fi nest 
stethoscope a 
nurse æn own 
The Medallion 
Combination Stethoscope 
The highest quality bell and diaphragm 
chest piece, the stethoscope for nurses who 
practice in critical care areas. Choice of five 
tubing colours - goldtone, silver tone, blue 
green and pink. 
The Medallion Nursescope 
Colour co-ordinated in five jewel like 
colours. This stethoscope was especially 
designed for the nurse. Weighs only 2 oz. 
and fits neatly into uniform pocket. 


Group Purchase Package 
Your local selected surgical supply dealer 
handles the complete line of'Littmann' 
stethoscopes and will offer discounts on 
group purchases of five or more. 


Write us today! 
for complete details on: 
D The 'Littmann' stethoscope line 
D The Group Purchase Package 
D The 'Littmann' Series portfolio 
D A list of selected 'Littmann' 
dealers 


3m (ANAD
O
;
I

 3m 


POST OFFICE BOX 5757 LONOON ONTARIO N6A 4T1 



-
 



 


The Canadian Nurse May 1976 


19 



 TRANSPORT OF NEONATES 
 
- a :matter of prevention 


Transport of the sick neonate by personnel unaware of his special needs may render 
the journey so hazardous that all efforts at the referral hospital become futile. 
The authors demonstrate that careful nursing and adequate preparation before and 
during transport can minimize the risks inherent in such a journey. 


Moya Johnson and Jamce Gash 


Moya Johnson, R.N.. B.Sc.N., is clinical 
instructor in neonatal nursing and Janice 
Gash, R.N., B.Sc.N., is research nurse in 
neonatal transport at The Hospital for Sick 
Children, Toronto, Ontario. 


Moya Johnson 



 --..... 


Every year, approximately 12,000 "high risk" 
infants are born in Ontario, many of them in 
hospitals without facilities for the necessary 
intensive medical and nursing care. If they 
become critically ill, these infants must make a 
potentially hazardous journey to a neonatal 
intensive care unit In another facility. The story 
is the same in other provinces. 
Some units have a transport team (usually 
consisting of a neonatologist and a speCIally 
trained nurse) and are equipped with a 
transport incubator, cardiac and temperature 
monitors, and complete resuscitation 
equipment. The team tries to stabilize the 
baby's condition before transportation, and 
provides intensive care throughout the journey 
to the referral center. Unfortunately, few 
isolated areas and not all cities have access to 
such transport teams, and in some Instances 
there is no one with experience in 
neonataology who can accompany the sick 
infant. Also, a team may receive more calls 
than it can handle at a given time or, because 
of bad weather, may be unable to reach the 
infant. 
It happens sometimes, then. that a nurse 
with no neonatology training has to care for a 
sick newborn Infant before and during his 
transfer to a referral center. 1 This makes it 
essential that all nurses in outlying hospitals 
with maternity beds be aware of the special 
problems of the sick newborn 1 2.3 and of the 
measures necessary for their safe transport. 
All too often there is a temptation simply to 
place the critically ill neonate in an incubator 
and dispatch him as quickly as possible - a 
well-intentioned but misguided approach. 1 
ThIs report provides some guidelines for 
nurses to help them understand the special 
requirements of sick newborn infants. The 
nurse should first of all obtain all available 
information concerning the infant in her charge 
- not only the disease or defect from which he 
suffers (its pathophysiology and possible 
complications) but also the maternal and 
family history, the gestational age, and general 
condition. Ideally, the nurse should have had 
previous contact with the baby. 


-- 


. 


...;.-- 


Jamce Gash 


Thermal control 
It is of paramount importance to prevent 
loss of heat in the newborn. He produces heat 
by body metabolism and muscular activity and 
cannot shiver in response to cold, so must rely 
on nonshivering thermogenesis for heat 
production. This involves energy generation in 
brown fat (a highly vascular deposit of fat 
chiefly between the shoulder blades and 
around the neck). This tissue's ability to 
produce heat as a metabolic adaptation to cold 
is greatest in the newborn. However, the 
greater the demand for ItS activity the more 
quickly It is depleted. 4 Because illness 
depletes his energy. depressing his 
metabolism and decreasing body activity, the 
newborn may be unable to produce enough 
heat to maintain his body temperature,S 
Cold stress is traumatic, even life 
threatening. Mortality rates in small, premature 
infants increase markedly with each degree of 
temperature loss1.4 hence the importance of 
preventing heat loss. 
Heat is lost from the body through 
conduction (to a colder obiect in contact with 
the body), evaporation (fluid changing to vapor 
on the body surface), convection (to cooler air 
currents), and radiation (to a cooler, solid 
object not in direct contact).s In an 
air-conditioned case room or nursery, an 
exposed, wet, sick baby can lose a great deal 
of body heat very quickly 
Heat loss can be prevented in several 
ways, as shown in Table I These techniques 
do not, however, increase an infant's 
temperature, but only minimIze loss of body 
heat. Therefore, heat shields, Saran. bubble 
plastic, blankets, and foil should be used only 
on warm babies. 
Cold stress may result in the following 
complications: 
. decreased energy stores, leading to an 
increased likelihood of hypoglycemia: 
. decreased activity of enzymes concerned 
in production of surfactant; 
. increased oxygen consumption; 
. Increased metabolic acidosis, if there is 
accompanying hypoxia or shock; 
. increased risk of kernicterus in jaundiced 
infants: 
. increased risk of hemorrhage. 


Before transit: If efforts to prevent cold stress 
have been unsuccessful. measures must be 
Instituted immediately to rewarm the Infant A 
normothermic environment during transfer 



20 


The CanadIan Nurse ,
ay 1976 


----- 


enhances the chance of survival, and is much 
easier to achieve with proper equipment at a 
base hospital before transit. In view of the 
survival factor, the extra time taken to rewarm 
the infant before transit is not wasted. 
A radiant heater provides the most 
effective and safest means of rewarming a 
hypothermic infant. Many commercial models 
are available, most of them servocontrolled. 
The temperature gauge should be adjusted to 
about 1 0 C - 2 0 C above the infant's skin 
temperature. Rewarming should proceed 
slowly; too rapid rewarming can result in apnea 
and shock. An incubator is used in conjunction 
with radiant heat as neonates are less able to 
absorb heat by convection. An incubator may 
be used alone for a slightly cold baby whose 
temperature is 35.5 0 C - 36.0 o C.The 
servocontrol should be set to maintain skin 
temperature at 36.5 0 C. If the incubator is in a 
cold room or near an outside window much of 
the infant's body heat may be lost by radiation 
through the incubator shell; hence the 
temperature of that area of the nursery or case 
room is important. 


During transit: The transport incubator must be 
preheated (Table II) and must be capable of 
maintaining the appropriate temperature (in 
accordance with baby's weight) by its own 
power source. A specially designed model is 
the apparatus of choice. Nursing procedures 
should be carried out through the portholes, to 
minimize escape of heat. 
Bubble plastic is an ideal insulator for 
transport, permitting a clear view of the infant. 
When warmed blankets are the only available 
means of conserving body heat, the nurse 
must be even more vigilant to compensate for 
limited access and visibility. 


J ' 
--- 
. ,}-/- 
! 
t1 
rr
. 
...., 


-1
 
I l 
 


, 


0. 


I .\ 


;.\ 
., 
 


r 
 


Figure 1 - Transport incubator with power source for light, heat and air-flow, as 
well as independent oxygen source. 


, 


... 



 


- 




 


Figure 2 - Rectal temperature of baby is checked while he is lying on bubble 
plastic. Note open N /G tube in place and suction mucus trap at hand in incubator 
Figure 3 - Nurse and baby ready for transport. Note: I. V. on pole with I. V. 'Holter' 
pump for continuous infusion; oxygen analyser; adjustment of temperature control; 
baby wrapped in bubble plastic with N /G tube in place. Nurse, with stethoscope 
around her neck, holds case containing emergency equipment. 



i 1 


.. -' 


I 

 



 
-.(\-' 


- 


---=:-- 


,. 



 



 


"- 

 


/" 


.... 


'11> 

t 


",. 
ia, . 



'- 


"-- 


-- - 


.\ 



 


'\.. 


, 
1 


- 
" 


. . 



- 


4
 \ 
:...
 ' 



The CanadIan Nurse May 1976 


21 


Respiratory care 
Airway: Maintenance of a clear airway is 
ssential. Most infants require only gentle 
,Llctionlng of accumulating mucous 
ecretions: but some may need intubation, 
:ither prophylactic (in case of apnea) or for 
:3spiratory complications. The endotracheal 
Jbe should be securely taped to maintain its 
'roper position, and suction catheters should 
,e used to maintain its patency. Air entry is 
Ihecked regularly with a stethoscope, over 
oth lung fields. If the breath sounds are 
I iminished, the chest does not visibly inflate: 
'r if cyanosis develops, the tube may be out of 
.osition or (rarely) blocked. Vocal sounds from 
,e infant will indicate that the tube is not in the 
'achea. If you think the tube is dislodged, 
9move it, and continue ventilating by mask. If 
'ou think the tube is blocked. suction it. 
Since the motion of the ambulance could 
:ause the infant to aspirate his stomach 
'ontents, the stomach must be emptied before 
Ie leaves hospital. 


Jxygenation: Having established that the 
iirway is clear, the nurse should attend to 
Jxygenation. The inspired oxygen 
:oncentration may need adjustment in infants 
Nith respiratory disorders. Hypoxia 
insufficient oxygen to the tissues) can result in 
,"ocal necrosis and permanent brain damage, 
,-iyperoxia (too much oxygen) can cause 
::>Iindness in premature infants by disrupting 
normal developmental patterns of the retinal 
iblood vessels, 
Accurate assessment of individual 
oxygen needs is the only sure way to prevent 
deleterious oxygen effects, An arterial 02 
pressure (POl) in the range of 50 - 70 mm Hg IS 
ideal for term or premature neonates. If 
blood-gas measurements are unavailable, the 
infant's color can be used as a rough guide. 
The flow of oxygen (liters per minute) is at best 
unreliable, as the 02 concentration (the 
amount breathed) will vary with leaks, the 
amount of ventilation, type of equipment, and 
method of administration, The 02 
concentration required for each patient must, 
therefore. be determined. and the actual value 
must be measured and maintained at this 
appropriate level. 
A guide for oxygen administration. if blood 
gases are not known, is as follows; 
1 Place the infant in 40 percent oxygen 
and assess his color. 
2 If he is cyanotic, increase 02 
concentration by 10 percent increments until 
he becomes pink: then reduce it by 5 percent. 
3 If he is pink in 40 percent 02, decrease 
by 5 percent decrements until cyanosis 
appears; then Increase by 5 percent. 
It should be borne in mind that oxygen 
requirements may change during transit. 
Therefore, constant evaluation is necessary 
until arrival at the neonatology unit (an 02 
analyzer is a valuable aid). 


Table I 


Methods of Limiting Heat Loss 


Equipment 
and Method 


Function 


Incubator 


ProVIdes flow of 
wanT! air 


Process 
leading to 
heat loss 


Convection 


Environmental 
humidity 


Reduces loss of fluid 
from body surface 


Evaporation 


Drying 


EvaporatIOn 


Prevents heat loss 
from evaporation of 
amniotic fluid 


Heat shield 
(Plexiglass) 
over infant inside Incubator 


Decreases heat radiation 
through incubator shell: 
insulates the infant 


Radiation and 
convection 


Bubble plastic. double- 
layer plastic wrap 


Insulates the infant 


Radiation and 
convection 


Saran: sll1gle-layer 
plastic wrap 


Prevents liquid -+ gas 
change at body surface 


Evaporation 


Warm blankets, 
aluminum foil 


Convection and 
radiation 


Insulate the infant 
(N.B.: Impair view of 
the infant; therefore. 
of limited value) 


Heating pad, 
hot water bottle 


Conduction 


WanT! surface In contact 
with baby 
(N.B.: May cause bums 
if temperature dIfference 
too great) 


. Aorcap. Bren' Manulactunng lid.. Mahon. Ontano 


Table II 


Incubator temperature during transport of sick neonates 


Body wetght 


"C Incubator temperature- 


1,000 g 


36 - 37 


1,001 - 2,000 g 


35 - 36 


2,001 - 3,000 g 


34 - 35 


. Temperatures bted are gUK!e'nes only. Rectal temperature should be lTIOI'I,to,ed every 10 to IS monI.Ces, and \he ,"cubator 
temperature adjusted accordingly 



22 


The Canadian Nurse May 1976 


' - 


Ventilation: Even though an infant breathes 
spontaneously and is appropriately 
oxygenated, he may not be properly ventilated 
because, in addition to inhaling oxygen, he 
must exhale carbon dioxide. Rapid, shallow 
respirations are less effective than regular, 
deep respirations in ridding the body of CÜ2, 
and a decreased respiratory rate may create a 
buildup of C02. Since breathing uses energy, a 
tachypneic infant is more likely to tire. and may 
even become apneic. Rates of 40 per minute 
for a term Infant, and 40 to 60 for a premature 
one, are appropriate. Rates over 100, or less 
than 30 per minute, which are likely to be 
inefficient. may be supplemented with 
intermittent bagging (e.g., for tachypnea, bag 
for 5 minutes each half hour). When the rate is 
markedly diminished, bag continuously at 40 
- 60/ min in conjunction with respirations. 
Before bagging by mask, aspirate the 
stomach with an orogastric tube, which must 
then be left open and in place to allow for 
decompression of accumulated air. 
Observe the infant for other signs of 
respiratory distress, such as grunting, 
indrawing, and flaring of the nostrils on 
inspiration. These, m addition to tachypnea 
and cyanosis, are signs of lung disease; record 
the time of onset, degree of severity, and 
change. 


Apnea: It is normal for neonates to breathe 
irregularly. However, cessation of respiration 
for longer than 20 seconds and/or 
accompanied by bradycardia, with or without 
cyanosis, is considered to be apnea and 
requires treatment. Apnea may be due to 
many factors, including overheating, 
immaturity, neurologic damage or depression, 
airway obstruction, C02 retention and hypoxia, 
hypoglycemia, or sepsis. 6 
If an infant stops breathing, he may 
respond to stimulation during the first 20 - 30 
seconds of apnea. Stroke the abdomen gently 
and flick the soles of his feet. If there is no 
response, quickly suction the naso- and 
oropharynx. In addition to removmg mucus, 
this may stimulate a gasp, followed by 
resumption of respiration. Suctioning must be 
brief: if prolonged it may result in hypoxia and 
pulmonary collapse. 2 If there is still no 
response, ventilate the baby with a bag and 
mask at 60 per minute with the requisite 
oxygen concentration. Give 5 or 6 inflations: if 
the color has improved and the heart rate is not 
below 120 per minute, pause to see if 
spontaneous respiration is resumed. In the 
continued absence of respiration, continue 
bagging and stimulating until respiration 
begins. 


,t 



 


........- - 
- 


, 
... 


- 


, 


-.: 


... 



 


, ......J- 


.
\-
 
" 
--- 


,. 



 


r 


. , 


) 


- 


-r -" 't f 
1]1?' 



.""'. 


-.- 


. 


... 
...... 


...ç 



l 


....- 



 
- ì 
.Î ;- 


.- 


":- ..... 


./ 


--' 


Figure 4- Nurse adjusts oxygen flow on transport incubator as incubator stand IS 
lowered to fit into ambulance. 


Metabolic homeostasis 
Hypoglycemia: Low blood sugar i n infants 
is most common in those who are small for 
date and/or premature; cold-stressed, septic, 
and asphyxiated; babies of diabetic ortoxemic 
mothers; and those with Rh incompatability. A 
glucose level of less than 40 mg/dl, especially 
if giving rise to symptoms, may result in 
irreversible brain damage. Therefore, it is wise 
to check the blood sugar level with a heel-prick 
Dextrostix (Ames Laboratories) or a laboratory 
test before transport. 
The infant should be observed for signs of 
hypoglycemia, including: 
- jittery state, twitching, convulsions, 
exaggerated Moro reflex: 
- apathy or lethargy: 
- apnea and/ or cyanosis; and 
- poor feeding, decreased sucking reflex. 
If intravenous therapy is given to correct 
hypoglycemia, the flow must be kept constant. 
A battery-powered LV. pump will help to 
achieve this 


Acid/base balance 
Events such as hypoxia, hypothermia, 
hypercapnea, cold stress and hypoglycemia, 
and conditions stemming from inborn errors of 
metabolism, may alter the blood pH. This may 
severely disrupt the metabolic activity of cells. 
Therefore, it is important to stabilize the 
acid/base balance before transport and to try 
to correct or treat the underlying cause. 
(Normal blood-chemistry values are given in 
Table III.) 


Fluid balance and Intravenous 
therapy 
It is dangerous to overload the circulation 
with fluid, which can easily happen in a small, 
premature baby when the I.V. line is 
unobserved for even a short while. The fluid 
requirement for a newborn or premature in the 
first 2 to 3 days of life is approximately 75-150 
mllkg of body-weight per day (for a 1 kg baby 
the LV. rate should be 3 - 4 ml/hr). 
It is difficult to maintain an LV. drip in a 
moving ambulance due to motion. lack of 
height for the pole, and the patient s activity. 
The LV. line must be securely fastened, and 
the site visible for assessment. This line may 
be invaluable for emergency administration of 
medication, both in transit and on arrival in the 
unit, henæ it must remain functional. 



The Canadian Nurse May 1976 


23 


Ambulance and equipment 
The ambulance should have its own 
p-'IIer source, unaffected by engine r.p.m. (12 
t DC battery is best). The cab must be 
-tted to at least 26 C before the Incubator is 
:::ed in it. Heat turned on at the time of 
p 
-up is ineffective, as the cool Inside walls of 
> ambulance permit loss of radiant heat. The 
gen and suction facilities must be in 
rking order. 
The transport Incubator has specific 
wirements. It should have its own power 
urce for light, heat, and airflow and also an 
ependent oxygen source for use between 
lbulance and hospital, or when the 
lbulance supply has been depleted. The 
bulance power supply must be used for the 
Jrney as most Incubator batteries have a 
serve of only 1 - 2 hours and take many 
furs to recharge. The Incubator should be 
ed with a thermometer and thermostat 
ntrol. The light source must be adequate for 
ar observation of the infanfs color and 
nditlon; this can be supplemented by using a 
ong flashlight. 
The nurse requires a good working 
lowledge of the incubator, including how to 
mtrol the 02 concentration in the baby s 
wironment. Dunng transport, the baby must 
? securely strapped down within the 
cuba tor. 
The best Incubator is only as good as its 
erator. 
Every transport should be provided with a 
It containing 1) bag. 2) mask, 3) 
lucus-collection trap and suction catheters, 
) stethoscope. 5) thermometer. 6) oxygen 
nalyzer. and 7) flashlight. The quality of care 
enhanced if, in addition, the kit contains 
rugs for emergencies and an LV. pump. 


Special conditions 
Certain conditions warrant additional 
reparations for transport: 
neumothorax: A chest tube is imperative, 
referably attached to a one-way safety valve 
-teimlich valve, Bard Parker Co., 
lutherford, N.J.. U.S.A.) or underwater seaL It 
luSt not be clamped. 
I/aphragmatic hernia: The Infant s head and 
lJnk should be elevated, to relieve thoracic 
ressure. Since gastric distenSion would 
Icrease intrathoracic and embarrass 

spiration, an open oro- or nasogastnc tube 
j mandatory. Endotracheal intubation is 

commended in case ventilation is required in 
'ansit, as mask ventilation increases gastric 
istension. 
'hoanal atresia: An oropharyngeal airway. 
ecurely fastened In place, IS essentlal:
 
rachee-esophageal fistula: (In 95 percent of 
ases a fistula joins the lower esophagus to the 
achea). These infants should be placed 
pnght, sothat gravity will prevent aspiration of 


Table 1/1 


Normal blood chemistry values in the newborn 


Blood pH 


7 34 - 7.45 


Pa02 (mm Hg) 


50-70 


aC02 (mm Hg) 


35 - 40 


HC03 (mEq/liter) 


19 - 22 


Base excess 


-4 to +4 


Blood sugar (mg/dl) 


Serum calcIum (mg/dl) 


45 - 115 


8 - 10 


Serum electrolytes (mEq/Uter): 


Na, 140; K, 4; CI, 100-105 


gastric contents Into the lungs. The upper 
pouch must be suctioned continually: this can 
be readily accomplished with a feeding tube 
and syringe. 2 
Exposed abdommal or neural 
contents ( omphalocele. gastroschisis, 
myelomenglngocele, and bladder extrophy): 
Wrap the defect in warm, sterile. saline 
dressings, and further cover it with plastic wrap 
to prevent drying. (Vaseline gauze is not 
advised). Treat the entire infant with sterile 
technique (gloves, sterile linen. etc.). 


Nursing memo 
Before departure. 
1 Ensure that the infant s identity band is 
securely attached and that the details are 
correct. 
2 Check that you have the following 
documents: 
- maternal and family history (the 
neonatology unit may supply speCIal transport 
forms for referring hospitals). 
- maternal and cord blood (5 ml of clotted 
blood of each speCImen). 


I 
'1, . l' . I 
.... 

 
---- 
 --

 
, 
þ ...;1 
\ ..r-f 
 ....- 
I, "- 
I' . \ 
,... 
\. ,.. 

 
,I ....;-'" ... -
 

 I 
\ "- ( 
/ 
Figure 5 - Nurse plugs incubator power line into ambulance power supply. 



24 


The Canadian N ur5e May 1976 


- test results, radiographs, and so on. 
- photostats of nurses' notes and doctor's 
letter. 
- signed parental consent 
3 Scrub hands and arms for 3 minutes 
before handling the infant. 
4 If there is time, talk with the parents and 
allow them to see and touch their baby: your 
reassurance at this time will do much to allay 
their fears about the baby's illness. 
5 Just before leaving, check: 
. Infant - clear airway; appropnate 02 
concentration; correct body temperature; 
empty stomach; correct blood chemistry; and 
treat special condition(s). 
. Equipment - incubator; ambulance; 
emergency equipment; and oxygen supply. 
. Full data on baby and mother, and blood 
samples. 


During transport: If preparation is carefully 
carried out. the infant will be in a relatively 
stable condition and transit should require no 
undue haste. Upon entering the ambulance, 
adjust the voltage control and plug in the 
incubator to the ambulance power outlet. 
Change the oxygen source from the incubator 
to the ambulance cylinder and analyze the 
concentration. Observe the baby's condition, 
color, and activity and record his body 
temperature. Check the LV. flow rate and 
infusion site. 
After this initial review, the journey can 
begin. Throughout transit the nurse must 
constantly observe and monitor for changes in 
condition, take appropriate action, and record 
vital signs and other pertinent information. 
Lighting may be inadequate for accurate 
assessment, and noise levels may preclude 
adequate monitoring of apical heart rate and 
air entry. If uncertain of the baby's condition, 
ask the driverto halt the ambulance at the side 
of the road for as long as necessary. 
If medical advice is required Or a medical 
emergency occurs. use the ambulance radio 
to contact the referral Unit or instruct the dnver 
to proceed to the nearest hospital. If possible, 
inform the neonatology unit of your impending 
arrival, and the infant's current condition, via 
the ambulance radio. 


On arrival: However brief the journey from 
ambulance to ward, there must be continuity of 
observation and care. The incubator power 
and oxygen should be used; all necessary 
eqUipment should be available; monitoring 
should be continued. The transporting nurse 
should remain in the referral unit for a short 
time, to answer questions about the infant's 
history and his condition during the journey, 
and to obtain information for the parents and 
referring doctor. 



 


;j 


, 


. 


, 
" 


t 


-....:, 



 


. 

 


" ^ 


. 


T 
.. 


Figure 6 - "Hope" bag and mask applied over baby's face for ventilation. Note 
bubble plastic, N IG tube open to allow for decompression of the stomach. 


Conclusion 
Special requirements and precautions are 
necessary for safe transportation of sick 
newborns. With proper care, further 
deterioration in a sick infant's condition during 
transit can be avoided. In fact, with proper 
attention to apparently minor details, the nurse 
will, in many cases, be rewarded by seeing her 
patient's condition improve. 


References 
1 Chance, G. W. Transportation of sick 
neonates, 1972: an unsatisfactory aspect of 
medical care, by... et al. Canad. Med. Ass. J. 
109:9:847 -851, Nov. 3, 1973. 
2 Segal, Sydney ed. Manual for the 
transport of high-risk newborn infants: 
principles, policies, equipment, techniques. 
Sherbrooke, P.O. Canadian Pediatric Society, 
1972.198 p. 
3 Klaus, Marshall H. ed. Care of the 
high-fisk neonate, edited by...and Avory A. 
Fanaroff. Toronto, Saunders, 1973. Ch. 6. 
Transportation of the high-risk infant. 
p. 90 - 97. 
4 Cardasls, CA The effects of ambient 
temperature on the fasted newborn rabbit, 
by...and J.C. Sinclair. I. Survival time, weight 
loss, body temperature and oxygen 
consumption. BioI. Neonate 21 :330-346, 
1972. 
5 Lutz, Linda. Temperature control in 
newborn babies, by...and Paul H. Perlstein. 
Nurs. Clin. North Am. 6:1 ;15-23. Mar. 1971. 
6 Segal, Sydney. Oxygen: too much, too 
little. Nurs. Clin. North Am. 6:1 ;39-53, Mar. 
1971. 



The Canadian N..... May 1976 


25 


connC!ction 


Jo Logan 


The Handmaiden is NOT Dead 


"Ie handmaiden is not dead, despite what 
)u read in current nursing literature. She is 
ive and well and residing in the hearts of 
'ost physicians. This fact presents a problem 
"many new graduates, who are unaware of 
e discrepancy between how nurses think 
'ey should practice nursing and how 
hysicians think nurses should nurse. 


lost physicians still feel the word nurse and 
le word handmaiden are synonymous. 
Jhether this fact is openly admitted or not, it 
ecomes obvious - often painfully so - to 
ny nurse who tries to slip out of her traditional 
:ìle while working in a traditional setting. She 
; faced with a reaction on the part of the doctor 
:'hich ranges from frank outrage to 
ondescending amusement. Not only does the 
,hysician emphasize the technical skills of the 
urse but he frequently and openly blocks any 
,f her attempts to function in a way other than 
,hat he considers to be her traditional role. 
"his difficulty will increase as nursing 
!ducation and nursing service continue to 
nove toward a different type of nursing based 
In the belief that nurses have a major 
'ontribution to make to the health care of this 
'ountry . 
Because of current and future changes in 
lurslng practice, nursing educators have 
nade necessary revisions in the curriculum 
md many traditional attitudes and skills have 
>een replaced. One concept that has been 
trapped from nursing education is that of 
'handmaidenism." At first glance this would 
.eerT1 to be a step in the right direction but 

ithout the attitudes and skills of the 
landmaiden, the new graduate cannot play 
he "doctor-nurse game"l that is necessary for 
;urvival in most work situations. This is 

specially true in hospitals, where most new 
Jraduates begin their career. 
Stein describes an important aspect of the 
joclor-nurse game as follows: "The nurse is to 
>e bold, have initiative, and be responsible for 
naking significant recommendations, while at 
he same time she must appear passive."2 
I/urses are being taught 10 make judgments 
md act on their own conclusions but they are 
10 longer taught the need to be passive. 



-
 


Combine this change with the effects of the 
women's movement, and the result IS a new 
graduate who thinks of herself as a novice on 
the health team but with an equal and unique 
contribution to make as a nurse. Immediately, 
the novice practitioner must work with a 
physician who has a very traditional frame of 
reference regarding the nurse. The new 
graduate is quickly aware of how much she 
needs the doctor in an acute care situation but 
she does not know the rules involved in 
keeping this relationship functioning smoothly, 
This fact was clear during a recent orientation 
program this writer attended. Three-quarters 
of a group of new, two- and four-year 
graduates had had a confrontation with a 
physician before the three-week orientation 
was finished. They expressed astonishment 
because they did not understand where they 
had gone wrong. In most cases the difficulty 
stemmed from their inability to play the 
doctor-nurse game; they were just not aware 
of the nurse in a handmaiden role. 
Just as the neophyte becomes aware of 
her dependence on the physician in the clinical 
setting. the experienced nurse becomes 
aware of the power held by the physician in 
most institutions. If nurses must rely on 
physicians, then it seems prudent to consider 
their frame of reference. Any changes made In 
nursing practice will be slow, hard-fought gains 
until the relationship between the nurse and F. Jo Logan (R.N., Ottawa Civic Hospital: 
the physician changes. B.Sc.N. Ed., M. Ed., University of Ottawa) is 
Obviously the change in this relationship" teaching part-time at the Ottawa Civic 
should be initiated by experienced registered Hospital and at Algonquin College School of 
nurses, rather than new graduates. The Nursing. .. 
priorities of the novice are different, and 
revolutionizing nursing practice is not 
necessarily high on their list. The 
inexperienced graduate does not have the 
self-assurance of the seasoned nurse nOr the 
credibility so necessary to work any changes 
with physicians. It is difficult to change the 
rules of a game if you cannot play the game. 
There are a few examples of physicians 
and nurses cooperating to change the rules of 


the game 3 but these models are rare. Most of 
the changes will be accomplished in a less 
direct manner by experienced nurses who play 
the game skillfully but are aware of the 
limitations of this relationship and consciously 
set goals for a new type of nurse-doctor 
interaction. The efforts of the experienced 
nurse, supported by the Impetus of other social 
forces 4 will create a new and, hopefully, more 
honest relationship. 
Considenng that nurses need physicians, 
and that it is unlikely the new graduate will be in 
a position to change the nature of this 
dependence, nursing educators must retain 
handmaiden skills in the curriculum until they 
are not so urgently required. I do not suggest 
that a formal course "Handmaiden 204" for 
three credits be offered or that this concept slip 
back into the hidden curriculum, but certainly 
students should be made cognizant of these 
attitudes and skills. The handmaiden should 
be presented, not as a way of life, but as a skill 
to be utilized until it is no longer necessary. 
To ignore this need and assume that 
nurses can practice in a nontraditional way 
without first changing the nature of the 
nurse-physician relationship is naive. The 
handmaiden must disappear forever but this 
can only happen gradually as nurses evolve 
their new role to replace her. 


References 
1 Stein, Leonard. The doctor-nurse game. 
Amer, J. Nurs., 68:1 :101-5, Jan. 1968. 
2 Ibid., p. 101. 
3 Thomstad, Beatrice. Changing the 
rules of the doctor-nurse game, by...et al. 
Nurs. Outlook, 23:7:422-7. Jut 1975. 
4 Hoekelman. Robert A. Nurse-physician 
relationships. Amer J. Nurs.. 75:7:1150-2, Jut 
1975. 



26 


The Canadian Nurse May 1976 


WHAT DOES"THE QUALIT
 


For criminologist 
Marie-Andrée Bertrand, 
truth is at the center 
of life. 


This year, the Canadian Nurses Association is 
encouraging serious thinking, and - who 
knows? - possibly even action on the "quality 
of life" in Canada. This is a vast concept; it is 
also a subject which is very difficult to gauge 
precisely and one which each person must 
deal with on his own terms. Indeed, 
sociologists, economists and political 
scientists have recently identified several 
scores of possible "quality of life" indices. 
These are factors which may be termed 
meaningful scientific or statistical clues in 
which some confidence can be placed when 
considering the notion of quality of life, in a 
given and related sociocultural context. 
In fact, there are economic indices, such 
as average annual income compared to a 
cost-of-living index. There are social indices, 
such as the organization of human and work 
relationships. Political indices may include, 
among others, strength of democracy, and 
power of individual and group expression. 
It is through these types of factors that 
members of one society can be judged to be 
living in more human conditions than members 
of another society. After all, "quality of life" 
involves those conditions of existence which 
let us be more human, more totally 
"ourselves," to be more involved citizens, and 
to be the most competent and professionally 
efficient individuals we possibly can be. 
Some years ago I had the pleasure of 
teaching members of your association on 
several occasions. It is in the context of these 
earlier and very enjoyable meetings, that I 
remember who you are, what your way of life is 
and what your problems are - so that I am in a 
better position to discuss the quality of life with 
you. Of course, my own current interests also 
have a bearing on these considerations. I refer 
specifically to the four years I spent as a 
member of the Federal Commission of Enquiry 
into the Non-Medical Use of Drugs, an 
experience which will, I hope, tie in with some 
of your own medical interests as they relate to 
the quality of life. In addition, as a criminologist, 
I will be referring to certain conditions of 
mankind - of equity, of justice -which I feel 
must be redefined in order to become more 
meaningful in our society. 
At the Le Dain Commission, after three 
years of hearings in 100 Canadian towns, 


three years of research, meetings and writing 
and editing, I finally came to understand the 
reality that 80 - 85 percent of all known 
diseases have no known cure and that doctors 
are too often satisfied with recognizing 
symptoms and relieving them. 
I also learned that several drugs which the 
Canadian population consumes by the ton 
(like drugs with a codeine base) or by the 
hundreds of thousands of pounds 
(barbiturates, minor tranquilizers) are just as 
dangerous as the so-called illicit drugs such as 
cannabis. I saw the representatives of the 
major pharmaceutical companies come to 
defend their Valium and their Librium, overthe 
products of other companies, assuring the 
Commissioners that their tranquilizers have 
fewer side effects than the others, and present 
less risk of creating tolerance and drug 
dependence. 
In an intensive study situation such as 
this, the quantities of lies and half-truths that 
were discovered day after day shocked me. 
For me, the quality of life in the health field is 
related to truth. It is related to the truth about 
the relative impotence of medicine; about the 
effects of drug therapy; about the fact that 
certain diseases are fatal: about the necessity 
of suffenng, which cannot always be avoided. 
The quality of life of certain women I know who 
drag out their neurotic anxieties in 
psychotherapy, in depression, certamly IS very 
poor. I do not think that they are truly alive. 
These women are trying not to see what they 
are and trying not to die. 
On the other hand, as a criminologist and 
in a different but not completely dissociated 
field, in my work on civil liberties committees, I 
have been especially concerned with the 
definition of crimes. When I say that I agree 
with the Criminal Code of Canada that murder 
is a very serious crime, I certainly am not 
saying that murder is the only serious crime. 
As I see it, racism, sexism, exploitation of the 
poor. and air, water and noise pollution are all 
extremely serious crimes, as senous as 
murder and much mOre serious than offences 
against property. Indeed, humans can be left 
with physical well-being, even after they have 
been deprived of their dignity through racism; 
their autonomy and freedom, through sexism: 
their chances for a decent life, through 
exploitation of the poor; or their environment, 
through pollution. As long as the attitudes of 
those who are engaged so ferociously in the 
selfish pursuit of unbalanced priorities remain 


so static as to exclude real crimes like thes 
from our criminal laws and our value system
 
the quality of life certainly will continue to be 
myth. Compared with the immense social 
injustices noted above. nonviolent theft can 
hardly be considered a misdemeanor, yet, 
thieves are often impnsoned while the real 
criminals, such as the merchants who 
encourage persons with insufficient income 
to spend far beyond their means, remain free 
If a person's race, language, sex orsalar 
'does not give him or her access to facilities te 
which the majority of Canadians have a righ 
then, racism, sexism, and exploitation of thl 
undereducated and poor do exist in Canada' 
society. These crimes are major obstacles te 
the quality of life, both of those who commi 
them, and of their victims. They spring frorr 
and feed on greed, profit at any cost, the 
exploitation of man by his fellow man, 
institutionalized scorn for people of other 
races, women and children. 
As long as the medical profession and 
their colleagues, the pharmacists, will not 
permit the destruction of the myth that they 
have fostered ... as long as they persist in 
perpetuating this myth by writing and filling 
prescriptions that do nothing to improve the 
health of their patients ... as long as the 
medical profession refuses to admit its 
impotence in the treatment of 80 percent of 
recognized diseases . it is hard to see how th 
quality of health and life of Canadians can bl 
improved. 
Nurtured as we have been, by lies and 
half-truths, and stuffed with medicines, toda 
we are becoming pitiable dazed half-citizens 
half-persons, sheltered, we think, from 
suffering, anxieties and insomnia ... 
Marie-Andrée Bertrand, who received her 
MA. in Social Work and in Criminology frorr 
the University of Montreal, obtained her 
Doctorate in Criminology from Berkeley 
University in Califorma. She is associate 
professor in the School of Criminology at the 
UniversIty of Montreal. 
From 1969 to 1973 she was a member 0 
the Federal Commission of Enquiry into the 
Non-Medical Use of Drugs. She is cUrrently 
working on a book that will discuss the 
relatively minor involvement of the female se) 
in crime... 



The Canadian Nurse May 1976 


27 


)F LIFE"M&qN TO YOU? 


;onvention planners. Glenna 

owsell and Lorine Bese/, tell 
vhy the association chose 
his theme. 
I 


-his year's convention theme, according to 
'3lenna Rowsell, is a highly individual topic that 
,eflects many aspects of life. In its entirety, the 
')rogram is intended to present a global view of 
1uestions about the quality of life. "We want to 
mcourage nurses to see themselves, not just 
'IS professionals, but also as citizens who are 
lware of the world around them." 
One evening during the convention will be 
1evoted to music and art. "This is important," 
'3xplains Rowsell. "because the nurse is often 
30 bogged down in her duties that she ends up 
joing the same thing day after day and 
150metimes forgets about all the other 
,mportant and enriching experiences that life 
'has to offer." 
i Rowsell hopes the convention will 
Imotivate individual nurses to look for deeper 
limplications of living, not only for other people 
but also for themselves. She believes this will 
help each nUrse to see herself and her 
contribution to society more clearly. "There are 
many questions that nurses should be asking 
themselves but the most important is: Do I 
really identify with the effect that the nursing 
profession has on society and does that 
relationship have anything to do with 
improving the quality of life?" 
Rowsell feels that nurses are becoming 
too far removed from their primary function. 
'The administrative ladder IS taking us further 
and further away from where we should be- 
at the bedside where the real rewards of 
nursing are found." 
'So many young nurses say, 'I'm just a staff 
nurse.' Unfortunately, this attitude is becoming 
more common among nurses of all ages." The 
program chairman hopes the theme of the 
convention will help nurses to develop an 
increased awareness of the needs of the 
people they care for. "We must recover our 
sense of values," she says "and orient 
ourselves towards human beings, not 
effici ency ." 
Lorine Besel says "the quality of life" was 
chosen as the theme of the convention 
because "as nurses, we have a particular 
responsibility to see how patients are affected 
by their work and environment." She feels it is 
unfortunate thatthe nursing profession has not 
yet taken much responsibility in this area, "Our 
concern has been mainly with sickness. We 
need to become invo1ved at an earlier stage in 


:?< --------------------------- 
I I 
I Please register me for: 
I Annual Meeting, Canadian Nurses' Association 
Hotel Nova Scotian, Halifax, N.S., June 20-23 1976 and mail reælpt, admissIOn 
I card with convention kit ticket, details on procedure for registration and hotel 
I reservation card. 
I Name 
1 
I Address: 
I 
I Present position: 
: Registration no: 
I Registration fees 
I 
I CNA members 
I Students 
I 
I Please return this coupon with your cheque or money order payable to: 
I Canadian Nurses' Association, 50 the Driveway, Ottawa K2P 1E2 
I 


order to help the population gather enough 
data to identify the real causes of health 
problems." 
When asked to give a more precise 
definition of the nurses' role, she stated that 
nurses should be activists in helping the 
population formulate action plans forthe study 
of specific problems. "They should also speak 
out in public, both as professionals, and as 
individuals." 
What about Besel's own philosophy on 
the quality of life?" I am concerned," she says, 
"that individuals should have the opportunity 
to choose the kind of life they want to live. The 
pressures of our society don't permit people to 
make many choices. Often, these people 
aren't even aware of being cheated of this 
freedom." 
How is CNA related to the quality of life? 
What is the Association's role in enhancing the 
quality of life for its members and society at 
large? Besel is convinced that it is the 
responsibility of the national association to 
speak out on issues that have a direct bearing 
on quality of life - such as abortion, 
euthanasia, commitment to the aged, etc. She 
hopes that, by choosing this theme for the 
1976 convention, CNA will be helping nurses 
to become more aware of the contribution they 
can make to society..., 


, 

 


- \ 


- 
,... 


---'" 


Mane.Andrée Bertrand 


, 


v q' 


Y -.., 


Glenna Rowsell 


" 


.,. 


"' 


Ilr 
I I 


c 


f 


.- 
- 
..,... 


Iþ. 



...... 
'I;, 


Lonne Besel 


Surname lirsr 


Provo of reg.: 


TOlal 
meeting 


$75.00 
$30.00 


Daily 
rate 


Specify 
days 


$30.00 
$15.00 



r 


28 


The CanadIan Nurse May 1976 


H b - t t 
Canada may go down in history as the country where nev.. 
a I a solutions were developed for the world's growing human settlemenl 
problems. This is the goal of Habitat '76, the United Nations 
.. Conference on Human Settlements, being hosted by Canada in 
quality of hfe Vancouver, B.C., from May 31 to June 11. As providers of healt
 
on a g lobal scale. care, nurses have a vested interest in the succe
sful outcome 
of this conference 


Claire Marcus 



.:.:-
: 
 
 
:;.,



 -. . - "" . ".. 
.
. 
.- , 
4-._ )0_ _ 
 


.
 
-. -\"..
.t- -- ---er- .. 
..... - '" '\ -- -::.. 
... -..(. . a _ ...... 
.. . . :"l. 
-- ....... 



 


......... -.... 
':....fi 'IS., 


.. - 


-. "" 
,,' ...
 
., r 


-- 
 


(" ..... . '--ij; 
l:,
 ,
.,-".. "
. " '"1f"
 '
 
. , - 1-< 
 I
 


f.j1; ;;;
 
, "i'
 
 t '. .. . . 
"I
!' 
:.. 
 
 :.
 I . I 


-
 - -, 
.... 1 
. 
_ "1, 
"
;r \J 
-M 1-1' 
\ , 
._-. . 'f 
\ 
.. 
;r-:; 
"- 
, ... 
,... \ 


I 


. - ...:.I, 
.. .. :J",! 


i" 


'. 


. 
... 


-..... 

 h.-: 
. '.......--.... 
""""'-- 1_..",." 
'" , '-
. 

 t .. ,;-- - _ ....... '"-- 
- f! __ -.:: -";.,.....::'>...,,, 


.0..:" 


- - -- 
j"....-
 ..,r.-,:"... 
 
n.

:::: --:(- - 
 _ , 
..
.
......... "
'. ,. 
, .:- -} 
_... ,4',:- - , 
. - "'" 
-.--....-.
 .. 
. --..;.-. -..,,- 
".t,- _ ...._ :;..:
 ..... 


.. 


..
 

Jo' .. 

'- 'Þ" . '
"<
 
 '-_;"O;I.. 
1t'.<l,J(5

 
 -

..'I:'.. .'" 


 _ ",,-e '1. '" .... 
- -f

'U'
' 


,V., ,.,.
';l- 

.'-":-i-;1,.."'" þ,. ... 
..,;t'" ...__... _ "" 



 


- ..
----n 


: 


........'.. 
,
 
., 
. 
0;.. t' ...\... 
. ,^" 


.- 


..- 


.... ....;.\-- 
, ... 


.
.. J." ,';- C..'"'''' ,. 
... - 
. .......,r.; '..., t., 
jij 
 
. ,siI)"'I.Ji". ! . ..'... 
is 
 
 i.
 .,.
 '),-.,' · 
,;, 
 '
... 't. ,t 't ...... 
æ 
 
 'Å-'......-. I 
-.... 

 
 ' -" '. i'.it 1 
5
 -..- tL"""'-
 
 
 . 
.. jij 
. - , ..." - 'I' 
J:: C J .#1 .. 
15 
 t . " " 
 , - 
>-.E
 "._..,.. 


ëþ- '!" ; 

 
 
 
 .- - ,.
 .:. . - 

 . 
: 
 
U)

 
 1:-:n1 
.9
Q) ... 
,g 
 
 -- ÇJ · .":'> f 
Q..(/}a:-. _' 


t
 


- 'iJ 
- - -..i 

.t. .i 

 
 - 
r 1] 
. -, 
IÞ. 
, 


.. 


, . 



 
r f " 
ttJI 


... 


.,. 


--- --- 
----==-=-=---=-=- - --- 
------ ---- 


\ 
., 


. 


\ 


--. - 
 
 
 


."o;a.-' 
--- .. 



--I 


. - , 


.... 


.t. 

c 


. I, 
.
-: 


...--.. 
'" .- 
,',.,.. - "' 


..... 



, 


"' 
 '" .' 
- : 
- - 
.. - 


..-b 
1 '" -=]i=.=1 .....- 
"'- "'.a' : : ... ::= ::i? 
" ,.... e 
 
"' .
 .-.' 
"" 


I 



 
. 
.. . 


t,' .' 
...... " 


"'-. 
..... 


,,. 


.... 


-
- 



 .. 


-.
- 
..r& ....... 


. 
 


.. 


..... 


..- 


........ 
.
. ...' - 
. 
'. \ .......... 
, 

 - "'-:: 



 
... 


....---#
> 
r 
...
 ." 
-_...
 w 
... .- _":''':'-': . 
'-.:i
 -..."...::..... 

., ....--....':y -.-<;..a.:
:2..- 


. ...1. 


If 


*4 


lIP 
", 


'l'1I1Yf1"TJim 




' 
.. 
" i 


.1 



The CanadIan Nuraa May 1976 


29 


abitat - a word that means 'he lives' in Latin - will 
ing together up to 5,000 delegates, visitors and 
lurnalists from 142 member countries of the United 
Ilations. Another 7.000 or more persons are 
xpected to attend the parallel Habitat Forum, a 
1>lated nongovernment conference and exposition. 
.0th are an outgrowth of the United Nations' 1972 

onference on Human Environment held in 
.tockholm. Both have involved the years of 
reparation and strategy planning befitting a global 
roblem. 
The Hon. Barney Danson, Mimster of State for 
)rban Affairs. has described Habitat as a process as 
l1uch as an event. and one that will profoundly affect 
III Canadians. 
"Like all countries," he said recently, "Canada is 
3Clng the challenge of accelerating change. Habitat 
epresents an opportunity for new initiative not only in 
neeting massive global requirements, but also in 
Iddressing the needs of our own communities." 
The problems are enormous. whether in 
Jancouver or Calcutta. It has been estimated, for 
>xample, that up to 7,000 people in Vancouver are 
Iving in slums or deteriorating housing, with little 
;hance of moving to a better place. In Calcutta, 79 
)ercent of families have to share living space. Except 
or Algeria, Libya and Iran, very few developing 
;;ountries have mounted large housing programs to 
T1eet the growing needs for shelter created by rapidly 
ncreasing urban populations. This lack of planning 
'or settlements creates health problems. Less than 
alf of Brazil's municipalities. for example. have a 
atisfactory water supply system and only 34 percent 
aye a sewage system. 
Solutions to these and related problems are the 
oal of Habitat. to ensure an improved quality of life 
or a global population that is expected to double by 
the end of this century. "Ideas come before bricks.' 
said Enrique Peñalosa, the secretary-general of 
! Habitat. 'Delegations must go home from 
Vancouver with new ideas and practical plans." 
New models and approaches to settlement 
problems are being tned out in many parts of the 
world and could be applied successfully elsewhere if 
they were more widely known. More than 250 
audiovisual presentations of such solutions will be 
shown by participating countries at Habitat. The 
result will be a unique film library, later available to 
the nations of the world. Canada's contribution will be 
film or slide show presentations on four topics: 
Management of Urban Growth and Land Use: 
Design Innovations for Settlements in Cold Climates; 
Governing Human Settlements: and Community 
Rejuvenation. 
Canada s preparation for Habitat included 14 
symposia and 16 public meetings across the nation 
to enable groups and individuals to give their views 
and to hear those of specialists on settlement 
problems. The Canadian Nurses Association was 
represented at one of these planning meetings. 
held late in 1975, by the Executive Director, Helen 
K. Mussallem, and the President. Huguette 
Labelle. All provinces, through a Federal 
IProvincial Preparatory Committee, are involved 
in planning for Habitat. 


On the international front, Canada has been 
working in close cooperation with the U,N, and, 
through it. with the countries participating in the 
conference. International groundwork included a 
four-day symposium at Dubrovnik, Yugoslavia in 
May 1975, attended by 30 of the world's best-known 
architects. planners. environmentalists and 
related experts; four regional meetings in CaIro. 
Teheran, Caracas and Geneva in which more than 
100 countries took part: and the work ofthe 56-nation 
preparatory committee, 
Plenary sessions of Habitat will be held in the 
Queen Elizabeth Theatre in downtown Vancouver, 
while the three committees that have the 
responsibility of developing recommendations for 
the plenary sessions will meet in nearby hotels. 
Technological installations provide for simultaneous 
translation Into six languages. as well as for the 
showing of audiovisual presentations. and local, 
national and global news coverage. 
Detailed strategy has been worked out for the 
provision of services such as accommodation, 
transportation, security. information, hospitality and 
health. 
To meet the health needs of the 12,000 visitors 
expected in Vancouver. registered nurses will man 
four first aid rooms at downtown hotels during 
Habitat. In each station. the nurse on duty will be the 
primary contact and will provide the necessary care 
or direct the patient to a doctor in the Habitat medical 
office. 
Should ambulance service or hospitalization be 
required, nurses will make the arrangements and 
advise the physician on duty at the medical office If 
dental or optical services are required. an 
appointment will be made and the patient directed to 
the appropriate offices. Dental services will be 
provided by Health and Welfare Canada while optical 
servIces have been arranged with a local optician 
situated near the main conference hotels. 
St. Paul's Hospital, in the downtown core of the 
city, will be the central receiving hospital for all 
conference attendees. and Habitat medical officers 
will have full admitting privileges there. 
With the conference arrangements planned to 
the last detail. what will it all amount to? What 
difference will it make in Canada or other parts of the 
world If thousands of people talk about human 
settlement in Vancouver? 
Yet how else can the world's settlement 
problems be tackled? Habitat organizers say that 
before the Stockholm conference, few governments 
gave pnonty to the envIronment: now virtually all do. 
Human settlement needs the same attention. There 
are skeptics in Canada. which is said to have an 
average of just over 0.7 persons per room, perhaps 
the lowest in the world. But despite this skepticism, 
Habitat will take place anyway, hopefully to develop a 
greater awareness of settlement problems. issues 
and new kinds of solutions. .,. 


The World 


Man 


HaMal 



30 


The Canadian Nurse May 1976 



 ,,

 
r \)se 
c'èJ.(\ 'O
: \\9
\
:(\ 
\O(\S.O \
e \s\O
 
se ss Ó
\\
. se s \
 
5 \
e'èJ.
 'èJ.\\e(\\ 
s\e((\ 

 
Q
S 
{"" ",,'" 


- 


Susan Hill and MarcIa Hoch 


t 


Susan Hill (B.N., University of Mamtoba 
school of nursing) is primary psychiatric nurse 
therapist in the Outpatient Psychiatry 
Department, Health Sciences Centre, _ 
Winnipeg. Marcia Hoch (BN, University of 
Manitoba school of nursing; MS., Boston 
University school of nursing) was clinical 
specialist at the Centre when this article was 
written. 


The authors worked together as primary 
therapists on an interdisciplinary team at the 
Outpatient Psychiatry Department, Health 
Sciences Centre, Winnipeg. As members of 
this team, they saw several cases where 
time-limited short-term psychotherapy was 
used to good advantage. They consider it an 
especially useful techmque in helping 
persons deal with losses. They also found this 
approach a satisfying experience. since a 
specific goal is agreed upon and can be 
monitored for change during and on 
completion of the 12 sessIOns. The therapist 
can, therefore, readily evaluate her 
effectiveness. 


., 


Time-limited short-term psychotherapy, used I 
as a treatment modality of choice rather than a 
treatment in crisis, is a relatively new concept I 
in psychotherapy. Some major issues Involved 
are: selecting and implementing the short-term 
therapy modality in light of indications and 
contraindications; factors to consider and even 
expect as therapy progresses; some 
implications for therapeutic intervention; and 
some relevant ideas related to transference 
and countertransference. 
The comments that follow are based I 
almost exclusively on the concept of 
short-term therapy developed by James Mann I 
and, more specifically, on his contention that 
short-term treatment should be confined to the 
time limit of 12 sessions. Although at least one 
other therapist, Peter Sifneos, uses a I 
time-limited treatment modality, he is not 
restricted to as definitive a time element as that 
advocated by Mann. Both writers, however, I 
seem to agree that there must be a clearly 
identified focus for therapy before a 
time-limited modality is selected. 
Limiting the number of therapy sessions I 
to 12 is not in itself magical, but Mann suggests 
that this number is most effective. since it I 
decreases ambiguity in psychotherapy by 
making the limitation of time constant in each 
case. Placing all patients within the same 
procedural framework makes it possible to 
assess the process and the outcome with 
some degree of consistency and reliability" 


. James Mann, Time Limited Psychotherapy, 
Cambridge: Harvard University Press, 1973, p. 115. 



. 


stribution of sessions can be flexible, but we 
efer the 12 sessions to take place each 
ek in 50-minute sessions. This seems to 
ovide consistency and render explicit the 
lplications of time and its meaning to the 
ocess of separation and loss. 
Major indications for selecting the 
10rt-tenn treatment modality are: a goal that 
n be identifred and, hopefully, reached: and 
e therapeutic alliance that can itself be used 
focus on one or two items in therapy. or on 
e precipitating event. 
This form of therapy is perhaps most 
early indicated when issues involve 
dependence/dependence (patient has 
Ifflculty separating from family), healthy/low 
<>If-esteem (certain behavior that renders 
tient vulnerable), and unresolved or delayed 
,ef (loss of a meaningful relationship through 
eparation or death). Short-term therapy is 
ntraindicated during an acute schizophrenic 
action, a deep depression where the patient 
suiddal or too depressed to participate in 
lerapy, a full-fledged manic reaction. or an 
rgamc psychosis. 


Process 
A thorough history of each patient and an 
Iccurate diagnosis are prerequisites In 
electing the short-term treatment modality. 
-he goal is then clearly identified and agreed 
'pon by the patient and the therapist, and a 
erbal contract is made. 
The contract involves the number of 
.essions (12), their length (50 minutes or one 
lour), and their arrangement (12 one-hour 
'essions per week; or 10 one-hour sessions 
er week, followed by a "free" month, after 
hich the remaining two sessions are held). 
rhe date of the last session is clearly set. The 
mportance of attending each session is 
;tressed - a missed appointment is counted 
as a session unless the patient's excuse is 
;alid. As audio- or video-taping and 

upervislon of each therapy session are of 
;alue, these matters should be Incorporated 
nto the contract. 
We have used the short-term contract 
'imarily for dealing with issues of loss and 
jelayed grief. The time-limited therapy has 
een useful for exploring feelings of loss and 
termination because the therapy itself implies 
Ian inevitable separation from the therapist. 
Feelings of sadness and grief are 
I reawak
ned in us with each termination. Thus, 
by helping the patient deal with his feelings 
about the termination of therapy, the therapist 
IS indirectly helping him come to terms with the 
loss or losses for which he originally sought 
therapy. These are the major reasons for 
preferring a short-term treatment modality 
when grief work and loss are at issue. 
In short-term therapy, the therapist 
usually becomes active and directive early in 


,n!C' .......,,,øu..... nU'-:Mr ....y I
'a 


the initial interview, encouraging the patient to 
concentrate on the focus of therapy. This is 
important as both therapist and patient must 
consciously try to stay on the focus agreed on if 
the goal is to be reached. During the therapy 
sessions, concerns and situations not directly 
related to the mutual focus of treatment may be 
brought up by the patient. The therapist then 
asks the patient to reflect on the relationship 
between the issue that has arisen and the 
original focus. If no relationship can be 
discerned by either therapist or patient. the 
issue is discarded or used as a goal for a later 
therapy contract. 


Problem solving 
A general pattern can be expected to 
emerge overthe 12-session penod. Dunng the 
first five sessions, the patient seems to 
improve markedly: anxiety and tension usually 
decrease and some of the presenting 
symptoms lessen. However. as therapy 
proceejs, the patient comes to realize that his 
problems are not all going to be solved. that 
one problem only is being worked on, and that 
even it may not be completely resolved. The 
therapist. too, may become discouraged as 
the patient realizes this but continues with the 
contract agreed upon. 
What becomes more apparent in the 
seventh, eighth, and ninth sessions, is 
separation from the therapist. All the onglnal 
symptoms may then reappear The patient 
may become more melancholy and even show 
anger toward the therapist: he may arrive late 
for appointments. or express fear that 12 
sessions "will just not be enough." These and 
other concerns need to be explored but, in 
general, It is wise to proceed with the 
agreed-upon number of sessions. Perhaps the 
most significant issue dealt with in short-term 
therapy is termination, with all its ramifications 
of separation, loss and grief work. 


. Antoinetta B. 
Antoinetta a pretty, slim 22-year-old 
woman of Italian descent, came to the clinic 
with symptoms of depression: crying. inability 
to concentrate, feelings of low worth, and 
general misery. 
Recently separated from her husband of 
three years, she had just come from another 
province and was staying with her married 
sister until she could find an apartment. Pnor 
to leaving her husband. she learned of his 
Involvement with another woman. Repeated 
phone calls have kept the situation stirred up, 
but Antoinetta IS sure her marriage IS at an end 
and seems obsessed with gaining some 
understanding of where she has gone wrong. 


.., 


She and her husband have agreed that she file 
for divorce 
One year pnor to her marnage. 
Antoinetta's family had given her sister a lavish 
wedding. When her sister. six years her 
senior, left the household. her mother turned to 
the patient. her only other child, to fill the 
sister s place. The mother, apparently having 
entered her menopause at this time, became 
very demanding. Antoinetta admits this 
overwhelmed her at the time and she began to 
do things that were unacceptable to her 
parents, such as dating a non-Italian. The 
mother responded with much emotion, 
sometimes beating the patient and sometimes 
beating her own head against the wall. 
Antoinetta is concerned that she will be like her 
mother. and this frightens her. 
The eventual outcome of the conflict 
between the patient and her mother was that 
the patient ran away to marry. She feels her 
mother drove her to it. otherwise she would 
never have married this man. Antoinetta's 
mother then disowned her and had no contact 
with her for more than a year. They have now 
been reconciled, but Antoinetta feels she 
cannot go home to her parents because of 
all that happened. 
Antoinetta recalls an unhappy, lonely 
childhood. She was afraid her parents would 
die, had crying spells, bit her nails, and was 
shy. In spite of physical problems. which often 
kept her from school, she was on the honor roll 
in high school. She went on to junior college, 
where she met her husband. She continued to 
live at home until her marriage. 
From this history, several concerns 
emerged as appropriate for treatment: a 
hostile-dependent relationship with her 
mother, problems with independence and 
getting started on her own, and depressive 
feelings about the marriage breakup. The 
diagnosis was reactive depression around the 
dissolution of marriage. Short-term treatment 
was agreed upon as a therapy modality with 
the focus being gneving over the loss of 
husband and marriage. 
Following is a brief overview of the content 
of the 12 sessions and the major focus of each. 


Session 1 Patient is in tears most of session 
She talks of relationship with her mother. 
Recent difficulties began with separation from 
husband. Talks of guilt and how the marnage 
dissolution was her responsibility. 
Session 2 Talks of specific incidents in her 
marriage Sad. crying. Relates how worthless 
she feels. Misses friends she left behind , 
Session 3 Has begun to date a man but is 
afraid she will have the same relationship with 
him as with her husband. Is confused about the 
role of sex in her marriage. 



-- 


"" 


U"(
S1:NG CAR"E 
N '[JJ 1 'rDREN 
o F C J:L .
 


9111 EDJ110N 


" ølØ C 
N" øccbtCr-- 
tcraJ1 
::---- 



---- 


 


, 
'* 



.
 
;r";térø.itY 
1Y .
lltsJJ18 
1,sJ1
 


J 


In Tune With TO-DA 


@ NURSING CARE OFTHE GROWING FAMILY: -
 
A MATERNAL NEWBORN TEXT W 
Adele Pillitteri, B.S.N., M.S" P,N.A, 
A basic, comprehensive textbook of maternal and neonatal 
nursing designed to meet the needs of students who will be 
functioning in roles which have expanded considerably, and to 
ensure their adaptability as the scope of their responsibilities 
expands even further in the future. Following a generally chro- 
nological order, each unit discusses anatomy and physiology, 
pathophysiology, psychological and social aspects of parent- 
hood, and nursil"g care in normal and extraordinary situations. 
In a lucid, interesting and sensitive writing style the author 
introduces the students to assessment, monitoring, intervention 
and long-range planning techniques which are largely lacking 
in other older texts. The focus on the entire family unit is also 
in keeping with modern thinking. 
LITTLE BROWN 
about $15.00 


700 pages 
May, 1976 


I 


@ MATERNAL-CHILD NURSING 
Violet Broadribb, R.N.. M.S., and Charlotte Corliss, R.N" M.Ed. 
A family-centered text, developed by the authors for combined 
maternal-child nursing courses wherein students are being pre- 
pared to give direct care to mother and children. 
The first half of the text covers the entire maternity experience, 
labor and delivery as well as pre- and postpartum care. Current 
information on homemaker service, family planning clinics and 
parent education is included in the chapter on "Community 
Resources Available to the Family." Units Five to Twelve deal 
with child care from birth to adolescence. Delinquency, drug 
abuse, and similar problems are considered in discussion of 
the often difficult family adjustment of the older child. 
To aid student self-evaluation, questions and situation-type 


problems follow each unit. Answers to the questions may be 
found in the Appendix. 
LIPPINCOTT 
$12.50 


702 pages 
1973 


@FOUNDATIONS OF PEDIATRIC NURSING 
Second Edition 
Violet Broadribb, R.N" M.S. 
The author, an experienced nurse clinician, has broadened and 
enriched the second edition to reflect nursing concepts stem- 
ming from recent findings in child psychology as well as ad- 
vances in pediatriC medicine and surgery. New or expanded 
material includes psychosocial development, genetic factors, 
the child as member of a family unit, care of the newborn in the 
intensive care unit, pediatric pharmacology, 
As in the first edition, material is presented according to age 
groups from birth to adolescence. The Appendix contains pre- 
parations for laboratory tests, common pediatric procedures, 
and a section on pediatric drugs, dosages, actions and effects. 
LIPPINCOTT 500 pages/illustrated 
Paperbound $8.95 1973 


@ EMOTIONAL CARE OF HOSPITALIZED CHILDREN 
An Environmental Approach 
Madeline Petrillo, R.N., M.Ed., and Sirgay Sanger, M.D. 
This text is an outgrowth of the dedicated effort by a group of 
experienced clinicians to reduce the trauma in children, as well 
as parents. brought about by illnesses requiring hospitalization. 
The authors and their consultants reflect extensive knowledge 
of growth and development; the variables and forces of family 
and culture; and the diverse reactions to stress, loss and sepa- 
ration. In specific, realistic and practical terms they present the 



e 


INTRODUCTORY 


I) NURSING CARE OF CHILDREN Ninth Edition 
Eugenia H. Waechter, R.N" Ph.D" Florence G. Blake, R.N., 
M,A., and Jane P. lipp, M.D. 
Completely revised and expanded, this edition is without peer 
as an in-depth study of pediatric nursing. The text is organized 
by age groups, from infancy to adolescence, with emphasis on 
physical and psychosocial growth, development, and health 
care planning for each age, Major revisions reflect increased 
nursing responsibilities in assessment and management of the 
well child, children at risk. and the ill child. A completely new 
chapter on the role of the nurse in primary health care for in- 
fants and children includes specific measures in prevention 
and assessment of disease; interviewing; and anticipatory 
guidance with parents. An excellent presentation is provided 
on medical team management of disease and disorders in chil- 
dren. The latest information is included on management of 
specific problems-incidence and etiology, pathophysiology, 
clinical manifestations, complications, differential diagnosis, 
treatment and nursing care. Immunology and immunodeficiency 
diseases are covered in depth. 250 illustrations are new to this 
edition, 
LIPPINCOTT 
about $16.50 


about 800 pages 
May, 1976 


e 


Thirteenth Edition 
@MATERNITY NURSING 
Sharon R. Reeder, R.N., Ph.D., Luigi Mastroianni, Jr., M.D., 
F.A.C.S., F.A.C.O.G., Leonlde L. Martin, R.N., M.S., and Elise 
Fitzpatrick, R.N., M.A. 
This comprehensive edition of an outstanding text reflects the 
most recent advances in knowledge and changes in family life 
style. It integrates nursing assessment of both physical and 
emotional factors, applies evaluation and diagnostic skills, and 
provides thorough coverage of current concepts in maternity 
nursing, New and revised material covers society's changing 
attitudes toward childbearing in light of socio-economic fac- 
tors, physical problems and psychological stresses; recent ad- 
vances in maternal physiology, development and physiology of 
the embryo and fetus; and clinical aspects of human reproduc- 
tion,Updated material includes antepartal and postpartal care, 
patient education, normal and complicated labor, care of full- 
term and high-risk infants, emergency nursing, fertility, infer- 
tility, contraception, abortion, pain perception, and fetal moni- 
toring. A new chapter covers diabetes, renal and cardiac 
disorders, and 
enetic counseling. 


LIPPINCOTT 
about $15.00 


about 650 pages 
May. 1976 


aternal-Child Care. 


techniques of communicating with children and their parents. 
Preventive approaches to minimizing trauma are supported by 
analyses of actual clinical situations. 
LIPPINCOTT 
Paperbound $6.25/Clothbound $8.50 


259 pages/illustrated 
1972 


AUDIO/VISUAL MEDIA 


HUMAN BIRTH FILMS 
In dramatic, live action. . . close-up, full-color (sound or silent) 
films of birth complications which students rarely have an 
opportunity to see in the course of their experience in the de- 
livery room. 


GROWTH AND DEVELOPMENT 
A Chronicle of Four Children 
This exciting new series demonstrates the full range of varia- 
tion in normal psychosocial and physical development during 
the first four years of life. Four children were filmed at three- 
month intervals from infancy to age four in natural but com- 
parable settings. In conjunction with an accompanying work- 
textbook, the films constitute a unique and extraordinary study 
program in growth and development. 
In preparation. 


For additional audio/visual information, 
please write. 


J. B. LippincoU Company of Canada Lid: 
Please send me the books I have circled. 


1 


4 


6 


3 


5 


2 


... Position 


Name.. 
Address 
City................... Prov............... .... Postal Code 
D Payment enclosed, ship postage and handling paid 
D Charge and bill me 
Dlilchargex Acct. No. 
D :=; Master Charge Expo Date 


LlPPINcon's NO-RtSK GUARANTEE: 
Books ar. shipped to you ON APPROVAL; If you are not entirely 
satisfied you may return them within 15 days for full credit. 
Prices subject to change without notice. 


Lippincott 
J. B. LlPPINcon COMPANY OF CANADA LIMITED 
Serving the Health Professions in Canada Since 1897 
75 HORNER AVE. TORONTO, ONTARIo 1112 4X7 (411) 252-5277 


CNS.71 



34 


The CanadIan Nurse May 1976 


ú
 

{è'(\o 


Session 4 Patient generally feels better. 
Thinks of moving from sister's home to her own 
apartment. Is planning around items she is to 
receive from her husband (kitchen utensils, 
furniture, and so on). 
Session 5 Has found an apartment. Has been 
in touch with husband by phone. Is feeling 
sorry for him because he is now alone too. 
Looks forward to setting up her own place. 
Session 6 Examining her feelings so closely 
makes her sad. States she feels 
uncomfortable with therapist. Disappointed 
that sister is not meeting her requests. 
Session 7 Feels close to therapist. Not sure if 
12 sessions will be enough. Frightened that 
she will have to return for more therapy. 
Session 8 Sister and husband plan to move 
from the area because of job change - 
expresses anger and sadness. Angry with 
husband . 
Session 9 Will miss therapist and wishes 
therapy could last longer. Crying about the 
breakup of her marriage. Ambivalent about it. 
Session 10 Apartment shaping up. Has made 
a friend. Happy therapy is ending. More settled 
in her decision to get a divorce. 
SessIOn 11 Can hardly believe there IS only 
one more session. Wonders if she can cope 
when therapy ends. Finds it hard to 
concentrate at times. 
Session 12 Feels better, but sad at having to 
say good-bye. 


The 12 sessions covered a wide range of 
topics but all were concerned with helping 
patient resolve her feelings about the loss of 
her husband and marriage. Short-term therapy 
seemed most appropriate for Antoinetta 
because the focus of therapy was clearly 
defined. 
The first five or six sessions indicated that 
Antoinetta was making considerable progress. 
She was generally less depressed and more 
optimistic, and was involved in work and in 
setting up her own apartment. However, 
during sessions seven and eight, it became 
apparent that she had begun to feel the 
imminent termination with the therapist. The 
therapist interpreted Antoinetta's transference 
feelings of loss toward the therapist as 
reflecting her feelings about losing her 
husband. Sadness and anger were openly 
expressed and dealt with. The sessions ended 
on a positive note of growth and, in retrospect, 
short-term therapy had been effective. 
. Jane R. 
Jane IS a 24-year-old, single, grade three 
school teacher who lives alone in an 


apartment. She telephoned our clinic; "My 
boyfriend left me three months ago and I can't 
seem to get over it." 
A thorough history elicited important 
information about the patient. Five years ago 
her best and closest woman friend was killed in 
a car accident. Four years ago her father left 
her mother for another woman, and they are 
now divorced. Three years ago, Jane's 
grandmother, to whom she had been close, 
died suddenly of a heart attack. A year ago, a 
previous boyfriend whom she had dated for 
three years left her. This time she took a 
serious overdose of sleeping medication. Jane 
spent a week in a psychiatric unit, her only 
involvement with psychiatry. 
Jane is pleasant, cooperative, 
well-dressed and attractive. She showed no 
evidence of thought disorder in either content 
or process. She cried whenever she thought 
of her boyfriend and the details of their 
relationship. 
Her diagnosis was reactive depression; 
and short-term treatment of 12 session
 was 
agreed upon, with the goal of helping Jane 
work through her grief over the loss of her 
boyfriend. 
Following is a brief overview of the 
sessions and the main focus of each. 


Session 1 Patient cries when thinking about 
boyfriend. Feels empty and lonely. Spends 
most of session in tears. 
Session 2 More tears about boyfriend. Talks 
about losing her father, and how boyfriend 
resembles him. 
Session 3 Feels therapist cares. Her problems 
worth the therapist's time. Is angry at father. 
Relates mother's situation with her own, as 
both men left for other women. 
Session 4 Wants therapist to tell her what to 
talk about. Feels better. Afraid to get angry at 
people for fear of losing or hurting them. 
Session 5 Boyfriend has come back to her. 
Worries about what therapist thinks of it. 
Wants to continue therapy. Changes goal. 
New goal is to work through feelings related to 
loss of therapist. 
Session 6 Notfeeling well: "theflu."lsangry at 
boyfriend and afraid to show it because he 
might leave her. Talks about termination of 
sessions. Cries over losing therapist. Feels 
alone. 
Session 7 Sad it is the seventh session. All 
problems may not be solved: what if boyfriend 
leaves her after sessions end? 
Session 8 Not feeling well. Talks more 
intensely about death of woman friend. 
Session 9 Sad about imminent termination of 
therapy. Talks about angry episode with 
boyfriend. Tries to relate this to goal of 
separation from therapist. 


Session 10 Finds it hard to believe sessions! 
coming to an end. Expresses sadness rather: 
than anger. Wonders if therapist will be I 
available to her following termination. 
Session 11 Expresses more difficulty over I 
imminent termination. Several anxiety 
symptoms reappear. Attempts to relate curren I 
feelings to her pattern of dealing with losses. 
Able to be more assertive in relationship with I 
boyfriend. I 
Session 12 Doesn't feel she will say good-bYE I 
to therapist until therapy is over. Still wornes 
over boyfriend leaving her. Still wondering if I 
she will be able to contact therapist. 
I 
Jane is a young woman who has sufferec' 
many significant losses she has been unable 
to resolve, The loss of her second boyfriend 
precipitated seeking help through our clinic. 
Based on the major issue of unresolved grief 01 
Iqss. a goal was negotiated between the 
patient and the therapist, and time-limited 
short-term therapy was agreed upon. 
During the first four sessions, Jane began 
to feel better and her symptoms disappeared. 
However, her boyfriend's return necessitatec 
changing the goal. A second goal related to 
loss (loss of the therapist) was agreed on, and 
the original contract of 12 sessions was 
retained. Jane was able to express her 
feelings about termination with the therapist. 
However, the goal was not resolved when the 
contract terminated. 


Summary 
The two cases cited illustrate how 
short-term therapy can be used to meet a 
patient's needs to deal with loss and grief. 
Although the goals as set out in short-term 
therapy contracts are not always fully 
achieved, this treatment modality, as 
delineated by Mann, IS valuable to psychiatry. 
Short-term therapy is not only a sound 
therapeutic intervention, but also a means of 
bringing psychiatric health care to a greater 
segment of the population. 
Bibliography 
Mann, James. Time-limited psychotherapy. 
Cambridge, Harvard University Press, 1973. 
SChafer, Roy. The terminallOn of brief 
psychoanalytic psychotherapy./nt. J. 
Psychoanalytic Psychotherapy 2:2:135-48 
May 1973. 
Sifneos, Peter. Short-term psychotherapy and 
emotional crisis Cambridge, Harvard University 
Press, 1972. 
-. Two different kinds of psychotherapy of short 
duratIon. In Barten. Harvey H. Ed. Brief therapies. 
New York, Behavioral Publication, 1971. p. 82-90. 
Swartz, J. Time-limited bnef psychotherapy. In 
Barten, op. cit. p. 108-118." 



The CanadIan Nurse May 1976 


35 


II . . 
..-" 
The author's name is known to The Canadian notify people living several hundred miles w-e.,,; 
Nurse but is being withheld away of the date and time. CAlI 
When the undertaker phoned on . .. 
II Several months ago my husband died and I am Wednesday, it was to let me know, as tactfully - .,. 
still bitter. My bitterness stems, not from his as he could, that he had had difficulty obtaining ..
t:;6 , 
death, but from the attitude of the people who the body, and that, since no doctor was 
!. .,
 
work in the hospital where he died. Hospitals available, he had had to ask the coroner to sign 
see death as the end of their responsibility, but the necessary papers. Because of the delay, .... a
 
II for the survivors it is the beginning of a totally he wasn t certain whether the cremation would ,. 
new way of life. As a nurse, I have always be completed in time for the plane! This meant 
.:
ti 
believed that the family of a person who dies in changing the day of the funeral from Thursday -
 ..
 
hospital should be treated as well, after the to Friday and more long distance calls. For '" , t): 
event. as before, but experience has taught those taking time off from wor\( to do my .
.,
 
I) me that this is not always the case. husband honor, this change was most .. .
f. 
My husband had problems with his heart disconcerting. 1 
".:... 
for some time. Eventually, our family doctor Nor was this the end of the matter. In my 
 ". 
referred him to a cardiologist in a city 800 miles first phone call to the admission office I had ":- t). 
from here. He was hospitalized there and we asked that my husband s cousin be given all of .). .t:!> 
. kept in touch by phone. When heart surgery his personal effects. She made eight trips to 
 -.,. . 
was planned, we agreed that I should stay the hospital before it was convenient for ! :C:tf. 
home with the children until he was anyone to accommodate her! Even then, she ;g
" 
convalescent. was given his wallet with his credit cards but ", .... 
On the Sunday night before his operation not the thirty-seven dollars he had deposited in ø)"
 

!.'.",f.
 was scheduled, he died. It was then the series the office. Finally, three months after my 


C
",
J of events began that shattered the ideals I had husband died. I learned that the autopsy I had 

. ,.
,
 

 C'- come to cherish in more than 25 years of agreed to. had not been done. I had agreed, 
, '. 
ø)..t
 nursing. not to help medical SCience, as we are taught 
II The doctor phoned early on Monday to say, but simply because I wanted to know 
morning to tell me what had happened. I why he died at that time. Now I never will. 
agreed to an autopsy and remembered to tell Two weeks after these events. I wrote a 
him that my husband had an eye bank donor letter of complaint to the hospital administrator. 
card with him. He asked me to send a telegram A month later. another hospital official sent me 
1'1 to the hospital admission office giving them a letter of apology. This was the first tIme any .. -,', .- 
this information. I did so immediately. member of the hospital staff contacted me. He 

...ti 
At noon that day, my husband's cousin. reminded me that they were short-staffed and 
-.. " 
his only relative in the city, phoned to enquire busy. He told me how dreadful it would have 
.,; 
about his operation. I had not yet contacted her been if someone besides myself were told that .
 
, 
II since she works during the day and I didn't my husband was dead. I couldn t help but m 
know where to reach her. She was told curtly to remember that, when I learned of his death the 
get in touch with either me or our family doctor. first thing I did was to start notifying family and 
At supper-time I phoned to give her the friends. With a broken-hearted ten-year-old 
news myself and ask herto fmd an undertaker. son in my arms. what would I have given to 

.....
, .... When she phoned the hospital again she met have someone say "Ves, I know, . instead of ... .
 

t!'="'
 the same response. She persuaded them she "Why, what happened?" i.:C;ff.. 


'-',: knew he was dead and was told the body As for the telegram. a tracer proved that .t 
- 4.
- 

 '.- 
"', -. would be released early the next morning. had been phoned to the hospital within an hour .
 
. 
v _ ø).'
 On Tuesday, the undertaker was refused of my phoning it in to our local office. ø) .t. 
. the remains because "we don't have the Apparently a copy was then mailed to the 'V 
telegram." My own clergyman and another in hospital rather than being delivered in person. \ ,0 
the city were asked to help. They got the same What legal status does a telegram have? - ê. 
story. I phoned the admission office. The Anyone can send one and sign any name he 
response was: "Maybe I'll leave a note for the pleases. Surely, It would be possible to . .L 
. day staff." 'Maybe I'd better contact the tape-record permission for an autopsy and I., r é V 
doctor'and "We can't release the body on your other similar consents. The human voice is as 
say-so." Naturally. I did not react calmly and distinctive as flngerpnnts. 
 ., 
my replies were not as coherent as they might Legal counsel advises me that not 
 ø 
have been. When I hung up. however. I carrying out the wishes of the next of kin 
It believed that the action I demanded would be amounts to negligence, but I have no interest 
 ",.. 
carried out immediately. I phoned the in lawsuits. The past cannot be undone. My 
 
..
 
. .. 
undertaker and gave him that information. At concern now IS to try to prevent other people in 

 .- 
home we proceeded to plan the funeral and similar situations from being subjected to the -.! 



36 


The CanadIan Nurse May 1976 


4> 


II 
II 
II 
&I 
II 
II 
I) 
I) 
It 


emotional stress I endured. Why couldn't 
some person have been designated to contact 
me an hour or so after the doctor told me of my 
husband's death and tape-record the 
conversation? That person could have 
assisted me in locating an undertaker and 
found out what to do with my husband's 
personal effects. He or she could have taken 
phone calls, given out the information that he 
was indeed dead and arranged a suitable time 
for his effects to be picked up. The situation 
could have been handled without the mental 
anguish that resulted from the fact that, when 
my husband died, no one in that hospital 
accepted the responsibility of meeting the 
needs of his family in their time of 
bereavement. 
I am told that some of the policies in this 
particular hospital have been changed since 
this incident. What happens when someone in 
your hospital dies? 


When The Canadian Nurse approached the 
hospital where this incident occurred, a 
spokesman gave his interpretation of the 
"administrative difficulties" encountered 
by the author of "Why?" His answers to 
some of the questions she raised are as 
follows: 


Q. Why did the hospital not phone me? 
A. Our hospital insists that it is the duty of the 
attending physician to notify the next of kin 
when a patient dies. This is a traumatic 
occasion requiring an expert handling of the 
communication, understanding and often 
explanation. The patient made himself the 
client of the doctor for the management of his 
health care. It is only right and proper that the 
doctor communicate with the family when 
death occurs rather than leave it to a nurse or 
ward clerk who mayor may not communicate 
Iml in the appropnate manne, 
Q. Why could a relative not be told of a 
'" person's death - particularly when it 
concerns an out-of-towner? 
A. The inability of your husband's relatives to 
obtain information by phone about his death 
should be seen in light of the policies laid down 
for our staff in that department. This type of 
information can only be released by relatives 
(present) or the attending physician to avoid 
the next of kin learning about the death in a 
second-hand manner. 


II 
I) 
II 


Q. What protection does the patient or his 
family have from a telegram that passes 
through many hands, can be garbled, or as in 
this case ignored? 


A. We apologize for the tragic delay in 
communicating your consent for autopsy to 
our pathologist However, these are very 
important consents for which we have 
developed stringent policies. You can't 
imagine what the reaction would be of relatives 
if an autopsy was done without their consent. 
We must have in our possession the official 
written document, i.e., the telegram. before we 
can proceed. Although the contents of the 
telegram were phoned to the hospital, the 
telegram company put the telegram in the mail 
rather than delivering it by hand the same day 
as has been the practice. Therefore, it took two 
days before the telegram reached the hospital 
and the clerk in the Admitting Department was 
correct in saying the telegram had not arrived. I 
can assure you you that we have not had a 
similar incident in at least the last ten years. 
We regret very much that it happened in your 
case. 


Q. Are patients' wallets checked when they 
die, for such things as organ donor cards? 
A. The normal procedure in this hospital is to 
encourage all patients to leave valuables at 
home. Valuables brought to hospital are 
placed in safekeeping and released only to the 
patient on discharge or to the next of kin. 
Wallets are only opened for authorization 
permits when the patient or his relatives have 
indicated to us that he wishes to be a donor 
When the patient has been an accident victim 
the police go through his wallet for 
identification and find the donor authorization 
card. 
No changes in our polices have resulted 
from this incident but two areas of existing 
policy have been reinforced: 
Although our policy demands written 
consent for autopsy, we do state that when 
consent must be obtained from remote areas, 
we will proceed with autopsy on the verbal 
authorization of the next of kin. witnessed by 
two members of our staff. The staff member on 
duty in the Admitting Department was a 
summer relief person and she went "by the 
book" and failed to communicate the verbal 
authorization. For this we offer our apologies. 
Our policy in respect to phone 
communications is that courtesy and 
consideration must be extended at all times. 
This incident was forcefully brought home to 
our staff as an example of communications 
which obviously fell short of the recipient's 
expectations, 
If there are lessons to be learned from the 
unfortunate experience, feel free to publish 
anything in this letter that you deem of value 


The Executive Director, 


. . . Hospital. 
 


I) 
I) 
II 
II 
II 
It 
II 
II 
I) 
I) 
II 
II 
II 



The Canadian Nurse May 1976 


Catherine Brown 


37 


t l i V I lln 
: 
 (j 
1 
=,1 V I ,I, .- 
""!!!"'!! 
",;
'![ T fl, 
 ( 

 C( 

 ST ',f.
 I I : , C .--:: 


' >-- =1 
,I II 
 
-= 
LJ ' . y '
' r (j 
 Ir R O 
' 11 '" fl e 

ê i! \ '
L: q
},

 ;I
/W\, II 
'<!!!!I II 1\ 
Ir-..:
 


'I i\1 


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 


. 
. 
,.. . 
.. .. 
t .. 
,. # . ..... 

..: '"::
 . .. .. 
,. . .. 

 .; . 
- .. ... 
) . . 
. .. . 
J>. 
 . 
.. 
.. . 
" 
\ 
. . Y. 
.. 
... 
.
 .. 
,- ..;.' 
... , 
.- , .... 
""'- 
.. 


.... 


agreed,"but aren't you glad those temble 
things don't really happen?" 
I sat silent among them thinking, "I'm 
different because those unthinkable things 
have already happened to my child, and I know 
that no evil eye, nor all my wishes, could have 
prevented them." 
My baby was born with cystic hygroma. an 
unusual condition in which his face is filled with 
cysts that swell and go down periodically, and 
are easily infected, until he is at least five or six 
years old. This condition also affects the 
tongue, causing it to swell, bleed, and, if badly 
enough infected, to cut off his breathing, so 
that a tracheotomy becomes necessary, 
In the city where I live, specialists in this 
field favor waiting the condition out, ratherthan 
surgically removing the cysts. For several 
reasons, they feel that surgery IS too traumatic 
for a young child, as well as ineffective in 
removing the cysts. The only treatment they 
prescribe is penicillin, when absolutely 
necessary, and waiting for five to six years until 
the condition becomes minimal. 
These are the technical details. They do 
not begin to express the agony a mother feels 
when her child's face begins to swell, her 
embarrassment for him when other children 
laugh and point nor her horror when he stops 




 
 t ' 

'ltll 
- .... 
 fir 
, 
I Itì"f 
., 

 tì,. i 
\. p!t 
tl'( 
 

 
tIll 

 
." 
t 


breathing. Not to mention the endless tnps to 
various doctors and her frustration as a mother 
in the face of their cool authority. 
1 was wide awake when Stephen was born 
- glad to have gone through labor so easily 
and proud to have a healthy boy. My 
obstetrician said his face looked a bit "puffy" 
on one side, but dismissed it as a swollen 
gland and told me my pediatrician would check 
it out later. 
That night, after my husband and 1 had 
cuddled our new son adoringly, puftyface and 
all, my pediatrician came in to speak to me. He 
is a kind, sensitive man, but his words took my 
breath away. "1 want to talk about Stephen," he 
said. "I've just checked him, He doesn't show 
signs of mongolism, but he has a tumor that 
must be examined, so I'm sending him over to 
the children's hospital tonight to be analyzed. 
Perhaps your husband could take him over." 
I was so shocked at the words, 
"mongolism," "tumor," and "another 
hospital," that I could only nod my head in 
amazement. 
After he left, I sobbed in despair. Though 
Stephen was returned the next day, he was 
now pronounced "abnormal" with a "special 


I 


Clinical Data 


Cystic hygroma is a rare, endothelium-lined, cystic lesion of 
lymphatic origin which usually occurs around the neck and is 
encountered most frequently in infancy and childhood. It affects bot 
sexes equally and is discovered at birth in 50 - 65 percent of caseE 
About 80 - 90 percent of cystic hygromas are detected before the er 
of the second year of life; In rare cases, however, it has appeare< 
in the teens. 
Although the disease was reported as early as 1828, it was fir, 
named and clinically described by Adolph Wernher in 1843. Man I 
theories were advanced about its cause and relationship with th 
lymphatic system, but today it is generally thought that in the fetus' 
during the formation of the peripheral lymphatic system, a Pinchin,! 
off or sequestration of tissue of one of the endothelial sprouts 0 I 
outbuddings that extend from the primitive sacs of the Iymphati<. 
system, gives rise to an endothelium-lined lesion called a hygromël 
The lesions of cystic hygroma can vary trom 1 mm to 5 cm In I 
diameter but have in common a potentiality for increasing in size tl l 
an almost unlimited extent, and a tendency to penetrate and destre 
anatomic structures. 
The accepted explanation for their growth and propagation wa' 
advanced by Goetsch in 1938. He concluded that endothelial fibrillë I 
membranes sprout from the walls of the cysts, penetrate into 
surrounding normal tisstJes, then canalize and produce cysts fille 
with secretions from the fibrillae. The pressure from the larger cys 
may force the tumor to spread in the lines of least resistance, i.e. int' 
the planes or spaces between large muscles or vessels. 
Thus, the mass called cystic hygroma is composed of a 
thin-walled, endothelium-lined cyst (or cysts) which is filled by a 


condition," that might or might not go away. My 
first son had always been so healthy, that I took 
good health for granted. Matthew always slept 
through the night and the worst thing he ever 
had was a diaper rash. How could my children 
be less than p,erfect? 
Stephen's problem became evident 
during my stay In hospital. His enlarged tongue 
made it a struggle for him to breast-feed. What 
had been so natural for my first son was torture 
for Stephen, so I bottle-fed him instead. 
I wanted to deny that he had a problem, 
but from day to day, I could see that he did. It 
took longer for his umbilical cord to heal, his 
circumcision hurt and bled more and he slept 
less soundly than Matthew. As I came to 
realize these differences, I searched within 
myself forthe cause of his problem. What had I 
done wrong? Had I eaten the wrong foods 
while pregnant? Worked too hard? Been too 
upset? I had had spotting in the sixth month of 
pregnancy. Had this harmed Stephen? Had 
the delivery been wrong? Was it related to my 
father's illness? Though doctors assured me 
that none of these factors made any 
difference, it took me almost two years to 
overcome these feelings of guilt. 
The first few months were 
hectic-managing two young children and the 


house as well as being a companion to m
 
husband. We were still on a survival level 
day-to-day coping. As Stephen got older, t 
developed a very engaging personality - 
warm smile, a cuddly, puppy-dog friendline
 
an intriguing way of playing with his fingers- 
source of fascination and jealousy to his 
brother. We loved him passionately, 
Also, as Stephen got older, other aspec 
of his illness manifested themselves - 
endless colds, weak stomach, series upon 
series of antibiotics. Then In the spring, ou 
babysitter left the gate open at the top of tl 
stairs. Stephen. in his playchair, fell down 11 
stairs, knocked a tooth out, pushed others ir 
his gums and bit his tongue the whole wa
 
through. I rushed home from work, took or 
look at what was left of his mouth and race 
him to the doctor, who sent us to the hospita 
We were all crying. All the recriminatio 
my husband and I could make about the gat 
the babysitter, ourselves, made no differenc 
The fall touched off a mouth infection that p 
Stephen in hospital for nearly a week. He w
 
in an oxygen tent and was given penicillin 
intravenously. I suppose I should have bee 
thankful that he was less badly off than thE 



lear. colorless fluid. The cysts may contain lymph nodules. muscle 
ibers, thrombosed blood vessels, or bits of fascia, depending on the 
ype of tissue entrapped by the tumor. 
Outwardly. cystic hygromas are characterized by their soft, 
laccld. "doughy" consistency and by their thin walls and translucent 
lippearance, particularly evident if they are large in size. 
The most common symptom is a soft mass in the posterior 
nangle of the neck. It is not attached to the skin but fixed to the deep 
' issues. Patients rarely experience pain or local discomfort and, if the 
eSlons are small, medical advice is often not sought for many 
nonths. In some cases, a mild trauma or secondary infection is 
ollowed by rapid growth of the cyst and it is this series of events that 
rompts a visit to the doctor. Some hygromas Ire dormant or increase 
n size slowly, some grow rapidly and then appear to shrink. In 
ome cases respiratory obstruction occurs. 
Various treatments have been attempted with cystic hygroma, 
,:;ome more successful than others. Many doctors prefer surgical 
13xcision, but the extent of the tumor cannot always be anticipated 
'-nd, if the cyst involves vital nerves and vessels, portions of the 
umor must be left behind. In this case, there is a risk of recurrence, 
though this usually occurs within one year. 
Some doctors prefer to wait indefinitely, administering 
antibiotics when necessary, because of the tendency of a hygroma 
to undergo spontaneous regression. The danger with this approach 
is the high risk of spontaneous infection which may occur with even a 
mild respiratory inflammation and, if severe, may threaten the 
patient's life. 
Other treatment measures that have been tried include 
I repeated aspirations, irradiation and injection of sclerosing 
Ichemicals. None of these, however, has proven satisfactory. 



 


1M 

 
JII
 

 
l\'\i 
J!!J 

 
"\1 
"!-I 

 
,q
 
Q 
fi\1 
'll.f 

 
"II. 
{' -;;;... 
l
 
J'!
 
ì
 
J"
 
..--
 
11
 
--


 
4'
/4 
I -:('ì;::::' ';::fr \!::=" -:::í .;::( ì
= J ;:::
\ ;';:::.( .. I';:::'; ,
:r. '\
 

 . 
i!! ,,-.. 
 ill! . /,
i!! '" _i!! 
ïí!!'\.tf
i!!\\,; !liii!!, iiíi!i. 







4Å

a

&


&


 


other children in the burn ward. Some had 
such hopeless, woebegone faces, Alii wanted 
was to get him released as soon as possible. 
When Stephen came home, we felt that 
he would be all right again now that the warm 
weather was coming. We celebrated his first 
birthday in May, joyously hoping our troubles 
were over. A week later, we found him face 
down in the grass, turning blue. He had 
stopped breat'ling.1 whacked him on the back, 
i pulled his tongue down and gave him 
I mouth-to-mouth resuscitation. 
Since. then, we have become more 
I resigned. We treasure the times when 
Stephen i
 well, and brace ourselves for the 
I difficult times when he is sick. Of course, I try 
I every conceivable thing to help him - 
I elevating his mattress, putting a humidifier in 
his room, feeding him vitamin C. keeping hin. 
on antibiotics for the winter, seeking out 
another mother whose child also has cystic 
hygroma to pool our experiences. 
Always in the back of my mind is the hope 
that someone will find a solution, a cure, but 
gradually that hope is coming up against the 
stark reality of waiting out the next few years. 
Every mother must cope with illness in her 
children - part of her must always be a nurse. 
Stephen's condition could be much worse but 
because my other child is so exceptionally 


.. 


healthy, I find it hard to assume this nursing 
role. Stephen usually needs 24-hour-a-day 
care. Everyone in the family has had to adjust 
to his illness. The tension and sadness we 
sometimes feel about Stephen is naturally 
communicated to Matthew. We want him to 
have a normal life but he is beginning to ask 
why Stephen needs so much medicine, why he 
wakes up every night, why his face goes up 
and down, Because my husband works full 
time, I am usually the mediator between our 
family and the doctors and have to relay all the 
messages. Sometimes my husband takes out 
his frustration about Stephen on me and often I 
need extra support from my husband. 
Stephen faces the biggest adjustment. At 
18 months, he is active, contented, 
self-confident, full of enthusIasm and spirit. But 
soon he will read the expressions on people s 
faces, feel hurt when they stare at him. 
realize that he is different. 
We can only cope day by day, working out 
solutions to problems as they arise and 
enjoying our two children as they are, while 
waiting for that elusive, perhaps nonexistent, 
time when Stephen will become, magically, 
normal. 


'- 


"'- .. 


"" , 
. 
'.0; 
. 


Catherine Brown, in addition to being the 
mother of Matthew (four) and Stephen (almost 
two), teaches family life education at Humber 
Community College in Toronto and is an active 
member of Aid. to New Mothers, a support 
group for mothers during the postpartum 
period. 
This group grew out of a Women's Health 
Group and has evolved into a cIty-wide 
organization that helps to bring together the 
work of public health nurses, hospitals and 
Children's Aid workers. 
She and her husband, came to Canada 
seven years ago as graduate students in 
English, .. 


Bibliography 
1 Brooks, Jack E. Cystic hygroma of the neck 
Laryngoscope, 83:117-28. Jan. 1973. 
2 Dowd, C.N. Hygroma cysticum coli. Ann. 
Surg. 58:112-32,1913. 
3 Goetsch, E. Hygroma coli cysticum and 
hygroma axillare. Arch. Surg.. 36:394-479. 1938. 
4 Gross, R.E. and Goeringer, C.F. Cystic 
hygroma of the neck. Surg., Gynec. and Obst. 
87:599-610,1939 
5 Sabin. F.R. The lymphatic system in human 
embryos with a consideration of the morphology of 
the system as a whole. Arner Jour. Anat., 9:43:91, 
1909. 



Uniforms. technical medIcal and 
general purpose hospital coats. designed 
for action-comfort as you work Seams 
areflrmlysewn Fastenersstayon Fabrics 
wash or dry clean for professional wear 


'-
't.. 
/",r 
....., 'C"i 


I 
.,/ 
." .. \ 
*' 
STYLE 814 


..IC 
, 
r:I.I'I:I. C 
CAREER ClASSICS 


\ 
\ 



 
'--- 


\ 


1-( 
t l \ 
I ......... 
,,' 
I 


STYLE 810 


YLE 888 


STYLE 814 PantSuit 
Polyester Textured Warp Knit 
White - Blue Yellow - Ice Mint 
Sizes 6 to 18 
To retail . $2800 
STYLE 81 OA 
Polyester Corded Warp Knit 
White Sleeves 
Sizes 6 to 20 
To retail 


STYLE 916 PantSuit 
Polyester Ribbed Double Knit 
White 
Sizes 8 to 16 
To retail $3800 
STYLE 888 
Polyester Textured Warp Knit 
Lace Trim White, Pink, Yellow 
Sizes 8 to 20 
To retail $2200 


STYLE 810SS 
Polyester Corded Warp Knl 
White Short Sleeve'" 
Sizes 6 t
 20 
T 


unifolml 
ICgi/tCICd 


$26 00 



-- 


. . 


II 


J' 


778 Kmg St W 
Toronh Ontario M ;- 



N'11111es 


Tha Canadian Nurse M8y 1 g76 


1111(1 Faces 


41 


'\ 


-
 


"'- 
..:::::.> 


he Ontano Occupational Health 
"urses' Association elected for the 
976-1978 term of office the following: 
.resldent. Dorothy Schwab, Reg. N.. 
.f SI. Catharlnes: 1st vice-president 
oan Subasic, Reg. N.. P.H.N.. of 
Toronto; 2nd vice-president. Grace 
Blackwell, Reg. N.. of London; 
'secretary, Gale Pearson, Reg. N., 
B.A., of Guelph, and treasurer, Sylvia 
Matchett. Reg. N., P.H.N.. of 
Mississauga. 
This organization, for registered 
nurses employed in the field of 
occupational health, is dedicated to 
the improvement of health services 
available to workers throughout 
Ontario via the promotion of 
educallOnal opportunities for the 
nurses involved. 


Gwynneth Paterson (R.N., Queen 
Elizabeth Hospital. Montreal) has 
been appointed Assistant Executive 
Director of Patient Services. at 
Medicine Hat General Hospital. 
Paterson has nursed chiefly in 
Ontario and Quebec, her latest 
position being Director of Nursing of 
the Montreal Convalescent Centre. 
She brings to Medicine Hat General 
many innovative ideas regarding 
nursing. She feels that nursing 
personnel must begin to work with 
rather than for other health personnel. 
In her judgment, Medicine Hat 
General is ready for change, and the 
staff involved have the potential. She 
wishes to develop nursing programs 
for patient care, rather than rely totally 
on existing doctors' programs for 
patient care. 
Paterson is at present working 
toward a master of sCIence degree in 
administration from McGill University 


Peggy Overton (B.Sc.N.. M.H.S.A" 
University of Alberta) has been 
appointed assistant professor, 
full-time research, in the division of 
health services administration at the 
University of Alberta. Her 
responsibilities center upon pure and 
applied research with reference to 
effective and efficient health delivery 
especially, but not exclusively, related 
to nursing, and involve participation to 
the multidisciplinary team research of 
the Division. 


\' 
... 
h 


--- 


-- 



 


Overton was a recipient of a 
National Health Research and 
Development research training 
fellowship_ She was formerly a 
surgical supervisor and nursing 
project coordinator at the University of 
Alberta Hospital, Edmonton. 


Catherine MacQuinn, (R.N., 
Highland View Hospital school of 
nursIng, Amherst) a public health 
nurse who works among the Indian 
people in Cape Breton, has been 
presented with a 25-year pin and 
certificate from the Medical Services 
Branch, Health and Welfare Canada. 
For several years, MacQuinn 
lived on the Eskasoni Indian Reserve 
where, early in her stay, she often 
delivered babies by the light of a 
kerosene lamp. Over the years she 
has seen the self-development of the 
Cape Breton native peoples; their 
changing attitude toward education, 
their improved health and housing. 


Jacqueline Sue Chapman, R.N., Ph. 
D., is pnnClpal investigator of a 
federally funded study: "Effect of 
Hospital and Home Planned 
Stimulation on Development of Short 
Gestation Infants," to evaluate the 
relative efficacy of selected 
interventions in the nursery previously 
found to facilitate the development of 
short gestation infants. The 
longitudinal aspect of the study is to 
develop a program (in consultation 
with Institutes of Child Development 
on this continent) to maximize the 
potential of the child who may be 
developmentally and/or economically 
disadvantaged. 


Pamela E. Poole (R.N., Queen 
Elizabeth Hospital school of nurSing, 
Montreal; B.N., McGill University: B.J., 
Carleton University, Ottawa: M.S., 
University of California, Los Angeles) 
has been appointed chief of the 
information and evaluation division, 
ResearCh Programs Directorate, 
Health and Welfare Canada. She is 
responsible for the planning, 
development. and direction of a 
program of completed research 
funded under the Natonal Health 
Research and Development Program. 
She is also engaged in planning, 
development and direction of a 
research information program that 
deals with dissemination of research 
findings and the provision of statistics 
and other data on health care 
research. 
Poole joined Health and Welfare 
Canada in 1965. She IS a former 
assistant editor of The Canadian 
Nurse. 


Anne S, Gribben, Chief Executive 
Officer of the Ontario Nurses. 
Association, was appointed a 
part-time member of the Ontario 
Labour Relations Board. an honor that 
gives her official recognition as a 
leading member of the labor relations 
community. It is the first appointment 
to the board of a woman, and the first 
time a union as young as ONA has 
received Ihis type of official 
recognition. 
Gribben was formerly director of 
employment relations of the RNAO 


'- 


Dorothy Fulford (R.N., Winnipeg 
General Hospital school of nursing: 
P.H.Dipl., University of British 
Columbia: B.A., Carleton University, 
Ottawa) has been appointed 
employment relations officer with the 
Ontano Nurses' Association, Ottawa 
office. She brings to her position a rich 
experience in public health nursing, 
having been with the Victorian Order 
of Nurses in Winnipeg. Toronto, and 
Burnaby; the Toronto Department of 
Health: the Ottawa Board of 
Education: and the Ottawa-Carleton 
Regional Health Unit. She also has a 
background of collective bargaining, 
having been on the negotiating 
committee for the Institute of 
Professional Personnel of 
Ottawa-Carleton 


Barbara McWiliiams(R.N., St. Paul s 
School of Nursing, Vancouver: 
B.Se.N., University of British 
Columbia) has been appointed 
assistant director of education 
services with the Registered Nurses 
AssoCIation of British Columbia. She 
will provide counseling services to 
members and others and participate in 
various commil1ee and departmental 
projects. McWilliams was formerly a 
public health nurse in Burnaby and 
has worked as an occupational health 
nurse, in the office of a family 
practitioner. and as a staff nurse in 
intensive care. 



42 


The CanadIan Nursa May 1976 


Information IS supplied by the 
manufacturer; publication of this 
information does not constitute 
endorsement. 


"llt\t 
s Xe,y 


- ,. 



.;" 
50 ,1.' 
;1 ...4t..I111'

 

"
.
;...
:
"
:
.. 
i,\": 
::..-'..
..::. 
C!:
;&:::. 
 .::...:.. 
__J ','
: ".'. 1'.... 
"'I
':'
::i': ..f;::':'. 
.:::
:;.
 ,.-;. 
;

 ",' '.:
"
\
 

 øt!o ,.....,t.'. 
,ee.f'" t.O......'.f 
f t ,t,:,::;,;::, 


Flame-check for Children 
Hospitex "Flame-chek"" children s 
pajama sets and gowns are available 
to hospitals for children up to age 6. 
These flame-retardant children's 
pajama sets and gowns are 
lightweight or flannel-weight, are 
colorful. and are a real patient morale 
builder. 
For informatIon write: Amencan 
Hospital Supply, 1076 Lakeshore Rd. 
E, Mississauga, Ontario L5E 3B6 


Hinged Knee Prosthesis 
Orthopedic Equipment 
Company s brochure in color 
describing the new OEC hinged 
Stanmore total knee replacement. 
This implant utilizes an ultra-high 
molecular weight polyethylene 
bushing for interphasing between the 
femoral and tibial components. The 
flexibility and weight-bearing jOint 
stability of the bushing renders the 
Stanmore knee joint particularly 
suitable for total knee replacement 
when rheumatoid/osteoarthritic knees 
have virtually no ligamentous stability. 
The brochure is available from: 
OrthopedIc EqUIpment Company. 
1011 Haultain Court. Mlsslssauga, 
Ontano L4W 1W1. 


Thomas Traction Kits 
Thomas traction kits from 
Orthopedic Equipment Company 
provide for quick, emergency Thomas 
leg splinting. The deluxe kit (No. 
3034-10) contains two sizes of 
Thomas leg splints, two sets of splint 
straps. two heel rests, two 
foam-padded ankle hitches and a 
Redi-Trac traction device - all 
arranged for quick access in a sturdy 
case that is carned directly to the 
accident victim. The foam-padded, 
vinyl-covered carrying case can also 
be used as an insulated emergency 
blanket when laid out flat, with all 
eqUipment removed. 
Two smaller kits are also 
available: Kit No. 3040-04 contains 
one large Thomas leg splint, plus 
accessories; Kit No. 3040-02 contains 
one small Thomas leg splint, plus 
accessories. 
For further informatIon wnte: 
Orthopedic Equipment Company, 
1011 Haultain Court, Misslssauga, 
Ontano, L4W 1W1. 


\ 


. 
" 
0, 


- I- 
.1' ,- 
 " 


Stylish Safety Vests 
New color print vests to help 
prevent patients from falling out of bed 
or sliding forward in wheelchairs, have 
been designed by the J.T. Posey 
Company of Pasadena 
These vests are in three styles: 
the Poncho Vest for gentle support; 
the Comfort Vest, a difficult to remove 
model, and the standard safety vest. 
Each style comes in red, blue, yellow, 
and pink and IS available in small, 
medium and large sizes. 
Posey products are available in 
Canada from Enns and Gilmore Ltd. 
2276 D,XIe Road. Mississauga. 
Ontario L4Y 1Z5. 


Washing Equipment Catalog 
The operational and design 
features of AMSCO washing 
equipment are highlighted in a new 
eight-page catalog. Described are 3 
different utensil washers, a portable 
flask washer, a hospital cart washer 
and a glassware washer and dryer. 
Productivity of the units and the 
resultant benefits to the user are also 
detailed for each piece of equipment 
For a copy of AMSCO Catalog 
IC-615 on washing eqUIpment write: 
AMSCO/American Sterilizer 
Company, AttentIon: Market 
Communications Department, 2425 
West 23rd Street Erie, Pennsylvama 
16512. 


Disposable Ear Plug 
The Bilsom Propp ear plug 
provides comfort, safety, and 
effectiveness and is nonallergenic. 
This disposable. ready-made plug can 
be inserted when needed, then thrown 
away. It reql::Jires no special fitting 
procedures as it is made of soft. 
permeable, down-like matenal. 
Propp s convenient pocket pack 
of 20 plugs means lost or soiled plugs 
can be replaced right on the job. 
The Proppomat dispenser, 
loaded with a bulk pack of 1,000 
disposable plugs, precisely cuts a pair 
of hygenic Propp plugs ready for use 
and releases them automatically at the 
touch of a button. Placed at the 
entrance to noisy working areas, at the 
time clock, In the changing room or 
any accessible area, the Proppomat 
provides continuous availability of 
heanng protection for everyone 
Wearing Propp plugs blocks 
dangerous and harmful noise from 
sensillve heanng organs so normal 
conversation can proceed without 
noise interference. Bilsom Propp, 
made of mineral fiber spun Into 
microscopic threads softer than 
cotton, provides excellent attenuation 
with cleanliness, comfort, and 
convenience. 
For information. write: Product 
Manager - Canada, Bilsom 
International AB, c/o Swedish Trade 
Commissioner, 920 Yonge Street, 
Suite 820, Toronto, Ontano, 
M4W 3C7. 


-- 


j 


-r
' 


. 
 


--'. 
::! 



l' 
- 

" 


Hand Gym 
The Hand Gym makes possible 
vanety of exerCises, including I 
isometric exercises, to improve and i 
maintain agility and dexterity and to I 
develop muscle strength in hands 
affected by disease or injury. It alsc 
helps to arrest development of ham 
deformities. I 
An '.'sometric Hand Gym" is 
available for people with normal hanc 
that may have stiffened with age an I 
for people to whom hand dexterity , 
particularly important (musicians 
dentists, sportsmen, for example). 
Hand Gyms are available from 
Hand Gym. Inc., P.O. Box ",, Po;' 
Lookout, New York 11569, U.S.A. 


Shoulder Immobilizer 
The Westfield Shoulder 
Immobilizer is designed to provide 
secure, effective immobilization of th 
shoulder and to apply controlled 
tension to the acromioclavicular are I 
An elasticized tension strap, 
padded with soft velvet foam on bot. 
sides for comfort, applies downwar'i 
pressure on the clavicle and upwar I 
tension on the forearm. The tensior 
strap is easily adjusted by means of 
pressure-sensitive Velcro closure. 
The padding on both sides of the 
tension strap permits the Westfield 
Shoulder Immobilizer to be used or 
either the right or left shoulder. 
For further information, contaci 
Orthopedic Equipment Company, 
10 11 Haultain Court, Mississauga, 
Ontario, L4W 1W1 




 


POSEY BODY HOLDER 


At Last... 



 
.}
 


The Posey Body Holder is one 01 
the many products which compose 
the complete Posey Line. Since 
the introduction of the original 
Posey Safety Belt in 1937, the 
Posey Company has specialized in 
hospital and nursing products 
which provide maximum patient 
protection and ease 01 care. To 
insure the original quality product, 
always specify the Posey brand 
name when ordering. 
The Posey Body Holder may be used 
in either a wheelchair or a bed to 
secure chest, waist, or legs. There are 
sixteen other safety belts in the com- 
plete Posey line. #5163-1731 (with 
ties), 


- 
, 


- 
-... 


The Posey Hand Control Mitts pro- 
tect patients from injury to them- 
selves if their hands and fingers are 
not restricted, This mitt is one of 
fifteen limbholders in the complete 
Posey Line, #5163-2811 (cotton), 


þ 


The Posey Tie-Back Vest ties in back 
making it difficult for the patient to 
remove and has shoulder loops which 
may be used to prevent the patient 
from sitting up or sliding in bed. 
There are eight safety vests in the 
complete Posey line. #5163-3533, 


a Canadian supplier 
for INlISeS needs . 
No 
 ltbouI Cwbns- Nodufy foPllY. 


\Hm E\ ER' ORDER. 
f R II \\ hit. viDvl POCKET SA \- ER for 
peon!j. .8Ci!i
r!IJ. rtc. fh
k box OD 
coupon. 


4 
. 


./ 


-
 


STETHOSCOPES 
'I R"FS STETHOSCOPES", S 
COWvTl. Ezceptionalaovnd 
Ira......i..l0... od]1Ulable 
lightweighl bina..raú: 
replacemenl part. avadable 
in Dmadß. 1I
1
 S,lver, 1I
15 
Gold, 1I
90 BIIte_ /I
9f 
v.e.,., /I
9
 Red 19.00 
neb. 1....lttde. m.lialI 
t''lJgNJved free. 
m -\1 Ht.:-\D 
TFTHI''''CUPF 
-1.mpllJlt's aUfrequl'J1Cu: . Bout 
 
af!ctwn hat,' 
.rtra large JI(Jphragm 
4dJlldabk chrome h,nallraú /l4/J. 515.95 .ach. 


SPHYG:\IO :\IAXO
IETER 


4- 


Ruqg.d and d.p.ndnble, Wllh 
A ne roiJ gauge calibrated to JOO 
m J7I \. I!lcrfl touch-and.-hold 
:;:- IIIIIIIIIWI. C1J.(( Handsume zippered Call' 

 9-:'.'" lO1Je6r!J1'6TØ7llee_ /1115 
_ 
 
 IU.95.acb. 

.... - IndlLdes i,..taall f>ngroved 


----'a.- 


"..... 


, 


, 
'" 


OTOSCOPE SET 

 IJ.ne ofGerman,,'s/tnest 

 mst
m nls. È:rceptuJ1UJl 
f ,UMmmatlon. ptJu-er:.ful 
- .n_ maqrufYlnglens.3stalldard.üe 

 J)'fHTlLla S':f' C boltenes 
ncllld
tl \It'tal carrying can 
...0.. I ".d U Ilh .ufl c1..lh_ //J09 
- 156.1MI.ach. 

CISSORS &. FORl'EPS 
I ,..TFR B-\ 'IHGF ...n......IIR... " 1 ' 
.-1. rnMst fore ery ,oursf'_ \,,,. 
"'fJnll.fad urt:'d of finest stt'el and 
tinrshed 
n sanitary chrome. 
1tt>Q9 .JI r 12.60 
"-;00 51." 13.00 ... 
_70'.! 7',- 13.75 
IIPFR-\TI'\G ...n......IIR.. , 
Slfun/f.''''
 ."iteel. strwqht b/ßde:i. 

7U5 5 sharp blunt 12."5.arh 
_7Ob 5" _harp _harp 12."5 each 
1:1710 .jllo'IRIS ..('i
s(lr'" S3.65euh. 
HIRn.p.... 
"'''1. t 
ta;nless Steel 51 .'10119. 
 
".11, For..ps 
7.!
 Slral!(hI. box-lock 1-1.35 each 
....t'liv Fon.t>po;;ltì25 Cuned. box lock .....35 each 
Thumh Pre 
mK 117-1 J Stra;Kht. .:oerraledS3.35 ruh 


The Posey Patient Restrainer with 
shoulder loops and extra straps 
keeps the patient from falling out of 
bed and provides needed security, 
There are eight different safety vests 
in the complete Posey line. #5163- 
3131 (with ties), 


.. 


t: 


:\l'RSES WATCHES 
..J. IJf'fH'11I1ublt'. ultrod f' l,i'Gtch Full 
nurnbt'rs 1m 11: hilt' j(Jl'
 Rl'd n t'p 
Sf'
fmJ hand Chrume ('ose, stmnle., 

t..t'/ hack Jell elkd mOl ement, bliJelc 
("ath..r stmp_ I yr. gu.aranl".. It!JO()_ 
1'''.50 9J cenls In Ontan(J 



 
0;) 
12. 


.. 


The Posey Safety Vest in Breezeline 
is an all purpose vest which can be 
used to prevent a patient from falling 
out of bed. or a wheelchair, #5163- 
3312 (with buckle), 


1',.,TlTI III" -\1 "l R!oot.:": \\nle on yourCompan) 
I('U
rhrad for our 24 pg. ('atalo
(', Quantity 
disC'ounts a.... adabl
. 50 cent handling chargE' for 
orders less than 15.00. 
----------- 
IIrd.r "0. It.m l'ol. QUaD. Siu Price 


5end for the free new POSEY catarog - supersedes aU previous editions. 
Please insist on Posey Qua/ity- specify the Posey Brand name. 


p 
o 
08EY 
E 
V 


Send your order today! 
Enns and Gilmore 
2276 Dixie Road 
Mississauga, Ontario, 
Canada l4Y lZ5 
(416) 274-2575 


9.0
 


HII In \\FIIII \.1 ...lPP11 (II 
P_II. RII'\ 72ti-"_ ßRII{'I\ \ III'" "' T. 1\6\ 5\ S. 


I 
I ....tond to: 
I "'(rH't. 
I ('in. Pro, .: 
I Posta] (,OOE': - ;;I 

----------- 



HS 702 
Plain Warp Knit 
90% Polyester 
10% Nylon 
Colours: White 
only with screen 
print of roses 
Sizes: 4-16 
Suggested Retail 
$40.00 


r,..... 


HJ 319 
Plain Warp Knit I 
90% Polyester 10 0 / 
Colours: White only I 
screen print of rose!' 
Sizes: 4-16 
Suggested Retail 
$33.00 


(\' 


I, 


HT 001 \ 
Plain Warp Knit \\ 
90% Polyester 10% Nylon 
\\. 
 
Colours: White, Blue. Pink, 
Canary, Sherbet, Mint 
Sizes: 4-16 
Suggested Retail 
$22.00 


MAYTIME 


FROM 
o White Cross 


Manufactured by Hampton MFG (1966) Ltd., Montreal, P. a., 125 Elmire St. 



I 


.J 


C) White Cross 

 


/ 


A 


Q 


AVAILABLE 
from 
UNIFORM WORLD 
(Mail Order Division) 
P.O. Box 296 
Renfrew, Onto 
K7V 4A4 


/1 


or shop in our branch stores 
TORONTO SCARBOROUGH OTTAWA 
641 Bay St. 691 McCowan Rd. 226 Bank St. 
InquIre from our mail order division in Renfrew 
about our "Mail Order Shopping Service" 


\ 


A 
HS 756 
Fancy Pleated Top 
Plain Warp KnIt 
90% Polyester, 10% Nyton 
Colours: White, Mint, Sherbet 
SIzes: 3-15 
Suggested Retail 
$38.00 While 
S3IILOO CoIouNl 


B 
HJ 316 
Fancy Pleated Top 
Plain Warp Knd 
90% Polyester, 10% Nylon 
Colours: While only 
SIzes: 4,16 
Suggested RetaIl $35.00 


C 
HJ 302 
Double KnIt 
tOO% Polyester 
Colours: Yellow, Mint, 
Blue, PInk 
Sizes: 4,16 
Suggested RetaIl $36.00 


D 
sa 1200 
3/4 Sleeves 
Also available In short sleeves 
PlaIn Warp KAt - 
T ucl<ed Bodice 
90% Polyester. 10% Nylon 
Colours: White only 
Sizes: 3,t9 
!=t1W"JnA
tAt't Rillllhul 

M 



46 


i . I.... 
 


( . 
1" .. 
' , ". 
 
, j. 
( 


r 


, 


C' 


. '.. 
\ 


:: 


o 


'0 


, .......,. 



, 
.. 
.. 


- 


-'- 


.. 


t' ." 
\' 
 
, 

 '
"i 
II . 
 
, 41: ... 4 .' 

 1\ 

. 

 " I 
, I, 
, Þo!' -or I 
, . " .r 
, 



 " 


\ 


. or 



 ...........-. 
...' ....
- 
.. 


" 


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 


Now available 
'.Ready to Use' 
Bandafix 
. Pre-measured 
. Pre-cut 
. 14 dIfferent applicatIons 
. IndIvidually illustrated 
peel-open packages 


IONi
 


1956 Bourdon Street, Montreal, PO. H4M IV1 


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) 


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 . . . . , . , , . . . . . . 



54 


The Canadian "..... u.r 1176 


Li I) '-Il'-!) [r 1)(111 t e 


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 


with 
c). øJ 
 
,S
Qm
Tß!!2
N' 

 T 
" '
ntlhistamlOe 
, Tablets REPETABS* Syrup Injectable 
. " Full prescnbing Information available 
} on request from 
"'" Schenng Corporal"'" L;müed 
' I · /
14L · 
'\ . .
v- . 
., 
, /. 


. 


. 


. 


. 


. . .... 

I:l 
.' .'-?' .
,
: . 

 
/#--


 
rJ
 _ _. ."=. 


. 


.' 


t
1D- 


. 


Advertising 
rates 


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: 


For All 
Classified 
Advertising 


$15.00 for 6 lines or less 
$2.50 for each additional 
line 


Rates for display 
advertisements on request 


The Canadian 
Nurse 


Closing date for copy and 
cancellation is 6 weeks prior 
to 1 st day of publication 
month. 


50 The Driveway 
Ottawa, Ontario 
K2P 1 E2 


ACTIFED' 
Tablets/Syrup 
Triprolidine HCI Pseudoephedrine HCI 
Antihistamine 'Decongestant 
Indications: The prophylaxIs and 
trootment of symptoms assoCiated with 
the common cold. acute and subacute 
Sinusitis. acute eustochian salpingitis. 
serous otitis media with eustochian tube 
congestion. aerotitis media. croup and 
similar lower respiratory tract disooses; 
in ollergic conditions which respond to 
antihistamines including hoy fever. 
pollenosis. allergic and vasomotor 
rhinitis. allergic asthma. 
Precautions: Use with caution in 
hypertensive patients and In patients 
receiving MAO inhibitors. Patients should 
be cautioned not to operate vehicles or 
hozardous machInery until their response 
to the drug hos been determined Since 
the depressant effects of antihlstomines 
are additive to those of of her drugs 
affecting the central nervous system, 
patients should be cautioned against 
drinking alcoholic beverages or taking 
hypnotics. sedotives psychotherapeutic 
agents or other drugs with CNS 
depressant effects during antihistominic 
therapy. Rarely. prolonged therapy with 
ontihlstamines con produce blood 
dyscrasias. 
Adverse Effects: None serious. Some 
patients may exhibit mild sedation or 
mild stimulation. 
Dosage: Adults & children over 6 yoors 
2 toospoonfuls of syrup or 1 toblet 3 times 
daily Children 4 months to 6 yoors. 
1/2 adult dose. Infants up to 4 months 
1/2 toospoonful of syrup 3 times doily. 
Supplied: Syrup Tablets: Each white 
bIconvex tablet 74 mm in diameter with 
code number WELLCOME M2A on some 
side as diagonal score mark or ooch 
10 ml of cloor lemon-yellow syrup 
contains tripro"dine HCI 2 5 mg and 
pseudoephedrine HCl60 mg. 
The syrup is avoilable in "5 225 and 
2250 ml battles; toblets are available In 
packages of J 2 ond 24 and battles of 
100 and 500 



 I Burroughs Wellcome Ltd. 
:m LaSalle Que, 


"TradeMark 


W451 



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 



't'" tor lJectQ4 

4_ -
A 

. 
 
c:-.:' to 
C>> 
 
- -- 
; 
 
".... . - 
 g 

 
 ,... "... ,"._
'X._..,,_ ""f!!'. ., ,, 
 

m ..
 
-

 


Medical Services, 
N0I1hwest T erntones 
Region, IS seeking 
Qualified personnel to 
fill a number of public 
health positions in 
locations throughout 
the NWT. 


Jt; 


For detailed Information 
on available posllions, 

 .. Interested applicants 
.. are invited to complete 
Clip and mad this coupon today the attached coupon 
r-----------I


- 
I ' ame I Personnel Administrator 
\1edlcal Services. 
I ddress I Northwest T erntones 
I c ty I Region. Health and 
Welfare Canada 
I' oVince 114th Floor. 
I ' )stal Code I Baker Centre, 
10025 106 Street 
I 
Iephone . Edmonton, Alberta 
I T5J 1H2 or call 
Olflcers, X -Ray and. I t;ollect Area Code 
laboratory Technicians .- - - _ _ _ _ _ _ _ _ _ 403 425-6787 


We have openings for 
physicians, nurses in 
possession of a Public 
Health Nursing 
Cel1ificate or Diploma, 
Environmental Health 



The Canadian Nurse May 1976 


School of Nursing 


The Registered Nurses' Association 
of Nova Scotia 


Research Unit in Nursing and Health Care 


POSITIONS AVAILABLE 



nvites applications for the position of 


Nurses with basic baccalaureate or master's 
preparation are required to work in new types 
of primary care settings to demonstrate the 
nurse clinician function in family nursing. 
These openings are part of a large research 
and evaluation project to implement and test 
a model of nursing. The opportunity of a 
lifetime for nurses with clinical expertise who 
are able to communicate in our two lan- 
guages. Send curriculum vitae and references 
to: 


Executive Secretary 


The applicant should have a broad nursing background, 
administrative experience and university preparation, 
preferably at the Master's level. A background in 
professional association activities would be an asset. 


Applications for this position will be accepted until 
September 1, 1976. 


Mr. I. Rosenfeld 
School of Nursing 
McGill University 
3506 University St. 
Montreal, Quebec H3A 2A7 


For complete information, including job description and salary 
range, write to: 


President 
Registered Nurses' Association 
of Nova Scotia 
6035 Coburg Road 
Halifax, N.S, 83H 1Y8 


If Paris appeals to you 
. . . so will Montreal 


. Modern 700 bed non-sectarian hospital 
. Excellent personnel policies 
. Registered Nurses and Nursing Assistants 
are asked to apply 


. Active In-Service Education program 
. Bursaries available 
. Quebec language requirements do not 
apply to Canadian applicants 


Director, Nursing Service 
Jewish General Hospital 
3755 cote ste. Catherine Road 
Montréal, Québec 
H3T 1 E2 



University Hospital of the 
West Indies 
Nursing Vacancies 
Applications are Invited from suitably 
Qualified Registered Nurses for the 
following posts at the University Hospital 
of the West Indies which is a Teaching 
Hospital of 500 beds and also conducts a 
School of Nursing with a complement of 
300 students. 
I A. Sisters 
1 Operating Theatre 
2 Paediatrics (For Surgical Ward) 
3 Dermatology 
Applicants must: 
1 Be dual trained and hold 
post-graduate certificates In the 
relevant specialist field. 
2 Have managerial experience and/or 
evidence of post-graduate managerial 
training. 
Salary in the scale of: $4440 x 240 - 5640 
per annum 
B. Staff Nurses 
Intensive Care Unit 
Applicants must be registered or 
registrable Nurses with special 
training in Intensive Care. 
Salary in the scale of: $3240 x 180 - 4500 
per annum 
Applications stating full details of 
Nationality, age, marital status, 
Qualifications and experience should 
be sent to the: Director of Nursing 
Services, University Hospital of the 
West Indies, Mona. Kingston 7. 


The Montreal 
Children's Hospital 


Registered Nurses 
Nursing Assistants 


Our patient populallon consists of the 
baby of less than an hour old to the 
adolescent who has just turned 
seventeen. We see them in Intensive 
Care, in one of the Medical or Surgical 
General Wards, or In some of the 
Pediatric Specially areas. 


They abound in our clinics and their 
numbers increase daily in our 
Emergency. 


If you do not like working with children and 
with their families, you would not like it 
here. 


If you do like children and their families, 
we would like you on our staff. 


Interested qualified applicants should 
apply to the: 


Director of Nursing 
Montreal Children's Hospital 
2300 Tupper Street 
Montreal, Quebec, H3H 1P3. 


TwO careers in one. 


Have you ever thought of combining two 
careers in one? As a Canadian Forces nurse 
you could, because you would also be an officer, 
eligible for regular promotIOn, enloying a mini- 
mum of four weeks vacation your very first year, 
free transportation privileges to many parts of 
the world, early retirement including a generous 
lifetime pension and a number of other bene- 
fits The Canadian Forces will give you every 
opportunity to continue your nurse's training, 
while using the skills you already have In one 
of the many military medical installations In 
Canada or overseas You might Qualify for lIight 
nurse's traimng or even for a complete doctorate 
study course 
1\ you're a graduate (female or malel of a 
school of nursing accredited by a provincial 
nursing association and a registered member 
of a provincial registered nurses' association. 
a Canadian citizen under 35 with Iwo years' post- 
graduate experience in nursing, you owe it to 
yourself to enjoy two careers in one 
Contact your nearest Canadian Forces 
Recruiting Centre or write to: 
Director of Recruiting and Selection 
National Defence Headquarters 
P.O. Box 8989 
Ottawa,Ontario.4 
K1A OK2 'W h 
\.t
J} 


. 

 

,. 
* 


. 


-- -- 


.....
 



 


. 


. 


. 


, 



 
. 


. 


, 


. 


. 


. 


, 


II 


. 


. 


I 


GET 
INVOLVED. 
WITH THE 
CANADIAN 
ARMED 
FORCES. 


Ff 


"" 


L 


'\ 


" 


.".. 


" 4 


Nursing Education at 
Royal 
Prince Alfred 
Hospital 
Sydney, NSW, Australia 
Royal Prince Alfred Hospital is 
Australia's largest teaching hospital 
(1532 beds) and the most highly 
specialised acute hospital in the 
country. It is also a teaching hospital 
of Sydney University, which it adjoin
. 
Graduate nurses at RPA get wide 
clinical experience in the most modern 
and advanced medical environment 
available in Australia. They also under- 
go continuous in-service education to 
ensure that their theoretical knowl- 
edge .keeps pace with their clinical 
expenence. 
Post-Graduate Education: RPA of- 
fers trained nurses a choice of seven 
post-graduate courses in nursing: ob- 
stetrics, gynaecology, neo-natal inten- 
sive care, intensive care, neurology and 
neurosurgery, cardio-thoracic, and 
operating theatres. Since the courses 
are heavily booked, early application is 
invited. 
Basic Nursing Education: Each year 
some 400 young men and women 
come to RPA to train as nurses on the 
3-year course which prepares them for 
the final examination of the Nurses' 
Registration Board of New South 
Wales; this qualification is recognised 
throughout Australia and in many 
hospitals overseas. 
If you would like to join Royal 
Prince Alfred Hospital either as a 
graduate member of the staff or as an 
entrant for either the basic training or 
post-graduate courses, please write to 
or telephone: 

 Ms Margaret Nelson 
*
 DIrector of Nursing 

 Royal Prince Alfred 
r.. !'t3:l. \ Hospiral 
'7f t J I Camperdown, NSW 2050 

>" Tel: Sydney 51-0444. 

 Australia, 



 



62 


""-- 


ç 
, 
 

 ".., ...do......... 
, I I f 
,1. Df 

 '

 



 

 

 
o 
CJ 
c:: 

 

 
o 

 
... 
-- 
U 


Di rector Of 
Community Health Nursing 
The City of Vancouver Health Department. a 
member of the Metropolitan Health Service of 
Greater Vancouver, is seeking a Community 
Health Nurse to plan, develop, admimster, 
supervise and evaluate a comprehensive 
community health nursing program for a 
population of 500,000. The successful applicant 
will be expected to continue in the development of 
innovative programs and work in conjunction with 
other professionals to improve the preventative 
health services to the community. 
The requirements for the position are a Bachelor's 
Degree in Nursing, including or supplemented by 
training in community health nursing and 
post-graduate courses at the Master's level in 
administration, and supervision in community 
health nursing. Preferably a Master's Degree with 
content in supervision and education and a major 
in administration. Considerable experience as a 
Community Health Nurse, especially in the various 
administrative and supervisory levels 
The monthly salary for this position is $1833 to 
$2246 per month (1975 rates), depending upon 
qualifications and experience. This position will 
become vacant in late 1976 or early 1977. 


All applications should be made on 
"Application for Employment" Form Pers, 35 
and returned, as soon as possible, preferably 
together with a detailed resume, to the 
Department of Personnel Services, 453 West 
12th Avenue, Vancouver, B.C. V5Y 1V4, Please 
quote competition number R-1501. This 
position is open to both male and female 
candidates. 


Government of 
Newfoundland & Labrador 
Mental Health 
Nursing Consultant 
Applications are invited for the vacant, established post as 
Consultant in the Mental Health Division of the Department of 
Health. The Nursing Consultant will work with a multi-disciplinary 
group of Consultants in the Division. 
The duties and responsibilities will be oriented towards the 
administrative. clinical aspects of nursing in programs relating to 
prevention, treatment, rehabilitation and the continuity of care. The 
Consultant will be concerned with existing mental health services 
in hospitals, and community clinics and with the mental health 
components of other community agencies, the schools and special 
services such as programs for the aged, the retarded and other 
developmental disorders. 
Opportunities will be provided for involvement in university 
teaching, and research and in the development of new mental 
health services through the province. 
Salary, effective August 1,1976, within the range $17,866- 
$22,119. 
Qualifications - eligibility to register in Newfoundland. A Master s 
degree in psychiatric nursing or some equivalent combination of 
education and experience. 
Full pUblic service benefits apply with annual and siCk leave wlih 
pay, provincial statutory holidays and contributory pension. 
Financial assistance towards re-Iocation is available. 
Applications and/or requests for information should be 
forwarded to: 
C. H. Pottle, M,D., F.R.C.P.(C,) 
Director 
Mental Health Services 
Department of Health 
Chimo Building 
Crosbie Road 
St. John's, Newfoundland 


The Canadian Nurse May 1976 


Vernon Jubilee Hospital 
Vernon, B.C. 


a 258 bed acute and extended care 
hospital in the Sunny Okanagan invites 
applications for the following 


Senior Management Positions 


Head Nurse - Operating Room and P.A,R. 
Head Nurse - Intensive Care Unit (6 beds) 


Previous clinical and administrative 
experience required. Post graduate 
courses and administrative education 
preferred. To commence June 1st, 1976. 


Rotating Nursing Supervisor 


Previous climcal and administrative 
experience required. Advanced formal 
preparation at a University level preferred. 
Responsible for the Nursing Department 
on evenings, and nights; clinical resource 
person on days. To commence 
September 1, 1976 


Personnel policies in accordance with 
R.NAB.C. Contract. Must be eligible for 
B.C. registration. 
Apply sending complete resume to: 
Director of Personnel 
Vernon -dubilee Hospital 
Vernon, B.C. V1T 5L2 


Women's College Hospital 
requires 
Nursing Coordinator 
Obstetrics and Gynecology 


Qualifications 
Extensive experience in Obstetrics, Administrative 
expertise, degree in Nursing and eligibility for registration In 
Ontario, are requirements 


Head Nurse 
Central Services Dept. 


Qualifications 
Previous experienæ in C.S.R. or other related position. 
Sound knowledge of aseptic techniques, quality control 
methods. management skills. eligibility for registration in 
Ontario. 


Women's College Hospital is a 400 bed general teaching 
hospital in downtown Toronto. 


Applications and enquiries to: 
The Director of Nursing 
Women's College Hospital 
76 Grenville Street 
Toronto M5S 162, Ontario 



IIIIII' .......fHlUIQ'1I nU'::I'1:: .....,. I
'V 


657 bed, accredited, modern, 
well equipped General Hospital, 
rapidly expanding... 


- 
. 
 ' 


ANNOUNCING A NEW PUBLICATION 


Saint John 
General 
CfIoÆPital 
ðaintc:John,NB. 
CANADA 


"Intravenous Drug Therapy Manual" 
by Marilyn E Brown, M.Sc. candidate 


q?J:;QUIRES: 
Genetãlðtaff f\(yrses C& 
Registered Nursing Assistants 


. monographs on over 200 intravenous drugs listing indications, 
dosage, preferred administration routes, hazards and 
recommended personnel for I. V. administration. 
. researched and reviewed by a munidiscipJinary committee at the 
Ottawa General Hospital. 
. designed to assist nurses with 1_ V. administration, physiCIans with 
I.V. prescribing and pharmacists with LV. drug information. 
. available in 3-ring binder with provisions for twice yearly updating. 
Cost: Single issue: $10.00 each 
5 or more: 8.00 each 
10 or more: 6.50 each 


(ThIS laller pnce allows relatIVely InexpensIve dslnbunon 10 nurSing UnitS) 


In all general areas: Medical, Surgical, 
Pediatrics, Obstetrics, Chronic and 
Convalescent, several Intensive Care 
areas and Psychiatry. 


I hereby submit a cheque/money order for 
$ for copies of Intravenous Drug Therapy 
Manual, payable to the Ottawa General Hospital. 


. ActIve. progressive in- service educalion program. 
Special Allenlion 100rienlalion. 
Allowance lor Experience and Posl Basic Preparalion 
FOR FURTHUR INFlllMATION APPlY TO 
-PERSONNEL DIRECTOR 
CSaintfjohn General Hospital 
po. BOX 1000 Saint John. New Brunswick ElL 4L1 


Send to: 
I.V. Drug Therapy Manual 
Drug Information Centre 
Ottawa General Hospital 
43 Bruyère Street 
Ottawa, Ontario 
K1N SC8 


Applications are invited from'suitably qualified 
members of the Nursing profession for the position 
of: 


Qualifications: 
Must be eligible for registration with the Nurses Board 
of South Australia as a Registered Nurse and 
Registered Midwife, Diploma in Nursing Education, 
Diploma in Community Health Nursing or equivalent. 


Senior Tutor 
Community Health Nursing Course 


Salary 
$10.251 under review 


Duties 
Plan, organise, implement and evaluate a 26 week 
Community Health Nursing Course, liaise with 
Government Departments. Voluntary agencies and 
other Allied Health Professions. Teach students and 
evaluate student performance, supervise clinical 
experience, Other related duties as required, 


Applications including all relevant details should 
be forwarded no later than Friday June 4, 1976 to: 
The Chief Personnel and Training Officer 
Hospitals Department 
158 Rundle Street 
Adelaide 
South Australia, 5000. 



64 


Serve Canada's 
native people 


-. 


... 


.. 


\ 


.....-- 


I 


.. 


. 
In 
a well 
equiDped 
hospital. 


. . Health and Welfare San'é ... Blen-êlre socIal 
Canada Canada 
,---------------
 
I Medical Services Branch I 
I Department of National Health and Welfare I 
I Ottawa, Ontario K 1 A OK9 I 
I I 
I Please send. me information on hospital I 
I nursing with this service, I 
I Name: I 
I Address: I 
City: Pro,,: _ 

-----------____J 


The CanadIan Nurse May 1976 


Index to 
Advertisers 
May 1976 


Burroughs Wellcome Limited 
-- --- 
Canadian Hoechst Pharmaceuticals Limited 
The Canada Starch Company Limited 
Department of National Defence 
Equity Medical Supply Company 
Ham pton Manufacturing (1966) limited 
Hollister Limited 
House of Appel Fur Company Limited 
ICN Canada Limited 
L'eg gs Products International Limited 
J.B. Lippincott Company of Canada Limited 
MedoX 
The C. V. Mosby Company Limited 
Nordic Pharmaceuticals Limited 
Posey Company 
Reeves Company 
Roussel (Canada) Limited 
W.B. Saunders Company Canada Limited 
Schering Corporation Limited 
Stensystems Limited 
Three (3) M Limited 
Uniform Specialty 
Uniform World 
Uniforms Registered 
White Sister Uniform Inc. 


2,55 
1 


Cover 4 


61 
43 
44 
51 
6 
49 
9 
32,33 
56 
46, 47 
5 
43 
15 
13.57 
7 
55 
17 
18 
Cover 3 
45 
40 


Cover 2 


Advertising Manager 
Georgina Clarke 
The Canadian Nurse 
50 The Driveway 
Ottawa K2P 1 E2 (Ontario) 


Advertising Representatives 
Richard P. Wilson 
219 East Lancaster Avenue 
Ardmore, Penna. 19003 
Telephone: (215) 649-1497 


Gordon Tiffin 
2 Tremont Crescent 
Don Mills, Ontario 
Telephone: (416) 444-4731 


Member of Canadian 
Circulations Audit Board Inc. 


I3E:] 



76 


The Canadian Nurse 


L..u......" .J I 
t-" l J - I r 
1.J J - 
6l -111 , U.b 
r flt T 


- - 

-. - ..,. 

 :s
t. . . ... 
 -,.. 'Yl'r': . 

 - I ' ....... . ,,
 

 I __ _ 

. ."
, T"'" . .
 101 .., #. 

 ""'1'.1 ',,
. I. 
: .., - ,..... ..
:, - -" . ",. . 
,: 

 
 {:; . 
,.
, "'" 0, ; .. .... 
.. 


-. 


';--.1 -' 
.. J 
, ... 
..' 
I . 
. 



L 


./ 


1CI"' c .;.A . 
'

" 
.., It. - 
.,. 

 i ' 
.) . '- 



 


..Ì'. 


1 J 01 
· , I -, l' 
'1- . . '.' 
.... 


.Å 


-t' .... 


;r 


. . 
_ .JI4..,f. 


.. ': '0"/ 


.. 


r' 
ø. 
::.J 
\. . 



 .. 


. 


, 
;,-"\t 
 


" 


.
 


"" 



-. ,; 


. I 



 " 


"" 


" . 
, . 


"p 


þ 



 


h. 


4 


", 


J 


- .. 


... 



......... 




, 
A 


A. Style No. 46596 
Sizes 5-15 
Pristine Royale 
White about $24 


B. Style No. 6699 
Sizes 6-20 
Elite - 80% Dracon, 
20% Cotton 
Bengaline Weave 
White about $2
 ( 



 


VVHITE 
SISTER 


See our new line of Whitps and Watpr Colours at finp stores across Ca ad, 



@ 


. I 


-. 


, 


The first and last word 
in all-purpose 
elastic l1tesh bandage. 


, 
, 


Quality and Choice 
· Comfortable, easy to use, and 
allergy-free. Widest possible choice of 
9 different sizes (0 to 8) and 4 
different lengths (3m, Sm, 25m, and 
sOm). 


rJ

;r 
:Fj1 ::'t; I\

. 
- . 
 . F-n 
. m . -tJr:;
 

 I.J_U :. . r i I 
r. .. u..(jJ..l.J!'. M 
,. ã '.J(,E;r
:t.. 
-....
 '
-=-
r"'
 
" q 
Ii G
'" 

:r I 
':i rã.-z'" - '- < 


Highly Economical Prices 
Retelast pricing isn't just competitive, 
it's flexible, and can easily be tailored 
to the needs of every hospital. 


. 
t 


Technical training 
· Training and group demonstrations 
by our representatives 
· Full-colour demonstration folders and 
posters 
· Audio-visual projector available for 
training programmes. 
· Continuous research and development 
in cooperation with hospital nursing 
staff . 


- 


" 
 


-- 


.:l,t er 
...
 . 
"..-, ,
'M 
 

..

"- 
...... ......
.....lINftge p 
...!.r!...:
""


..y 
.
.
";
t1.. c..... 
.:d:
 ,,:::., 


",",. 
....."""" 

 :. Clt\\. 
...
:;:
:
::
 ,. IC.I....
, 

....
't ..;.. ..........- 
_ _,",-:r--"r:-
..4..... 
 ",.,... e 
-- ......
4"6. .,. 'fff 
:.....c.".." .1IJ1. 
4."'
 
-::::_ 
.
.
'tø. _ , 
':.
.." ., " 


For full details and training supplies, 
contact your Nordic representative 
or write directly to us. 


Nl @ (;)C[)\ O@ PHARMACEUTIQUES LTËE 
l.}\J W
 PHARMACEUTICALS LTD 


2775 BOVET ST., LAVAL. QUEBEC.TEL: (514) 331,9220 TELEX: 05-27206 



---;\L 
I 


-:\ 


"- 
,.... 
f'I"" 


, 


.. 


...... 


L'f' 


We care about nurses 


THE 
CLINIC 


SHOE 
p kWornm ï",WhJi,@ 


ABOVE STYLES ALSO AVAILABLE IN COLORS. . SOME STYLES 3
/2-12 AAAA-E, 23.95 to 32.95 


For a complimentary pair of white shoelaces, folder showing all the smart Clinic styles, and list of stores selling them, write: 


THE CLINIC SHOEMAKERS · Dept. CN-6, 7912 Bonhomme Ave. . St. Louis. Mo. 63105 



it 76 


Input 
News 
Names and Faces 
What's New 
Audiovisual 
Books 
Calendar 
library Update 


In. (;Snaa..n Nurse .June lBrtj 


.j 


The Canadian Nurse 


The official journal of the Canadian 
Nurses' Association published 
monthly in French and English 
editions. 


6 
12 
48 
50 
52 
54 
56 
56 Breast Cancer 
Mammatherm: A Weapon 
in the Fight Against 
Breast Cancer 
Prejudice in Nursing 
Legg-Perthes Disease 
A Clinical Evaluation 
Tool for Student Nurses 
Storyboarding - 
A Teaching Tool 


Volume 72, Number 6 


A. Butler 17 
M. Bacon 23 
N.J. Briant 26 
C, Nichol 31 

 Morton,A. S#nso
 
J. Wagstaffe, M. Yakimoff 37 
G. Dubm,A. Dunsmore 
D. Pedersen, J, Quiring 
R. Rubeck 42 
P. Nendick 45 
D. Scott 46 


Extended Care 
Connection: 
Home Ec, Anyone? 


JI':
 
-:ç



 


 '..' 
TitJ>
 . 
- - 
_l ,. 
,.. 
r "II'f.

: .. 
--.:; ';#F.. -.r.p 
 

'_' >t., , 
.
_.. 
;
 ... 
 

. 

 . 
-- .. - 


.. 
-"oJ, 
.:.. 


::: 
- . 
ì 
;:< 
.... 

 
" ; .... 

 


, 
"'-4IÞ 


The final hurdle for nursing students 
across Canada is the examination for 
nurse registration/licensure set by the 
Canadian Nurses Association Testing 
Service. This month The Canadian 
Nurse salutes the RN's of the future 
who are writing these all-important 
exams in June. The cover photo. 
courtesy of The Globe and Mail. 
Toronto, shows a group of 1975 
graduates during their exams last 
year. 


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


ISSN 0008-4581 


Indexed in International Nursing 
Index, Cumulative Index to Nursing 
Literature, Abstracts of Hospital 
Management Studies, Hospital 
literature Index, Hospital Abstracts, 
Index Medicus. The Canadian Nurse 
is available in microform from Xerox 
University Microfilms, Ann Arbor, 
Michigan, 48106. 


The Canadian Nurse welcomes 
suggestions for articles or unsolicited 
manuscripts. Authors may submit 
finisht d articles or a summary of the 
proposed content. Manuscripts should 
be typed double-space. Send original 
and carbon. All articles must be 
submitted for the exclusive use of The 
Canadian Nurse. A biographical 
statement and return address should 
accompany all manuscripts. 


A Canadian Nurses' Association, 
':::( 50 The Driveway, Ottawa, Canada, 
K2P 1E2. 


Subscription Rates: Canada: one 
year, $8.00; two years, $15.00. 
Foreign: one year, $9.00; two years. 
$17.00. Single copies: $1.00 each. 
Make cheques or money orders 
payable to the Canadian Nurses' 
Association. 


Change of Address: Notice should be 
given in advance. Include previous 
address as well as new, along with 
registration number, in a provincial/ 
territorial nurses' association where 
applicable. Not responsible for 
journals lost in mail due to errors in 
address. 


Postage paid in cash at third class rate 
Montreal, P.Q. Permit No. 10,001. 
CCanadian Nurses' Association 
1976. 



4 


The Canadian Nurse June 1976 


.-P'-SI)P(-. i ,ep 


Every writer who submits an article to 
The Canadian Nurse has something 
original to offer readers. ThIs makes 
opening the mall a little like Christmas 
every day and adds greatly to the 
editor's appreciation of what nurses 
across the country are thinking. The 
number of submissions that can be 
accepted is, unfortunately, limited Of 
the ones that do get into print, most 
end up as an article, or maybe a 
letter-to-the-editor. The one below is 
an exception: it's on this page 
because I think the challenge it offers 
health professionals, while not new, is 
important. It was submitted by 
Patricia Ford of Thunder Bay, Ontario 
and here is what she wrote: 
What I have to say is going to be 
as popular as shooting puppies but, in 
the past year, I have become 
convinced that exercise is not 
something exclusively for athletes or 
the educated few who pound around 
university tracks. Rather, it is a 
biological necessity: 10 live to your 
potential both quantitatively and 
qualitatively you must exercise. 
A vivid example occurred recently 
when a 38-year-old man with a 
myocardial infarction was admitted to 
the Intensive Care Unit where I was 
working. Right away, some of you will 
suggest that his heart attack was due 
to some quirk of cholesterol 
functioning or a stressful situation. 
Perhaps, but I doubt it. Studies of 
three groups of people known for their 
longevity in Kashmir, Russia and 
Ecuador, found a high level of physical 
activity was common to aiL The 
gerontologist involved, Dr. Alexander 
Leaf, was amazed at the exertion 
displayed by men and women over 
100 years of age. For those who may 
quibble about their true ages, he 
states - "It is the fitness of many of 
the elderly rather than their age that 
impresses me." These people do not 
possess some special gene or 
immunity which protects them from 
aging. They appear to suffer from 
many of the same cardiovascular 
diseases that we do, but their heart 
muscle is so superior due to activity, 
that their heart attacks are silent. 
Consider the human potential this 
represents. Imagine not just surviving 
to the age of eighty or ninety, shuffling 
around the halls of a nursing home, 
but really living, being able to walk 


miles, swim and enjoy your 
grandchildren. What is more exciting 
is that this possibility is within our 
grasp. Why should we passively 
accept a reduced life expectancy just 
because of the life style technology 
forces upon us? Why should we allow 
technology to fatten us like sedentary 
cattle for a futile kill? We have control 
over our lives and we must exercise 
that control to live. Of course, it takes 
some effort: slick advertising implores 
us to drive everywhere; the slightest 
smell of sweat is reason for social 
ostracism; parents who tell their 
children to walk a mile to school are 
cruel; and our highways say "No 
Bicycles Allowed." 
What can you do? First, 
recognize that man has survived as a 
species not in spite of hardship but 
because of it. Exercise should be 
recognized not as an occasional 
indulgence for a flatter stomach or 
firmer thighs but a daily biological 
necessity - whether it is running, 
swimming, skating, jogging or 
whatever. Exercise must be 
approached with intelligence, but as 
Astrand the noted Swedish 
physiologist indicated, a checkup by a 
physician is more important for those 
who are going to continue a sedentary 
existence than forthose who are going 
to start exercising. Depending on your 
situation, it will probably take you 45 
minutes per day including a shower 
afterwards, to maintain a reasonable 
level of physical fitness. And, it must 


Ile.-ei'l 


Editor 
M. Anne Hanna 
Assistant Editors 
Lynda Ford 
Sandra LeFort 
Carol Thiessen 
Production Assistant 
Mary Lou Downes 
Circulation Manager 
Beryl Darling 
Advertising Manager 
Georgina Clarke 
CNA Executive Director 
Helen K Mussallem 


I 
be regular. Also, every chance to walk I 
in your daily routine should be taken 
Can you walk to work? Too far? Then 
get off the bus one mile from work and I 
walk the remaining distance. You will 
not only look and feel better but you 
will be controlling your own destiny. 
If you value your life, you will 
exerCise. Only you can increase the 
quality and quantity of your life - for 
less than an hour a day you can add 
years to what is presently being 
programmed as your life expectancy. 
Run for your life and avoid the 
slaughter! 



 


Doreen Scott, the author of this 
month's "Connection," is program 
coordinator for the Department of 
Nursing at the Alberta Hospital, 
Ponoka, Alberta. She obtained her RN 
from Calgary General Hospital some 


time ago and last November received 
her B. Sc. in Nursing from the 
University of Alberta. She describes 
her present work as "exciting and 
challenging and I love it." She and her 
family live on a farm and her activities 
these days include work on a novel 
which will feature a nurse. 
Breast cancer CAN be beaten .., 
but only If nurses make full use of their 
caring qualities to help women detect 
and cope with this disease. To learn 
more about "getting in touch" with 
these patients, read Ada Butler's 
feature story "Breast Cancer" 
beginning on page 17. We suggest 
that, along with this article, you read 
"Thermography" by Monica Bacon as 
well as this month's audiovisual 
feature section. 



I 


I 


- 


,r.v. 


- 
II 


zo\a 


seru Recently d' 
Min: cholesterol was' ,.: letary program 
fish I sota. It included :,rted from the U to reduce 
Res
l

:'
:ts, and 

ia n;gt' poultry, f

":::y of 
a verage of 17 % cholesterollevel % pure com oil. ggs, 
. s were reduced 
. F
 M 
Important stud a complete r 

1orm h ation, B":t r= 
te :;Ñ
t o.n t . this 
arc Compan DIvIsion T h n JOnal 
Station AMY' P.O. Box 129' e Canada 
H3C ICI' ontreal, Quebe ' 
M c, 
azola Corn 0 0 1 
54% polyu I contains' 
14% satur:t::

:
 fats. and 


.. 
: 
A8tF Jf 


-- 









 
c,
Q




 

O
 
\)\.

. 


100% plJ
t 
'..... ttUILE DE """I
 

 32 oz fI 909"" 
___ ..._.._rII""'''''' 


.... 


B
s
 Foods 
LIvIn g 
up to our nam 
e. 


... 


\,. 



6 


The Canadian Nurse June 1976 


The Canadian Nurse Invites your 
letters. All correspondence IS subject 
to editing and must be signed, 
ahhough the author's name may be 
withheld on request. 


111))ot 


A bureaucratic battle lost 
Beverly MacLellan's article 
"Matthew My Son," (March, 1976) 
should occasion no surprise among at 
least one group of Quebec citizens. I 
refer to those of us who struggled so 
valiantly, and so vainly all through the 
summer and fall of 1973 to convince 
the Quebec Ministry of Social Affairs 
under Claude Castonguay, that the 
closure of the Catherine Booth 
Hospital with its family-centered 
maternity care services, was a grave 
and serious error in judgment. It is 
difficult. well nigh Impossible to refrain 
from saying ." told you so," 
What happened to Beverly and 
Keith during "prepared childbirth at 
the General" was good. What 
happened to Beverly, Keith and 
Matthew durinq the next four days was 


not Iragic, but it was sad, and as a 
nurse I feel ashamed and obliged to 
say to them in the name of nursing "I'm 
sorry. It should not have been like that. 
It would not have been like that at the 
Booth." 
Thirty thousand Quebec citizens 
in 1973 saw fit to sign a petition asking 
the Quebec government not to close 
the hospital. Nobody listened. Dr. 
Sidney Lee, Associate Dean 
(Community Medicine), McGill 
University, advised the ministry 
then: "These units must be effective in 
both the human and scientific 
domains. We don't want hospitals 
which fail in either of these 
respects....Science without warmth 
and kindness is unacceptable to our 
views of what medicine is and should 
be." Noble sentiments, but one is 


FURS MUCH BELOW 
RETAIL PRICES 
NURSES ARE PRIVILEGED TO BUY DIRECT 
FROM FACTORY AT SENSATIONAL SAVINGS. 


Cut down the high cost, avoid 
the middle-man profits. Buy 
direct from the manufacturer at 
lower costs. 


BUDGET if you wish at no 
extra charge. 


LEATHER COAT DEPARTMENT 
Famous brand of genuine leather 
coats in latest styles and 
colours - plain - fur trimned - 
zip-in lining. 


1IDUSBOF- 
APPIL 
1>' U R CO. LTD, 


Manufacturers of 
FINE FURS 
119 Spadina Avenue 
Toronto,Ont. 
M5V 2L 1 
Tel.: 363-7209 



 


-- 


, 


I 


I 


- 
tloi.JU.iI,D 
- 




 


forced to ask as Susan Pomerantz did 
in a Montreal Star editorial regarding 
the Booth closure "What justification is 
there for ending maternity care in the 
one place where treatment on the 
human level is as highly emphasized 
as treatment on the medical level; 
where the mother, the individual is still 
as Important as the mother, the 
patient?" 
In 1973 we asked The CanadIan 
Nurse for moral and editorial support 
In our battle, and were told that this 
sort of action would be against 
editorial policy. Coverage of our loss 
of this small battle in a big war, was 
less than negligible, but as Canadian 
nurses, how could we prevail against 
the "editorial policy" of our own 
professional journal? And now, in 
March of 1976, you editorialize that for 
Beverly MacLellan "the support and 
encouragement that she 
needed....was not available when she 
needed them most." So, I ask you 
what else is new? WHEN will you 
people open your eyes and honestly 
confront yourselves and your readers 
with the truth about what is happening 
to people in hospitals at the hands of 
the "health professions?" 
- Mary E. Hal',B.A., R.N., D.N Ed., 
Chateauguay, Quebec. 


The editor replies: Your charge that 
we are not "telling it like it is" is a 
serious, - indeed, a fundamental one 
- for a professional journal that exists 
primarily to do exactly that. In an 
editorial last January I tried to explain 
my commitment to this task. That is 
why the decision was taken to include 
an article by a non-nurse (Beverly 
MacLellan) in the March issue. We 
thought it was essential for the 
profession to see how people on the 
receiving end of health care perc
ive 
the system and the providers. It was 
regarded by the editonal staff as a 
step in the direction of "telling it like it 
is" rather than simply describing the 
ideal in maternal {child care. 
Whether the profession chooses 
to work together for the improvement 
of the health care system depends 
upon its members. Their Joumal is 
willing - indeed anxious -to provide 
the necessary forum. 


March issue a winner 
It is a change to write someone a 
letter to say what a good list of articles 
appeared in the March, 1976 issue of 
The Canadian Nurse. The diagrams 111 
" A Practical Guide to Successful 
Breast-Feeding" were excellent. I also 
appreciate your printing Beverly 
MacLellan's article. 
- L. Cliffe, Public Health Nurse, 
Delta, B.C. 


I enjoy your new look, espeCially 
the fact that each issue appears to 
have a theme. 
March's issue was of particular 
interest to me since I am a nurse and 
also a nursing mother. It's very 
encouraging to see that nurses are 
becoming more knowledgeable about 
the subject since I know from personal 
experience and the experience of 
others that too often the nurse has 
been responsible for the mother I 
getting off to a bad start. 
I do have some argument with II 
Taggart, though. She says 
"Meticulous washing of the breasts- 
is necessary before and after each 
feeding in order to avoid infection..' If 
one keeps one's clothes clean, nature 
will keep the breasts clean. A daily 
bath with warm water is plenty and 01 
course no soap or alcohol on the 
breasts. The purpose of the 
Montgomery's Tubercles is defeated if 
one follows a routine of cleaning the 
nipples before and after every feeding 
- that purpose being to keep the 
nipples clean yet supple with their 
wax-like secretions. In fact this regime 
of cleaning could easily lead to sore, 
cracked dry nipples, (even if creams 
are used) leading to a stasis of milk 
thus an infection. Free-flowing milk is 
by far the best prevention of mastitis. A 
good healthy neonate is in no danger 
of infection from his mother's breasts 
unless she has T.B. or whooping 
cough, of course. 
What of the mother whom the 
nurse suspects is not personally 
clean. Well, let that nurse be thankful 
the woman IS nursing her baby. Her 
milk will be fresher and more sterile 
than any formula she could probably 
make at home RIght? 
I think that breast-feeding, among 
its other advantages, is the simplest, 
most convenient way of baby feeding. 
Let us, as nurses, keep it that way. 
- Judith Vestre, Saskatoon, Sask. 



GENEROUS NEW GROUP DISCOUNTS on ./1 
Items shown. for group øurctaases. graduation gifts. fawrs. etc. 
6-11 Same Items, Deduct 10%; 12-24 Same Items, Deduct 15% 
25 or More Same Items, Deduct 20% H 


'
,* 7k,...;-
 


-------------------------------------. 


IT'S EASY TO ORDER REEVES NAME PINS FOR YOURSELF OR FRIENDS! I 

 d
'
 
..;'= 

/é

:
:
 
Wu
:fiG\ :.r;c
rim
at

.
 '::1=,::, I 
boxes ... cIIort, dill thIS section .IId .1txJI 10 <OIJI)OI\ spn II .... II ..... 


I 
I.ETTERING.______________________ 2nd LlNE.________________1 
II C1Ioost DßCIIPOOM IACUIOIING LEmllIIC PIIW. 11'11 
!.: I 
......' 


All METAL.. _ rich, trim. tailored. lllhtweighl 
nootI1 edJes. rounded corne.. Choo$e 
)I,shed, satin or Duotone finish. comblmnl 
satin background with pohshed edEIna. 
. ..ETALFRAMED.._smoothPIa5tfCback- Frame: o White 
I' 
&::

'r:=':=-== B
':r D 8 
r:n 
Smart pro'ess.ional.ppearance Brown 
I . PlASTIC LAMINATE _ _ Shm. broad, 
t Ilght- DWhlte 
. 
f:s


='c

':

 
 

. 
r:" 
match6 lettenng. Excellent Vi11lue 0 Cocoa 
D MOLDED PLASTIC. .. Somo" ISsmor\. SmooIh o Whi.e 0 Black 
. clean p
stlC deeply enara't'ed. lacquer-filled . Ok Blue 3llnes 
Edges and comers gently rounded. The o Dk. Blue o White Lettennl.. 03.1' 05.29 
OI'lllnal nurse sty".. ..lways correct. 0 Ok.. Green (....I1eb'1 559an1rJ 
- ------------------------------ 


169 


o Ouotone 0 Black 1 LU1e 
o Gold 0 Pohshed 0 Dk Blue Le"e"l1fI.. 0 2 69 D4A9 
o Silver 0 Sabn 0 Whote 2 LInes 
Lell."ns .. 0 1A9 05.79 


SCISSORS and FORCEPS 

:
tn
:
: :::
: 

 LISTER BANDAGE SCISSORS 
... 31'1" lIJI.sciss.. Tiny, handy, slip Into 
uniform pocket or purse Choose Jewelers 
.L aold 0' sl...mi.. chrome pille finlS"- 
:
: 
 No. 3500 3V," Mini".",.. 2.75 
No. 4500 4""" size, Chrome enl, . . , 2.95 
No. 5500 5W size, Chrome onl, . , . 3.25 
No. 702 7V." size. Chrome onl, . . , 3.75 
For enaraved initials add 60'11 per instrument 


51'1- 
JV.." 


KEllY FORCEPS 

 So handy lor .wry ....... Ide.11or .lampi.. 

 . olltubln elt. Shinl... sl..I, 51'1" 
No. 25-72 
tni2l1t, Box LøcII , , , . , 4.69 
1M. 725 Curved. Box Lock , . . . . . . . 4.69 
" No. 741 Thumb Ora..ins Foreep. 
Son.led, Stn.pt, 51'1" . .3.75 
For enlraved miti..s add 60'11 per instrument 


MEDI-CARD SET 
I ,,'er. 
ence ever' 6 smooth plastic cards (3
" I' 
5"''') crammed with infonnlbon: EC)Ji'fa. 
....ies 01 Apolhtclry 10 "'.Inc 10 Hous.hold 
Me.... Temp. oc 10 of, P'escnp. Abbr . Un.. 
II}'IS Body OIem., Blood Cham ,ll..r rests. 
Bone Merrow, DIS.... Inc"'. Periods, Adult 
Ws\S, .It. In wtnt.. .inJ1 holde,. 
No. 289 Card Sit. .. 1.75U, 

\
:r
s.131:;:
"mped on blck of 



 
f 



 


. 

 


NURSES BAG Finesl block 

 !hIck I.num. cowhide, beaJlifull, 
cr.lled, xtJlched end ,ivel colISlrue- 
bOIl, Wiler ,opell..l. Room, lI1!.iI,oor, 
with sRlþ-in washable liner INS com- 
portmerrts 10 orpnoze contents. Snaø 

.:'::,tt
ng



':
 
'; 
I 12". You, ;nrti.1ls BOld embossed 
FRfI ... lop. M outstondi"i 
..Iu. 01 superb quolrty. 
He. 1544-1 s., (willi liner), . 42.!1O .., 
Ext.. linlr No. 4415. . . B.50 


, , 


\ I 


14K G.F. PIERCED EARRINGS 
Dam1J, det.lled 1/20 12K Gold Filled CIcIu.eus WI", 141\ 
posts. Io, ... or all dulJo we... Shown lClual .".. Gill 
boxed lor I..ends, 100. ldell sr....p/l'ldu.I"'" RlII I 
No. J3/035... 5.95 per plir 

 - ,""""'-;jt
- T 
CRDSS PEN 
 ,,_ 
World.famous ballpo/ßt, with 
sculplured caduceus embl.m Full n_ 
FREE .."..ed 00 bI".1 !Include ...... wllh co
 
Refills avail. ewerywt1ere. Lifetime guirantJe 
Na. 3502 Chrome 9.95 u. Na. 6602 12kt. Ii.F. 13.95 .1. 
PIN GUARD Sculptu'ed CIcIuceus, cIIoined---.Jí. 
 
10 JIIU' pral...1011I1 I.tt.rs. each wi"' pinblCt</ 
safety arch Or replace either With class pin. Gold 
 I 
finISh, 1111 boled. Choose RN, lPN or LVII. 
No. 3420 Pin GUird. . 2.95 u, 
<@B:> 
 .f;-EXAMINING PENLIGHT 
Whit.. borrel WI", Cllklceus Imprinl .Iv- 
minum bind and clip. 5" Iona. US. made. batteries 
included (replacement 
tte(les "",lab.. In, storel. 
No. NL-I0 Pen!lllll . , . 3.95 u. In;l;a'. en'....d, Idd 60.. 
Bzzz MEMO-TIMER TIme 1001 picks, !$ 
 !I ' 
hut 11m.... oark met." R.member to c,"",k .,lal <io 
siøns. I'" mediClI""', .It. llghtweighl, COll1plCI Go' . 
ny," di.J, ..ts 10 bun 5 10 60 mlO K.r rq. I .. 
s.... 1Mde. No. 101-22 TImer, . 6.95 '\ 11\ 
-.- 
.Æ 
TIMEX Pulsometer WATCH 
f 
 - ' 
Dependable Tllnex NuBeS,' Pulsometer/Calendar Watclt 
"'l\ ::e::ta



:fs.
:ee
= 
.D
:ecad: 
lumu'ICIUs. white strap. Stainless bact, ""ter INS duxt. 
reSistant. Girt-boxed. 1 rear warrantee Initials 111:1'1"11 
la Uci fret. 
No. 237761 Hum.' W.tch . . . . . 19.95 u. 


. Black 
o Dk Blue 3 Lones 
o Who.. Le..."nl__ 0 4.29 0 6.99 


. Black 1 Line 
· Ok Blue lettennl.. 0 lA' 0 2A' 
DWhlte 
2L.,
s 
Lelle"nl 0 2.29 0 3.69 


') 
'h 
/ 


Q 


.......... 
\ 


Free Initials and 
Free Scope Sack with vour own 
LittmatlRAH
 Nursescope! 
Famous Littmann nurses' 
diaphragm stethoscope . . . 
a fine precision instrument 
with high sensitivity fo' 
blood pressures, apical pulse 
rate. Only 2 Ols,. fits in 
pocket, with g'ay vinyl anti- 
collapse tubing, non-chilling 
eJlllxy diaphragm. 28" o.er. 
all. Non-rotaling angled ear 
tubes and chest piece beau- No: 2160. Nursescope 
tifully styled in choice of 5 1n
I.udlng Free 
jewel-like colors: GDldtDne, Imtlals and Sack 
SilnrtJlle. Bile, Green. Pin\.' DutY Free.., 16.95Ia. 
'1III'OITAlfT, N.w ..M...."..... slyllng .nc'udes tubIng In colo.. 10 m.lch 
met.ol carts If des,red, .,.. $1. .... 10 price _:.,.. 'II" 10 Drder 
1Io.21
..._ 


FREE INITIALS AND SACK! 
Your intiafs engraved FREE on 
chest piece; lend indi.idual 
distinction and help prevent 
loss. FREE SCOPE SACK neatly 
carries and protects Nurse- 
scope. Heavy f,osted .inyl, with 
dust-proof press.type closure. 


LITTMANN COMBINATION STETHDSCOPE 
Maximum sensitivity from thIS fine professlOflal instrument eon.. 
......nt 22" owe,." length, weiglls ooly 31'1 Ol. Chrome bil1lur.ls 
filed .1 co,rect lII111e. Inhmal spnng, slllnl... chesl piece, I
" 
di-'!>hr.gm, H'." bell R.movable non-chlll sl.... Groy .inyl tub,ng. 
Two inllllis .ngr. 00 cllesl plec. FRfI SCOPE SACK INCLUOfD 
No. 2100 Combo SI .th .,. 29.9S u. DutY Free 
CLAYTON DUAL STETHDSCDPE 
lightweoghl 
.I scope Imported f'om Jaoon, highesl 
sensitivity for IpICIl pulse flte Chromed blMUrlls 
chast piece with ] 
'" bell INS ]
... diaphragm, 
sr., ..II-COI'oose rub,",. 4 Ol., 29" 1m, Ell" 
:


=d}r?
D
I
 






s QD 
No. 413 Dual Steth . . . 17.95 ea, 
LOW-COST STETtioséõPE 
Ou' Iowesl cosl precIS"'" sl.thoscope' S nste dlaDh..... ()
" d,.J. 
Choose Blue. Green, Red Silwer or Gold tubing and cheslp,ece. 51he, 
billlUrals 001, 3 Ol Th,ee ..illib engnwed Ir... FREE SCOPE SACK 
No. 4140 C,.,. Stoth " , 11.95 u. Out;' Free 


LUGGAGE TAGS 
DR PLAQUES 
Bnghl, colorful 11'1" I 2
" plaslic 
chios wi"' JOUI' .....'odd'... deeply 
engraved (3 lines, up to 25 letters! 
spaces per lineJ. TII .ittI bead chiin 
led ",ru 2 hol.. so .1wo1'S loces oul . . . 
or plaque wers,on With self-.dheslve 
beck 10 mounl on l1li surt.... Choose 
Red, Dring., Y.IIow. CocoI. Blu., G,een 
or Black Attach wordi"i dsSl'ed 
T-300 (be.d ch.in) or 
T-400 (..If-.dhe.i..)... 1.9804. 
Each Iddltiona. item with same 
wðrd no TlU'laa 



 cø-'" 
..." 
-- 


-- 
.. .. "-' 
, ---.- 


....-- a 


l 


MRS, R. F. JOHNSON 
SUPERVISOR 


AI-IIIIII 
Ie. 1. 


J 


N 


.=-- 


CHARLENE HAYNES 


- 


L .... 
tARS. \10 · 
OHN. L.PN. 


,.... 
1. 


WtI 
.511 
AI ...... with oaIetI c8IcII 


NURSES PERSONALIZED SPHYG 
Now in Fashion Colors! 
A suo.rb ...roid sphyg. especi.llr designed 
for nurses by Reister. precIsIOn craftsmen 
in W. Ge""""J. Emy-lHtI.och V.lcro" cutI, 
lightwelghl compact, fils ..10 sot! sun 
Itither zipper CISe 2"''' I' 4" I 7". Dul- 
c>bbr.led 10 32Omm., IO-rear ICtUrocy 
,""""Ieed 10 :t:3mm ServIced by 
Rer'le! if ever required. Your initllb 
..,,_ 00 manom.I., lIId BOld 
slnped ... case FREE. Choose BlACK 
With chrome metal manometar, or 
BLUE. GRffIj or BEIGE WI", plastic 
mano. housing tubing, cuff .nd case 
.11 colo,-coordin.1ed !specify 00 coupon!. 
No. 1011 Sphn. . . . 39.95 u, 
Out;' Free 


............. 


i 


I 


I 


:
 
.. 


BLOOD PRESSURE SET 
An ....tst..chnS .n....d sphy& IIIIde 
on IlPIn especllll, lor R..... ....ts 
,a. :::

=''Ir';.;':-=
 
chrome manomete-r, Cli. to 300mm 
Vele'" ''"Y curr, bIaå tubing, soli 
leatherette zipper case measunfIJ 
2"'- I 4" I 7". Serviced In USA If 
..., needed. Clayton No. 4140 
SI.1hescope (s"..,1 Ind Scoøe Sack 

 - Included !see pholo lelt) FRlE BOld 

 initilis on CISe. Here is I sensible, 
. t,oc= =
Ie kit JUSt riatrt 
No. 41-100 B,P. Sot. . . 
Duty Fr.. 33.95 sit complete 
Sphn. on', No. lOB. 27.95 WIth c... 


, 


CAP ACCESSORIES 
 
CAP TOT E keeps JIIU' caps crISP end cl..... 
Flellble cl.... pllst1c, while Inm. opper, Cloryin, 
slrap, hlnl 1_ Stor.s IIsL Also fo, wiSI.ts, 
curlers. etc 81'1" die. 6" high. 
No. 333 Tobo . . . 2.95 ... 
Gold inlt. Idd 60,. 



 ...., 
 WHITE CAP CLIPS Holds ClpS 
-- firm" '" place! Hanl-Io-find whit. bobbie pi1s, 
_ - eunel on fine sørirW steel SIX 2" INS four 
'./ 3" cloos onc:luded in plastIC...... boL 
Na, 529 Clips 85, per bex (m... 3 box..) 


w 
......
 
(1!W) 

 
----------- 
TO: REEVES CO., Box 719- C, Attleboro, Mass. 02703 


. 


METAL CAP TACS P.i, of dolnl, 
)Owel'J-'IUlirty TICS wi"' grippe", holds c>p 
binds securely. Sculplured mel.I, roId finish, 
_... "" WId.. Choose RN, lPÑ, lVII, RN 
Caduceus or PI...n CadUCIUS. GIft boxed 
No. CT.l (Specil)' 'nil.). . . . . No. CT-3 (RN 
Cld.). . No. CT-2 (Pllln Cla.l. . . 2.95 pro 
I 

 I OROER NO. 
I 
I 


\ 


ITEM 


COLOR QUANT. 


PRICE 


Use eKtra sheet for additional items or orders. 


INITIALS es desird: _ _ _ 
TO ORDER NAME PINS. fill out III informalion in box, lop 
lell, clip out InO attach to thl' coupoo. 


I 


! Pie... Idd 50( hlndlonl/postoþ 
I enclose $ I on orders latollinl under $5 00 
No COD's or billing to indi.iduals. Mass. resulenls add 3% S. T.. 
Mastor Chorge and BankAme,icard chorses are wel"",""" on 
orders totalinl $5. or more. Please submit complete Card 
Number (IncludIng M C. Interbank #), Expiralion Dale, Ind 
your Signature with order. 


I 
I 


Send to .. 


Street 


--. 


('tv 


Stale 


. ..lID 



8 


The Canadian Nurse June 1976 


I II I) lit 


More tips for nursing mothers 
As a nurse and La Leche League 
Leader, I was very pleased with the 
articles on Breast-feeding and Mastitis 
(March, 1976). The education of case 
room and postpartum nurses is 
essential since their attitude can 
"make or break" a nursing 
relationship. I feel it would be a great 
service to nursing mothers if 
information about the local La Leche 
League was routinely handed out at all 
hospitals. Most problems in the 
management of lactation are not 
medical in nature and could be 
handled by an experienced. nursing 
mother rather than bothering the 
hospital nurses after discharge. 
I would like to make a few specific 
comments. 
Preparatory Exercises: We find it 
helpful to have the mother actually 
express a few drops of colostrum daily 
from each breast in the last trimester. 
There is some feeling that this helps to 
open the milk ducts as well as giving 
the mother practice in hand 
expression. 
Hygiene: I feel "meticulous washing" 
is really unnecessary. Simple rinsing 
with plain water should be enough. 
Drainage: If a mother can nurse her 
baby every two hours or oftener, her 
problems are greatly reduced. I 
question the need for emptying the 
breast after each feeding if the baby 
has not nursed for half an hour. Not 
many newborns have the physical 
stamina to nurse effectively for that 
length of time. We advise that if baby 
tends to fall asleep after ten minutes 
on one side, he be allowed five to 
seven minutes on the first side and as 
long as he likes on the second. 
Alternate breasts are offered to begin 
each feeding. Studies show that an 
infant can remove 90 percent of the 
milk in a breast in five to seven 
minutes. 
At-Home Instructions: should include 
advice about handling a "growth 
spurt." This often occurs at about six 
weeks of age. Baby suddenly wants to 
nurse every hour to one and a half 
hours . This is simply his method of 
increasing the milk supply to meet the 
new growth demand. This frequent 
nursing will last at the most 72 hours 
and maybe only 24-48 hours. If 
allowed to nurse as often as he wants, 
he will resume a more reasonable 
schedule as soon as the milk supply 


Increases sufficiently. This is the time 
when Mother panics, thinking she is 
losing her milk and reaches for the 
bottle which defeats the whole 
process. 
We have found that always 
offering both breasts at each feeding 
is best. Starting on the side she 
finished on last time ensures 
adequate emptying of each breast 
every other feeding. 
Lastly, though a "healthy child 
with a good sucking reflex" is a great 
help to successful nursing, it is not 
essential. Many premature, cleft lip 
and palate. and otherwise 
compromised infants have been 
successfully nursed - much to the 
delight and pride of the anxious and 
deeply concerned mothers. 
Once again, thank you for 
opening R.N. 's eyes to a much 
needed area of information. 
- Cheri Purpur, Red Deer, Alla. 


Non-support 
Thank you for the article 
"Matthew My Son" and the articles on 
breast-feeding. When I trained in the 
forties great efforts were made to 
teach us to help mothers breast-feed. 
However, in 1947, when I successfully 
was breast-feeding, on departure from 
the hospital where I trained, my 
obstetrician handed me a formula to 
take home. When I told him I was 
breast-feeding, he remarked: "Oh 
you'll get tired of that soon," Ever 
since then I have been appalled at the 
attitude of many doctors regarding 
breast-feeding. Nurses have always 
been taught to work under the 
direction of doctors. Is it any wonder 
that the emphasis on teaching nurses 
to help mothers breast-feed has 
decreased! 
I hope there are enough doctors 
in Canada who are really anxious to 
have their patients breast-feed their 
babies that Canadian nurses can put 
into practice the fine lessons provided 
by Taggart. 
- Lois B. Hord, B.A, R.N., Québec, 
Qué. . 


Help for abortion patients 
As a nurse and as
 woman I take 
exception to "What are the bonds 
between the fetus and the uterus?" 
written by a male. (Adamkiewicz, 
February. 1976). This sort of article 
reflects a very narrow and provincial 
view that helps neither the patient nor 
the nurse. The idea of a womb being 
somehow outside the body and 
separate from the person who carries 
it, is extremely repugnant and 
anti-feminine. Surely in an age when 
women are struggling for their rights in 
all areas, the only national nursing 
publication in Canada can do better 
than to advocate such a position. 
Our patients are having 
abortions, we must face this and deal 
with it as best we can. Do we want 
them to go back to dYing or sufferinq 
(as I once witnessed) an abortion 
well-done, but without anesthetic? 
Legislation repressing the ability to get 
abortions will lead to this and will not 
help our patients. 
Too often I have seen nurses 
display an absolute disregard for the 
feelings of their abortion patients 
because they (the nurses) felt It was 
wrong. How cold they were and how 
they left the patient even more empty 
and frightened than before. Surely if 
we are nurses we must be prepared to 
nurture and teach these women just 
as we nurture and teach our other 
patients. It is our professional 
responsibility to recognize our 
patients' needs and to put aside some 
of our feelings. 
I am not saying that we should not 
deal with our feelings nor that we 
should work in areas which are 
distasteful and frightening to us. But 
we do not have to treat the abortion 
patient cruelly, nor do we have to 
advocate the legislation implied in 
your article. It seems to me that the 
patient should come before 
everything, and her reality is that she 
will seek abortion no matter what we 
feel. 
- Georgiana Kish, B.N, Montreal, 
Que. 


A woman's right 
I thought I had encountered all the 
arguments of the anti-abortionists but 
Dr. Adamkiewicz's suggestion that the 
uterus be accorded extraterritorial 
status amazed me. 


I certainly would nOI argue that 
the fetus has a different biological 
identity from that of its mother. When 
women refer to having rights over their 
own bodies they talk of the uterus, not 
the fetus, as being part of the female 
body. When society denies women 
access to abortion the fetus is given 
the right to occupy and use the body of 
another person - a right accorded to 
no other individual in our society. 
Dr. Adamkiewicz states that the 
uterus protects the fetus from rejection 
by the mother's body. It is my 
understanding that the placenta is the 
organ which performs this function. 
The uterus is a female organ and as 
long as the fetus can only develop to 
maturity within the uterus, I believe 
that only the individual woman 
concerned should decide whether or 
not to continue her pregnancy. I 
- Audrey C. Hall, Prince Albert, Sask. 


A question of drugs 
I am Inservice Coordinator in a 
small 57-bed general hospital. 
Recently we have been made aware 
of the fact that most of the training 
schools and hospitals in our province 
do not train or allow RN'sto administer 
certain parenteral medications such 
as iron preparations, magnesium 
sulfate and medications in oil 
suspension form. Many of our new 
R N's are refusing to administer these 
medications 1M. Naturally we have 
become wary of these drugs. The 
problem is that we cannot find out from 
any source why hospitals and schools 
of nursing are not allowing these drugs 
to be given by supervised students or 
RN's. What, besides special methods 
of administration, is the danger? Are 
RN s now not capable of learning 
special techniques for the 
administration of certain 1M 
medications? I consider an RN always 
responsible to be aware of and watch 
for reactions but this does not seem to 
be the problem. 
- Nan Holden, Shelburne County, 
NS. 


P.S. - Congratulations on a much 
improved Canadian Nurse. 



E 


I FE 


\.... l- (:. r' 

J' 

 


- 


1"1\ 


'? 


, 
, 



 I Burroughs Wellcome Ltd. 
:.r.ll laSalle, Que. 


, 


, 


NE. 


Only ACT I FED combines pseudoephedrine HCI 
with triprolidine HC!. the potent ontihistomine 
discovered in The Wellcome Research loborotories 
Drolly effective, ACTIFED reoches areas nose 
drops con't-for long-term symptomatic relief of 
ollergic ond vasomotor rhinitis, the common cold. 
hay fever ond ollergic osthmo. 
ACTIFED. The different one for initio! treat- 
ment; the different one for patients who've grown 
toleront to other antihistomine combinotions. 


the year-round way to stop 
sneezes and sniffles 


ACTIFED 
Tablets/Syrup 
Triprolidine HCI/Pseudoephedrine HCI 


.TradeMark 



10 


The Canadian Nurse June 1976 


1111)111 


Nurses' dilemma 
Nurses in Ontario are worried 
about the government's decision to 
close hospitals in order to reduce health 
care costs. This decision is having a 
major impact on everyone involved in 
health care services, especially 
nurses. Thirty-six hundred nurses will 
graduate from community colleges 
and universities this year, but fewer 
than two hundred positions are open; 
for those, the new graduates will have 
to compete with unemployed nurses, 
many of whom have experience. 
What will all these unemployed 
nurses and new graduates do? Does 
the government really believe that a 
well-trained nurse will be happy in an 
unskilled or semi-skilled job earning 
half or even less of her salary? 


The Minister of Health states he 
understands the situation but these 
are the times we live in. Isn't it the 
government's responsibility to guide 
and direct? Ten years ago everyone 
wanted to increase the supply of 
nurses. At that time the Health Ministry 
should have worked out a long-range 
plan and tried to establish a balance 
between supply and demand. In 1971, 
or earlier, the government should 
have limited enrolment in nursing 
education. With the current 
unemployment situation, obviously 
the government did not look ahead in 
time. 
Since the Ministry of Health has 
created the problem, they are 
responsible to assist nurses in finding 
new jobs within the health care system 


Moving, being married? 
Be sure to notify US in advance. 


. 


Attach label from 
your last Issue or 
copy address and 
code number from it here 


New (Name)/Address 


Street 


City 


Prov JState 


Please complete appropriate category 


Postal Code/Zip 


.J I hold actIve membership in provincial nurses assoc. 


reg. noJperm. certJlic. no. 


o I am a personal subscriber 


Mail to: The Canadian Nurse, 50 The Drivewav, Ottawa K2P 1 E2 


or in starting a new profession. The 
governrnent should set up a task force 
to help nurses reestablish 
themselves. 
It will be a dillicult time; a lot of 
reexamining and setting of new 
priorities must be done. Our lifestyles 
will change, but it is up to us to make 
the best of it. Don't sit back and give 
up, or hope things will change by 
themselves. The problem has been 
created... let's solve it. 
- Konrad and Nila Sadek, 
Cambridge, Ontario. 


Nursing ed philosophy 
In response to Stinson's "Frankly 
Speaking About Nursing Education," 
(The Canadian Nurse, January 1976) 
and the concept of national or regional 
centers: Anyone wishing training, 
education, or information, ought to go 
directly to the source. Teacher 
preparation should be in a school of 
education. Administrators should be 
prepared in a school of administration. 
Nurses should be prepared in a school 
of nursing Teaching is a profession. 
Nursing is a profession. 
Nurse-teachers must have knowledge 
and skills from both professions. 
In Canada we do not have health 
care. We only have disease care. 
Government "health care" schemes 
only pay for care of people who have 
demonstrated disease. II seems that 
no money is available for preventive 
mediane. 
Up to a point, centralization has 
value. Probably there is need for both 
regional health science centers and 
smaller centers for the preparation of 
nurses. As long as patients are treated 
in various types of facilities, nurses 
should be prepared to work in these 
situations. 
We need to take a hard look 
at "preparing," to the point of doing a 
needs assessment analysis. I believe 
that there are alternative solutions to 
the problems of inadequate 
preparation of nurse teachers. If part 
of the problem is lack of teaching skills, 
one alternative could be for nurSing 
schools to employ a master teacher to 
work with the nurse-teachers, 
In fact, the problem may be in the 
learning environment, or indeed the 
basic ph ilosophy of nursing education. 
When one considers the continuing 
rapid development in all fields, and 
realizes that an individual has to work 


very hard to keep pace with advancing 
knowledge, techniques and 
procedures in specific areas of a 
profession (teaching and/or nursing), 
the job of a nurse-teacher seems 
almost impossible in the present 
structure. 
- Jane C. Haliburton, Director of 
Education, Yarmouth Regional 
Hospital, Yarmouth, N.S. 


CNJ by pony express 
The date is April 7, 1976, and I've 
only just received the March issue of 
The Canadian Nurse in this morning's 
mail. I'm wondering why the delay? 
Most journals are out before time. Had 
I wanted to apply for a post, or attend 
any of the meetings mentioned in 
the "News," I would probably have 
been too late. I know we live to the 
West of the Rockies. but nowadays we I 
don't have to rely on the pony express 
or the mule train. Pierre Trudeau must 
have thought B.C. important enough 
to be on the map, for didn't he come 
West to marry Margaret? My plea is, 
please let us have our professional 
magazine here before it is five weeks 
late! 
- Grace Burrows, R. N., Brentwood 
Bay, B C. 


Editor's Note: I hear you. If there is 
anything more irritating than receiving 
a magazine late, it's producing one on 
time and finding that readers aren't 
getting it till much later. Have you 
taken a good look. at your local post 
office lately? Does it by any chance 
have a hitching post near the door? 
People power 
We wish to commend you on the 
excellent issue of The Canadian 
Nurse (March, 1976). It was most 
refreshing to receive a journal oriented 
to infant care which is so vital to those 
of us in Public Health Nursing Many 
thanks. 
- Kathie Wdowiak, R.N, P.H.N, Ann 
MacDonald, R.N., P.H.N., Gwenda 
Hartlen, R.N., P.H.N.. Mary Mercer, 
R. N., PH N., Elizabeth Watts, R. N., 
P.H.N., Eva Parsons, R.N., P.H.N., 
Heather McCleave, R.N., P.H.N., 
Patricia McManus, R.N., P.H.N., 
GeneVieve Nason, R.N., P.H.N., 
M. Patricia MacLeod, R.N., PHN., 
Margaret Martin, R.N., P.H.N., 
AtlantIc Health Umt, Department of 
Public Health, Nova Scotia. 



POSITIVELY.. 


.. 


..... 
- .... 


" 


, 


',-' 

' 
- ..:(i' . 
'. . 
 . .
. i 
'
""r' ......'
 
'-.. 
 '\ 

 ....
 't 

 .".:' ': .f " 
tI:\
.. . . ... 
. r ,IA ...'(" . 
.' 


! 


f' 


.... 


. 
. 
III 
,n 


.' 


'.. 
>/'.f\ 1- 
'>. \è It 
,'I.. 



. 


. . 
'..I f 
 
,. ' 
, 
 tri l . 
'1. 1 ... .', ' J!tJ.... . 
1,.:' ,
 
 
.()'\ 
.( J ) .. i 
,. .. · \ t" : .' 
,'" 
 '. . 
.;. . 


I.-' ,
:y. '1 
p
' 
 . .f 
,. ..t...., ,', 
.., ': 
yo I . 


r 



 


, 
J 


THE INFUSION PUMP 
YOU CAN COUNT ON 


The IVAC 530, now with battery power, offers you exact I.V. fluid 
administration-accuracy to within ::t: 2% of the drop rate selected. 
With the IVAC 530 Infusion Pump you can be positive patients in the 
ICU, CCU. nursery, or 08 ward receive the precise dose of medication 
prescribed. In the ER, the stabilized coronary patient can be infused 
at a constant rate before beginning the trip to the CCU. With battery 
power, even in an ambulance, fluids can be started and continued at 
the drop rate you select. 
When your patients' lives may depend on reliable I. V. infusions 
administered under pressure, doesn't it make good sense to evaluate 
the IVAC 530 Pump? Positively! 


IVAC. 


. CORPORATION 
DJ;;;;
;
STEMSLTD. 
47 Bavwood Road, Rexdale (To onto) Ontario M9V 3Y9 


-- 


........ 


, 


DROPS PI[ll MtN 


3 0 


ON OF F 


BT.IIT 


[Iii 


. 



12 


The Canadian Nurse June 1976 


Ne\\"s 


RNAO delegates examine 
nursing power and process 


One of Ontario s best known and 
loved nursing educators believes that 
the profession has lost its sense ofthe 
whole of nursing. "We have created a 
community of boxes related to our 
specialities, our places of work, our 
education and our roles in practice," 
Jessie H. Mantle, told delegates tothe 
51 st annual meeting ofthe Registered 
Nurses' Association of Ontario in 
Toronto recently. "There is some 
caring within these boxes but very little 
across their walls because we defend 
our territories so ferociously," she said 
in her keynote address on the 
convention theme - "The Quality of 
Our Caring." Mantle, who is a member 
of the faculty of the school of nursing at 
the University of Western Ontario in 
London, is now on sabbatical at the 
University of Washington, Seattle, 
where she is enrolled in predoctoral 
studies in the area of gerontology. 
She challenged the nurses in her 
audience to accept change and to 
develop a peer support system within 
the nursing community. "Because we 
are women and nurses," she said, "we 
still cannot guarantee that the patient 
will have access to the caring process 
but nurses who are willing to act as 
bridging agents can help to reduce 
fragmentation of the health care 
system if they learn to practice as a 
community." 


-- 


"- .. )- 
r- "," 


.,. 
\. 


, 


, 
)- 


v _. 
Keynote speaker, Jessie H. Mantle 
(right) with RNAO assistant executive 
director, Doris E. Gibney. 


Photos Dy Suzanne E Emond 


She also urged nurses to develop 
a positive self-concept about the 
profession and to work to increase 
nursing input into decision-making in 
health care. "We are grossly ignorant 
of what other health professions are 
doing and thinking," she 
charged. "Talk to your colleagues and 
learn to consult one another. Nurses 
must speak out but learn to do it 
effectively and appropnately," 


- 


""L 
Chairman of the Resolutions 
Committee, Margaret Kuchmak. 


More than 1200 RNAO members 
and nursing students registered for 
the three-day meeting. Much of the 
discussion and action on resolutions 
was colored by recent health care 
cutbacks and curtailments in the 
province. Among the resolutions 
passed during the meeting was one 
directing the RNAO to "investigate 
ways to assist new graduates without 
opportunity for employment in nursing 
to maintain knowledge and skill 
relevant to current practice in 
nursing." Close to 3600 nursing 
students are competing this year in 
Ontano for an extremely limited 
number of openings. 
Other resolutions were directed 
towards "identifying and 
demonstrating the effectiveness of a 
health maintenance system (a system 
directed towards improving health 
levels - i.e. keeping people well) and 
the creation of a citizens' advisory 
council "which would provide input for 
RNAO's response to health care 
needs and trends affected by social 
change:' 


.. 


RNAO president Norma Marossi. 


President Norma Marossi 
described these as turbulent times for 
young graduates beginning careers 
and also for experienced nurses 
seeking employment. She reminded 
delegates of RNAO's historical 
interest In and contribution to the field 
of employment relations. She said that 
an employment referral service had 
become an essential service for 
nurses and one probably best met by 
the professional association. 


lor 
"'\. 

 

 JI' 
Irmajean Bajnok, president-elect of 
the RNAO. 


Executive director Laura Barr, in 
her report to the membership, 
described the essence of nursing as 
"presence - presence for three tours 
of duty, seven days a week. 52 weeks 
of each year. This presence is so 
essential that it is often required on a 
one-to-one basis. Is it any wonder that 
the bulk of hospital budget applies to 
nursing?" she asked. "We are a 
cluster of skills required to render the 
service needed. We do not depend on 
the expensive hardware demanded by 
other services." 


Individual members expressed 
concern over the need to examine the 
nursing process in the light of recent 
cutbacks as well as the need for the 
association to support nurses at tl1e 
bedside who may find that it is not 
possible in the future to provide 
adequate care. They also stressed the 
importance of demonstrating as a 
profession the effectiveness of 
alternatives to aClJte care, 


Ontario to study 
two-year programs 


A study to determine the effectiveness 
of the two-year community college 
training program of nurses in Ontario 
will be tendered shortly by the Ontario 
Ministry of Colleges and Universities. 
Gerry Wright, the Ministry's 
Administrator of Health and Scienæs 
Programs, says that the study will be 
an objective analysis of how well I 
two-year nursing graduates perform 
on the job, with an aim to implement 
any changes indicated as soon as I 
possible after the study's completion. 
Wright says that the steering 
committee for the project includes 
representatives from various interest 
groups, including the College of 
Nurses of Ontario, the Ontario 
Hospital Association, the Registered 
Nurses' Association of Ontario, and 
the Ministry of Health. This committee 
will formulate objective questions and 
research specifications for the study. 
The study will attempt to evaluate 
the effectiveness of the community 
college program, a program that has 
been the source of much opinion and 
controversy. 
Before 1973, most nurses were 
trained in three-year courses given by 
Individual hospitals under the College 
of Nurses of Ontario. The course was 
shortened to two years before the 
community colleges took over nursing 
schools in 1973. 
The study will be contracted 
outside the Ministry, with its first phase 
expected to begin in June. The second! 
phase, Wright says, will probably 
begin in September, to be completed 
hopefully, by spring of 1977. 



The Can.dian Nurse Jun. 1976 


13 


Canadian Task Force Concludes Annual Pap Smears 
Not Necessary for Most Women 


uch of the repetitive annual screening of women whose previous 
'apanicolaou) smears have been normal is unnecessary. By reducing the 

quency of examination in such women and deploying the resources to 
)ncentrate on women at risk, who presently are not being screened at all, 
anadian cervical cancer screening programs could become much more 
''fective without utilizing more resources than they do at the present time. 
I The views are those of a seven-member Task Force on Cervical Cancer 
creening Programmes, appointed by the Conference of Deputy Ministers of 
ealth following a meeting in December 1973. They are contained in a report 
Jbmitted by the chairman of the Task Force to the Deputy Ministerof Health 
nd Welfare Canada, the Hon. Jean Lupien. This report was published in the 
une 5,1976 issue of the Canadian Medical Association Journal (vol. 114, 
o. 11). It deals primarily with frequency of screening, quality control and 
)lIow-up mechanisms. Members of the Task Force reached a number of 
igniflcant conclusions on the basis of their findings. Among them: 
Squamous carcinoma of the cervix does lend itself to control by means 
f a cytological screening program, 
, There is evidence in Canada that: 
- cytological screening programs are becoming effective in reducing 
norta
ity from carcinoma of the cervix; 
- the extent of this reduction is directly related to the proportion of the 
IOpulation screened; 
- the prevalence of abnormalities in an unscreened population is of the 
Irder of 5.5 per 1000. If this population is reexamined the incidence of 
Ibnormalities is of the order of 0.5 to 0.7 per 1000. 


A screening program will use resources most efficiently when it 
oncentrates on bringing women into the program and when the frequency of 
'xamination is tailored to the degree of risk rather than when examinations 
Ire performed on the "customary" annual basis. 
In considering the category of risk, the report concludes that. 
- a woman is "at risk" as soon as she becomes sexually active; 


- within this group, a "high risk subgroup" exists, consisting of women who 
began sexual activity early, especially with multiple partners; 
- a woman may be assumed to be "no longer at risk" after reaching the age 
of 60, having participated regularly in the program, without having had a 
smear show significant atypia; 
- women who have never been sexually active are in a "low risk" group. 
On the basis of the conclusions contained in the report, the members of 
the Task Force presented a series of eight recommendations, including: 
. Health authorities should encourage and support the development of 
cytological screening programs designed to detect the precursors of clinically 
invasive carcinoma of the cervix. 
. Appropriate means should be employed: 
a) to inform women of their degree of risk of developing carcinoma of the 
cervix; 
b) to persuade women at risk to participate in the screening program. 
. Frequency of examination should be as follows: 
a) initial smears should be obtained from all women over the age of 18 who 
have had sexual intercourse; 
b) if the initial smear IS satisfactory, a second smear should be taken within 
one year; 
c) provided the initial 2 smears and all subsequent smears are satisfactory, 
further smears should be taken at approximately three-year intervals until the 
age of 35 and thereafter at five-year intervals until the age of 60: 
d) women over the age of 60 who have had repeated satisfactory smears 
may be dropped from a screening program. 
e) women who are not high risk should be discouraged from having smears 
more frequently than is recommended above; 
f) women at continuing high-risk should be screened annually. 
. All mass screening programs should have follow-up systems to ensure 
that normal patients are recalled at regular intervals for repeat smears; that 
action is taken following the discovery of an abnormality; and that long-term 
follow-up be provided for patients who have received treatment following the 
diagnosis of an abnormality. 


)id you know? 


increased by approximately 28,000 
readers. The Canadian Nurse now 
reaches a total of 87,786 persons in 
this country; of these, 82,698 are 
Registered Nurses. Almost 
one-quarter of CanadIan readers 
(21,408) live in the province of 
Ontario. British Columbia (15,304) 
and Alberta (13,140) are next largest 
in size of circulation. The Canadian 
Nurse is received by 1,667 nurses in 
the United States and 983 nurses in 
102 other countries outside of North 
America. L'infirmière is delivered to a 
total of 36,951 persons in Canada and 
to 42 other countnes. 


:irculation figures for The Canadian 
'urse and its French counterpart, 
'infirmière canadienne, are now 
lose to 128,000 each month. The 
:anadian Circulations Audit Board 
'c., which calculates "qualified 
irculation" reports that the number of 
opies of the two official CNA journals 
istributed in March, 1976, was 
27,747. Of these, 90,436 were 
opies of The Canadian Nurse. A year 
IgO, in March 1975, the CCAB 
eported total circulation of the 
)urnals was 113,944 copies. Since 

arch, 1972, when 99,018 persons 
eceived the journals, circulation has 


N.S. hospice unit 


A Hospice Care Unit, the third of its 
kind in Canada, is being planned for 
the Victoria General Hospital in 
Halifax. Project originator, Norma 
Wylie, Associate Professor at the 
Dalhousie University school of 
nursing, proposed the hospice as a 
long-needed unit to care for the 
terminally ill and their families. The 
project has been approved by the 
hospital board, the executive director, 
the director of nursing service, and 
senior medical staff. 
A "Working Party" Committee is 
being formed to plan the uOlt, establish 
criteria for admission, and provide for 


education of personnel. The 
committee is chaired by Wylie, and will 
include physicians, nurses, clergy, 
social workers, consumers, and 
volunteers. 
The project evolved from a 
research project developed by Wylie 
over the past two years - a 
demonstration patient care unit known 
as Project "Back to the Bedside." 
Wylie spent some time at the 
most widely known Hospice, St. 
Christopher's in London, and has 
been in correspondence with its 
founder and medical director, Dr. 
Cicely Saunders, for advice and 
assistance. 



14 


The Canadian Nurse 


June 1976 


L
, 


t 
. 
V 
, 


Ke't'8 


!- -...... 

-,- 
. 


 -. 



, 


r, 

 


1 


\. ,
 


.::. 



 _. 
. - 
, ,'" 

 


c.:. 


- .... 



 
- .'11 

. 


... 


.. 


"\, 


ÍII....
 


...... 


'
 


..
 
,r 


....... 


__ïlllliii. 
-- 
- 
-- 
- 
- 
- 
.. 


- . . 
')- 
... 
 
.., J
... 
.:.. 
:;- 
'"" " 
...... .S _ 
,- -- 
,. 
"'it ' 
. 1 , 
.. tt-
, 
.. .t 
.4- \4 
.. -I 
" f' Ì" 
, ... ..il 


Plumptre visits bargaining officers' conference 


Employment relations officers with 
Beryl Plumptre during spring 
conference at CNA house. 
Representatives are: (left to right, 
back row) Mane Campbell from N.B.. 
Malcolm Smeaton, Ntld.; Nora Paton, 
B.C.; Tom Patterson, N.S.; Gertrude 
Hotte, Que.; Glenna Rowsell, N. B.: 
and Allan Rosky, Man.; (middle row) 


"The government anti-inflation 
program is not designed to attack 
wage earners, nor to roll back the 
gains hard won by organization, 
solidarity and tough collective 
bargaining. On the contrary, it is 
designed to provide a structure for 
protecting those gains, and for 
allowing real wages to keep on 
growing steadily without being eroded 
by increasing prices for goods and 
services." This was the message of 
Beryl Plumptre, vice-chairman of the 
Anti-Inflation Board speaking at the 
spring conference of provincial 
bargaining officers at CNA house in 
Ottawa. 
In order to clarify the 
compensation aspect of the 
anti-inflation program for the 
representatives of provincial nursing 
groups, Plumptre outlined the aims of 
the program and detailed the 
procedure used to rule on 
compensations. She explained the 
three components of the guidelines 
and then discussed the discretionary 


Jan Traynor, Professional Institute of 
the Public ServIce of Canada; Judy 
Morry, Ntld.; Joyce Gleason, Man.; 
Renee Tremblay, Que.; Florence 
Stemper, Sask.; and Yvonne 
Chapman, Alta.; (front row) Christine 
Reynolds, P.E.I.; Anne Gribben, ant.; 
Beryl Plumptre; and Mary 
Parchewsky, Sask. 


powers of the Anti-Inflation Board to 
take into account special 
circumstances. 
The three general provisions to 
limit wage increases to between 8 and 
12 percent are: the "basic protection 
factor" which allows pay to increase at 
the rate of cost-of-living increases as 
forecast by economic experts, Ihat is, 
8 percent in the first year, 6 percent in 
the second year, and 4 percent in the 
third year; the "national productivity 
factor" which gives each working 
person a share in Canada's long-term 
productivity growth; and 
the "experience adjustment factor," 
an equalizer which the AIB can apply 
yearly to restrict those groups who 
leapt ahead before the program was 
instituted and allow those who were 
left behind to catch up. 
She stressed, however, that the 
Board was aware that, in some cases, 
special circumstances must be 
considered. "The program is not 
designed to be a cast-iron 
Procrustean bed that every settlement 
has to lie in, with the bits that do not fit 
lopped off or rolled back." To allow for 
these special cases the Board "has 
been given considerable discretionary 
powers to deal with exceptions to the 
regulations." For example, a group 
may argue for an increase above the 


9 


guidelines on the basIs of an 
"historical relationship" between 
themselves and another group of 
employees in a similarindustry whose 
salaries have borne a demonstrable 
relationship in the last two years, and 
the Board has the power to grant an 
increase well above the 12 percent. 
Thus, Ontario public health nurses 
may supply evidence of an historical 
relationship with hospital nurses to 
support a wage increase above the 
guidelines. 
The AIB only deals with 
settlements, however, it does not 
enter into negotiations. Tough 
bargaining may be' necessary to get 
the employer 10 provide even basic 
economic protection and, as one 
representative of the nursing 
profession pointed out, a clear 
understanding of the provisions of the 
program is necessary to avoid being 
duped by some employers who may 
choose to hide behind the guidelines 
at the bargaining table. 
When asked what protection the 
union has that the employer will 
present a high wage settlement fairly 
to the AIB, Plumptre stressed that both 
the union and the employer have an 
opportunity to make representation to 
the Board in support of a settlement 
that exceeds the guidelines. 
Plumptre also reviewed the 
methods of monitoring and restraining 
prices and emphasized that "the 
Board means business." She 
expressed tentative optimism that the 
rates of price increases are slowing 
down, with recent statistics showing a 
rise of 9.1 percent after 20 months 01 
double-digit inflation. She also 
indicated that, according to price 
reviews, most industries were 
restricting themselves voluntanly 
within the guidelines. 
On the pay side, too, she said the 
vast majority of settiements are within 
the 12 percent limit. Figures up to the 
beginning of April show that of 2300 
settlements 2150 were within the 
guidelines. 
Finally, she called for the 
cooperation of all Canadians, 


regardless of their economic roles, to 
make the program succeed. The 
program "is not a price freeze any 
more than it is a wage or salary 
freeze. It allows prices to fluctuate as 
an expression of supply and demand. 
It allows prices to rise to reflect the real 
costs of doing business, just as it 
allows wages and salaries to rise to 
reflect increases in living costs. What 
the program is designed to do is bring 
these increases more closely into line 
with our rate of growth. Or rather, to 
help us learn that we can only get 
more if more IS being produced.'- 


Inflation hits 
Accreditation Council 


The number of hospitals surveyed by 
the Canadian Council on Hospital 
Accreditation reached a new high in 
1975, according to the recently 
released annual report of the 
17-year-old CCHA. 
A total of 336 hospitals were 
visited last year, compared to 294 in 
197 4. Teams of surveyors reported on 
145 of the institutions visited. The 
report notes that despite the increase 
in the quality of visits, "quality of work 
was maintained by improved surveyor 
education, intensifying team surveys 
and other means." 
The total cost to the CCHA for the 
survey program and other related 
activites amounted to $396,152 In 
1975. In spite of a fee increase during 
the year, this cost resulted in a deficit 
on all operations of $59,738. 
During 1975, the CCHA Board 
determined that the accreditation 
program was of sufficient value to the 
Canadian health field that it should be 
self sustaining and should not be 
dependent upon grants. Directors 
authorized substantial increases in 
fees paid by hospitals per surveyor per 
day to $475.00 per surveyor day; and 
in membership fees from $5,000 per 
seat in 1975 to $6,000 per seat in 
1976. 
The report notes that "a further 
increase will be required in 1977 if 
there is to be reasonable maintenance 
of quality of CCHA programs and if the 
required growth to bring more 
hospitals up to CCHA standards is 
realized. 



I ne ll...ilniiOliln "U'-
 


I 
'eaching the TV generation 
'- "Multi-Media in Focus" 


I 
hat is self-learning? How can 
Ilucators use available tools 
fectively in teaching and in helping 
e student learn for himself? Where 
) we go from here? These questions 
ld others were explored by 64 
ntano nursing educators at a 
ilization seminar sponsored by the 
rsing Education Media Project and 
e Ontario Educational 
ommunications Authority (OECA) 
ld held in Toronto on April 23rd. 
The theme of the seminar was 
fhe Teacher and Tools Together- 
fulti-Media in Focus" and it was 
imed at examining the meaning of 
e term 'self-learning," assisting the 

acher to develop confidence in the 
se of self-learning matenals, and 
nhancing teacher creativity. In 
ddillon to providing teachers with the 
pportunlty to discuss their efforts and 
.ommon problems, the seminar itself 
as an example of creative learning 
nd the use of audiovisual materials. 
Most of the day was spent in small 
roups led by nurse-teachers and 
)ECA utilization staff. Participants 
Iscussed common aims and 
xperiences and attempted to reach a 
on sensus on what constitutes 
elf-learning, what problems eXist in 
sing available resources and 
eveloplng new ones, and how these 
roblems can be overcome. The 
oming was devoted to discussion of 
he learning process and what 
eact.ers have to offer their students. 
In the afternoon excerpts were shown 
rom an OECA film "Don t Cry for 
David - Part 2'. on grieving due to 
loss of body image. As weli as the 
obvIous choice of using this ftlm to 
complement the study of grieving, 
team leaders discussed the feasibility 
of showing excerpts to stimulate 
discussIOn of other subjects, e.g. 
techniques of patient interviewing. 
Some attention was also given to the 
use of low-cost audiovisual aids that 
can be produced easily by the teacher 
Team leaders stressed that teachers 
are teaching the . televIsion 
generation" and that a wealth of aids 
eXist in this environment ranging from 
full-length programs relevant to 


nursing education, to excerpts from 
serials such as Archie Bunker. 
The seminar also provided staff of 
the Nursing Education Media Project 
with a chance to assess what 
nurse-educators need in the way of 
informal ion and instructional 
materials. The Nursing Education 
Media Project was established two 
years ago to develop films and 
audiovisual materials for nursing 
education, to evaluate films and 
projects prepared by nursing 
programs in community colleges and 
universities, and to explore ways of 
using the media in the college system. 
11 is supported by the 23 member 
community colleges, the RNAO and 
the OECA Membership also includes 
eight universities, who have been 
granted observer status, and the 
College of Nurses of Ontano. For 
further information about the prOJect, 
write to Marilynne Seguin, Project 
Officer, Nursing Education Media 
Project, Ontario Educational 
Communications Authority, 4th floor, 
2180 Yonge Street, Toronto, Ontario 
M4S 2C1. 


All packed? 


The Registered Nurses Association 
of Nova Scotia has some last minute 
suggestions for those who will be 
attending tne Canadian Nurses 
Association Convention in Halifax in 
June. With east coast weather by 
nature unpredictable, the Association 
suggests being prepared for rain and 
chilly sea breezes as well as the June 
sunshine. 
If you want to look festive at the 
Opening Ceremonies or at the Ceilidh 
at the Chateau HalIfax, formal dress is 
as acceptable as casual clothes. 
Slacks or jeans are recommended for 
the trip to Peggy s Cove, and casual 
clothes for the water tour and dinner at 
Clipper Cay. 


CTRDA nursing 
fellowship 
available in 1977 


The Canadian Tuberculosis and 
Respiratory Disease Association IS 
again accepting applications for the 
$7,500 fellowship the association 
awards annually for studies in 
pulmonary nursing. The award is for 
study at the Master's or post-Master s 
degree level at a university offering a 
clinical specialty in pulmonary 
nursing. 
The six universities offering 
programs acceptable under the 
conditions of the award are: the 
University of California at San 
FrancIsco, the University of California 
in Los Angeles; The University of 
Cincinnati; the University of Arizona; 
the UniverSity of Rochester and the 
University of Florida. 
The first CTRDA Nursing 
Fellowship was awarded In 1973 to 
Josette Maranda. Notre Dame 
Hospital, Montreal She completed 
her Master s Degree Course in 
Clinical Pulmonary Nursing at the 
University of California In December 
1974 and is now working in the RD 
Home Care Program at the Rosemont 
Pavilion, I'Hôpital Maisonneuve- 
Rosemont, Montreal. 
Winners of the 1974 Nursing 
Fellowship were Joanne Perry of 
Vancouver, B.C. and Pauline Kot of 
Edmonton, Alta. Perry worked as a 
nurse clinician prior to completing her 
course credits at University of B.C. 
She focused on the educational needs 
of the patient, the family and the 
community with emphasis on 
prevention of illness and rehabilitation 
of patients suffering from chronic 
bronchitis and emphysema. She IS 
now a Clinical Specialist at St. Paul s 
Hospital. Vancouver. 
Kot is Associate Professor in 
Medical-Surgical Nursing at the 
University of Alberta. Her Interests lie 
In the area of preventive and 
rehabilitative nursing as well as 
research. The CTRDA Fellowship 
allowed her to complete the Master s 
program at the University of Arizona 
School of Nursing, Tucson. 


Deadline for applications is 
February of the current year. Inquiries 
should be directed to the Chairman, 
Nurses' Advisory Committee, 
Canadian Tuberculosis and 
Respiratory Disease Association, 345 
O'Connor Street, Ot1awa, K2P 1 V9. 


How's your image? 


Health promotion is catching on! 
Following a two-day workshop on 
fitness and lifestyle at CNA house in 
Ot1awa (See The Canadian Nurse, 
April 1976), representatives from 
member associations set to work to 
organize a program with similar 
content in their home territory. Now, 
just three months later, most of the 
workshops have been completed. 
After the February training 
session, each respresentative, with 
the assistance of Jean Everard, 
CNA's research officer in charge of 
fitness. and a grant from Recreatior 
Canada, was given free rein to set up a 
program that best suited the needs of 
their area. The resulting workshops 
were all aimed at spreading the 
message of fitness for better health to 
leaders in the health field, but their 
focus differed from province to 
province. While some included key 
people from many health disciplines 
(such as physiotherapists, 
occupational therapists, social 
workers, dietitians and nurses from 
VON, public health and hospitals), five 
provinces concentrated directly on 
nurses in the public health field, in the 
hope of reaching the maximum 
number of people in the community 
who are In a position to change their 
lifestyle and improve their health. 
The goal of the national fitness 
program for nurses is to encourage 
nurses and members of other health 
disciplines to change their lifestyles to 
improve their own health so that they 
become models of real health to 
patients and members of the 
community. 
The word is spreading. . watch 
your provincial bulletin for news of 
fitness programs. Better still, jog to 
your provincial or chapter 
headquarters and find out what you 
can dOl 



ME? IN SAUDI ARABIA! 


II 
I: 


I . . 
 
. . , , 
. . . 
I . 
. 
\J . I 
J 

 ----- 

 
, 


I 


We're excited! The NEW King Faisal Specialist Hospital-a 250-bed 
referral research center-Riyadh, Saudi Arabia-has a place for you. 
Members of Hospital Corporation of America management group is 
staffing. operating and managing this hospital-described as the 
"World's Most Modern:' 


WHY NOT! 


Unlimited opportunities are now available in every specialty. We're 
looking for the nurse who is really seeking a new. . . different, . . and 
meaningful experience Nursing in a foreign land in an international 
community. We'll provide the very best: an excellent and extremely 
modern hospital with free furnished modern apartments (all new), 
swimming pools, tennis courts, American TV program system. . . all in 
the hospital compound area with a professional staff from the USA, 
Canada, England, Ireland, Scotland, Lebanon, Saudi Arabia, and many 
other countries: sharing ideas, knowledge and skills;using modern, so- 
phisticated equipment; working extremely hard; and being challenged 
as never before, 
Requirements include: Graduation from an accredited school of Pro- 
fessional Nursing, current RN license, 3-years' experience in an acute 
care hospital. . . fluency in English, the official language of the hospital. 
The person we seek will be experienced, flexible, adventuresome, de- 
sirous of a challenge. . . and is truly dedicated! 
We'll give you rewards that are unbelievable-JOB SATISFACTION 
- TRA VEL-Ultra-modern medical facilities-excellent salaries, free 
housing, free medical care, free relocation allowance, free return travel 
from Saudi to Canada annually with 30-day vacation. And. these are 
only a few! 


an equal opportunity employer 


\\ 


If you are interested, we'd love to tell 
you much more. Please forward a cur- 
riculum vitae to: 


RONALD MARSTON 


Director, International Recruitment 
Hospital Corporation of America 
One Park Plaza 
Nashville, Tennessee 37203 
This could be the first day of the rest of 
your life-we truly hope so! 


-.. 
, 
II..r:::J \ 
, " 
0 
 
.. \ 
,. o. 
4 
. 
 
-.- .. 

 - 


u. 


'- 


..... 


. 
- .. . 


" 
<J _
 .,.. 



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. 


, . " 
J 
, 
to t. 
, 4 
.. . 
f f 
'- 

I' I t " .. 
. 
. 
f : .. 
) 't7 

þ y" 

 '1.1 
\ ./ 
\. ,
 , 
j. " \ 
 
, ":. ) 
"C \ '{S: -./ 
 
::; :f 
'" 
.s:: It, 
a. 
'" 
 
c, t
 
0 J. 

J . 
õ 
.s:: .' 
Q. 
- I 
.. ... 
"C 'It 'If 

 
" I , 1 
0 ... .. 
i" 
Ë 
0 
 
a 
>- 
D 
'" ...,) . . .. 
0 
Õ 
.s:: 
n. 


associated with the procedure could be 
avoided or dissipated and the examination 
would become an accepted "fact of life." 


2. Suspicion 
Most breast lumps are found by the woman 
involved, who then asks herself, "What shall I 
do?" Often, there is a period of delay before 
professional help is sought. This stage may be 
short or long. The woman who usually copes 
well with stress will probably seek immediate 
medical attention. Other women say,"1'1i go 
right after my daughter's wedding," or "as 
soon as the kids are back in school." There 
may be magical thinking, "If I don't look, it will 
go away." 
What contributes to delay? Only a small 
percentage of palpable breast lumps prove to 
be malignant. Therefore. most women with 
breast lumps will receive good news after 
checkup. However, many women still regard 
finding a lump as the beginning of the end. 
A significant number of women lack 
knowledge about breast cancer and the 
importance of early diagnosis and treatment 
They do not know that a lump or thickening of 
the breast is a warning signal. Less common 
signals are also unknown to many women. 
These include: 
. puckering or dimpling of the breast skin; 


. scabbing skin around the nipple, changes 
in skin texture, cracked nipples, or secretion 
from the nipple; 
. asymmetry in either appearance or 
movement of the breast: 
. hot, swollen or sore breast. Any unusual 
ache or pain that is persistent and not 
associated with cylical changes. 
The fearful woman may become 
completely disorganized and unable to 
function after finding a breast lump. She may 
detay seeking help. Some women say, '" 
couldn't tell anyone" or "I didn't want my 
husband to know." 
Husbands and families are important. 
One woman recalled, "My husband ignored 
the lump. He put me down, told me to forget It 
and it would go away. I ignored it for two 
years." In contrast, many women are able to 
share fears and concerns with family, friends 
and health professionals. Open and honest 
communication is one of the keys to dealing 
with this kind of streSS and fear of the 
unknown. 


3. Medical evaluation 
The evaluation period invokes stress 
responses that differ according to the 
experiences. beliefs, attitudes and cultural 
values of the individual. The stoical woman 


says,"'t will be O.K." The fatalistic woman 
says,"My life is in the hands of the gods." 
There may be displacement of feelings,'Tm I 
only worrying about my family" Projection c 
feelings is associated with fear and 
despair, "I'm just a guinea pig." All women I 
need help in explaining and examining their 
feelings, adaptive and maladaptive. I 
If the lump is found to be malignant, thll 
woman has a choice; to accept both diagnosi: 
and treatment, or to reject one or both. She I 
may choose. as is her right, to seek additiona I 
professional opinions. Scrupulous honesty, I 
preservation of hope, frank discussion of 
outcomes and involvement of family member
 I 
or friends are essential if she is to pursue I 
treatment and become closely aligned with a 
supportive health care delivery system. She 
needs caring people to share her hurt and 
pain and to endure with her over time. 
Decisions about treatment involve facts 
but are based on much more than just facts 
Under stress, many people do not hear, 
remember or process the information that car 
enable them to make meaningful decisions. 
The woman who has been told she has breas 
cancer needs a caring person to help her 
perceive and deal with the facts. 
More and more women are showing a 
desire to become involved in decision-makin
 
processes regarding medical treatment. In 
some centers, biopsy is done on an outpatien 
basis. A woman can then discuss treatment 
plans with her husband. family and physician 
while remaining in the comforting, familiar 
home atmosphere. The trauma of breast 
surgery is less of a shock for women who 
remain at home for even a few days before 
surgery. This brief time permits anticipatory 
psychological work in terms of the grieving 
process and also allows time for the staging 
and testing procedures which are so important 
at this stage. These procedures determine thE 
extent of the disease and the feasibility of 
surgery. 
In recent years, there has been 
widespread debate and controversy over the 
surgical procedures which offer the best 
chance for long-term survival. Quality of life 
also enters into consideration at this stage. For 
some, radical mastectomy seems "worse than 
death." Most women, however, weigh the 
risk-reward ratio and decide to have surgery. 
This attitude is sometimes expressed in the 
statement that, ''I'd give up my breast in order 
to save my life." 
Seven surgical procedures are available 



The CønlKlløn Nurse June 1976 


19 


and 3. The "Pulley MotIOn" is 
other of the exercises patients can 
irn while still in hospital. Here, 
lunteer Myers improvises by using 


an IV pole instead of a door to 
demonstrate the principle of the 
seesaw motion involved in this 
exercise. 


, f t " , ' 
J ... t 
- 
 
1 
 1 f 

>o I 
j
 i 


. - 
.. 
,., 1 
' 
.. \ " , t! 
 
\ :\

 ,:1 
j l: > 
. \ 

 
(' 
\ " 
J \:. 


w 


.. 
, 
\ ,f 

 f 
, 


.... 


-'" \ 
.... 


,
 
" 


=rom least to most extensive, these are 
I) lumpectomy, tylectomy, and local excision, 

) partial mastectomy, segmental resection, 
:md wedge resection, 3) simple (or total) 
astectomy, 4) modified radical mastectomy 
) halsted radical mastectomy. 6) supraradical 
astectomy or extended radical mastectomy 
and 7) subcutaneous mastectomy. 
Some of these procedures allow for the 
I pOSSlbility of future reconstructive surgery. 
The latter should be discussed with the 
Isurgeon preoperatively. At present. restorative 
I surgery is available to only a few women 
but there is hope for the future, espeaally 
if many women are concerned enough to 
I press for breast reconstruction. 


4. Response to diagnosis 
A. woman's response to the diagnosIs of breast 
cancer follows a clearly identifiable pattern, 
colored by her post-conditioning. The feelings 
of a woman whose mother IS alive and well 17 
years after surgery will be quite different for 
example, from those of one whose older sister 
died after a lingering illness. 
Nevertheless, everyone dies a little on 
diagnosis. Feelings of denial. anger, 
depression and fear are common. The woman 
may also feel abnormal "in an unreal space." 
She needs to be reassured that this is normal 


her diagnosis he left the office profoundly 
upset. This feeling was followed by total loss of 
memory for the events of that particular day. 
Fear. This is the most pronounced 
feeling. The woman not only mourns the loss 
of her breast but also experiences 
anticipatory gnef In relation to loss of her life. 
Both husband and wife have a strong 
realization of death. Often they are not able to 
discuss this with anyone, even each other, 
open communication and acknowledgement 
of feelings helps both partners learn to face 
and cope with fear. A middle-aged man with 
two daughters recalled, "my greatest fear was 
that my wife would die during surgery. I 
prepared for the worst. I needed help but was 
ashamed to ask for it. Everyone seemed so 
busy. On some days this feeling still lives 
within me." The wife of this man had breast 
surgery three years ago. 
A woman with young children thinks, 
"What will happen to my children if I die? . She 
may need help In delegating her life tasks, at 
least temporarily, to a competent person who 
understands and respects her feelings and 
concerns. It is essential that she feel certain 
that her children are safe and well She also 
needs to know that her family love her. need 
her and miss her unique kind of loving care. 
Children fear that their mother will die. 
They cannot help but feel the upheaval in 
family life style, and the anxieties and fears of 
their parents. Information should be given to 
children at their level of ability to comprehend: 
withholding information causes anxiety and 
resentment. Later, the child may be very angry 
that he or she was not allowed to participate in 
the family CriSIS. A ten year old can feel the 
lump in her mother's breast and realize that it 
should not be there. This preparation makes 
the surgical procedure easier for the child to 
understand. 
Teenage daughters can be very helpful 
and supportive If they are allowed to share with 
the mother in her loss. Teenage sons may 
have a difficult time during the crisis. A son 
may refuse to visit his mother or talk about her 
illness. He may refuse to tell anyone outside 
the family. It may be helpful to his mother to 
5. Reactions to breast surgery know that this kind of reaction is not 
Shock and Disbelief After diagnosis uncommon. Sometimes it is useful for a boy in 
there may be a short period of denial, quickly this position to talk to the son of a woman who 
followed by feelings of shock and disbelief. has made a successful adjustment following 
Women say, "I can't believe this is breast surgery just as his mother may find 
happening,' and "I can t think." Husbands, consolation in talking to another mother whose 
children and friends share these feelings. One son, at one time. behaved in a similar way. 
man told his wife's physician that on learning Perceptive health professionals can help 



 ( 


-. / 1 , Ii 
I fI e 
4, ,,

 
 
I u 
, 'I 
1 
t ,,' 
\ I f 


.. 
"'
 I 



 
, 



 ,," " 
,
 I' _,
 I 
, t #! 'iI' 

. :--) '- 
 
I. - 


I 


" 
" 


, 
, 



 


I
-.' 


t 


so she does not think that she IS alone and 
unable to share "unnatural" emotions. These 
feelings are cyclical in nature, recurring from 
time to time over many months. The woman 
must work through her feelings in order to deal 
effectively with her loss. The person who is 
secure in the feeling that she is loved and 
respected for herself is often able to adjust 
more quickly. It is harder for the person who 
feels valued for appearance, physical ability 
and capacity to work. 
A frightened woman was recently 
hospitalized and booked for breast surgery. 
Her husband visited her the evening before 
surgery. They talked, and he said "The advice 
you have given me over the years has meant 
so much to me. You are so important to me." 
The woman told the evening nurse that her 
husband had helped her to view things in a 
different way and she felt much relieved and 
less fearful. 



20 


The Canadian Nurse June 1976 


4. "Rope Turning" is an exercIse that 
can speed the mastectomy patient's 
return to a normal way of life. The 
equipment in this, as In the other 


exercises, is sImple and easy to 
obtain. Patients must obtain the 
approval of their doctor before 
beginning the program. 


, 
I" 

 t · 
 
It 
 


 Ie, 
 

 t 
t 
'I'.' -( 
· t ,!J. 1 !
 f ""t 
 
' \ 
1 <: ,It, . 1 
:1....1 b, i 1 u 'i \ 
. · 'f ,
 M 
-- 
.. 
\
 Q, 
t ,
 
,'t-ij 


. 


t 


\ 
\ v 


..' 


f 

 


J 
... 



 
-- 


facilItate such valuable learning opportunities. 
Anger and Depression. Many women are 
overwhelmed by feelings of hopelessness and 
helplessness after breast surgery, followed by 
feelings of anger which may find one or several 
targets. The woman may be furious at her 
surgeon, at God, at society or at organized 
religion, She many say, "Why me," especially 
if her life style has been exemplary. A well- 
established older couple may say, "Why us? 
We can only just now afford to enjoy and relish 
our lives." It is healthy and cathartic to express 
feelings of anger, even if they come out as 
blind, diffuse fury. Problem-solving is difficult 
when strong feelings of anger are repressed. 
A mastectomy patient recently said: 
I didn't know what was the matter with 
me, I just felt miserable. One morning 
the head nurse came and sat down close 
to me. She said she felt I was very angry, 
I soon realized that she had hit he nail 
right on the head. I spent the next 
half hour telling her how much I hated 
everyone and everything, and how awful 
everyone was to me. That was the 
beginning of my recovery. I never looked 
back. She who was my worst enemy 
became my dear helping friend. 
Venting of anger may avert the severe 
Jepression which sometimes follows breast 


, 


z. \. 
...._ C. I 

:-- --
 

 


. I 


f 


l 


J 



 
"I. 


I 

 
. 
j. . 
. 
,
--- 


.. 
u. ___ 


t 
I 


.f 


" 


>urgery. Some degree of depression is normal 
and occurs on an intermittent basis for a long 
time. Many husbands share this feeling which 
is associated with gnef and mourning. 
Guilt. Feelings of shame or guilt are 
sometimes present. The woman relates her 
loss to a personal flaw or wrongdoing and 
reviews the "precipitating event" again and 
again. She may say, '" was careless and hurt 
myself or, "If only I had not ...." It is as though 
the disease appears so irrational that the self 
must be blamed. 
It is important for the helping person to 
recognize that such a woman is experiencing 
feelings of shame or guilt. She should be 
encouraged to talk about her feelings and to 
try to determine the reason for them. In what 
way does she feel inadequate, humiliated or a 
failure? In what ways does she fall short of her 
ideal? How did she acquire these 
expectations? Are they still appropriate? What 
does she want to do? 


6. Crisis following surgery 
A year following her mastectomy a woman 
confided to a friend, "At first I felt mutilated and 
mangled. Someone told me I ought to be able 
to go home and carry on as though nothing had 
happened. This made me feel worse." She 
went on to say; 


I 


Nearly everyone on the ward was 
comforting and helpful to me. During 
the first week, I was encouraged to look 
at my scar. I did, and it finally hit me thaI 
my breast was gone. I cried, talked 
about it, and gradually got myself 
together. A few days later I wanted my 
hus band to see the scar too, so he would 
know what I knew. This was hard, but 
he managed O. K. After that he sat 
and held my hand for a long time. We 
sort of went through it together. He's 
been wonderful. 
Breast surgery DOES make a difference; 
support people are very important. A husband 
can be a pillar of strength if he is included and ' 
not rejected or encouraged to withdraw. With 
the help and encouragement of understanding 
health professionals, otherfamily members- 
sisters, mothers and daughters - can also be 
key support people. Through them the woman 
gradually regains her image of herself as a 
person who is loved and who cares for others. 
Volunteer Visitors. Throughout Canada, 
volunteers from the Mastectomy 
Rehabilitation Programme offer practical help 
to women facing breast surgery. They are 
women who have undergone breast surgery 
and can act as a role model. They are 
prepared to visit pre- and postoperatively at thel 
request of the physician. They provide a 
lightweight temporary prosthesis and can offer 
expert advice on permanent weighted 
prostheses. Sponsored by the Canadian 
Cancer Society, these volunteers present a 
realistic picture of adjustment to the woman 
as the works to resolve her feelings following 
surgery . 
Health Teaching. After radical 
mastectomy it is vital to begin exercising 
immediately, to strengthen the auxiliary 
muscles of the arm that take over for the 
removed pectorals. This is also important after 
a modified radical, even though the chest 
muscles are intact. In addition to arm 
exerdses, breathing and relaxing exercises 
should be routinely taught as one method of 
tension relief. The woman needs assistance in 
commencing and carrying out these exerdses. 
Patient teaching is extremely important 
and should be reinforced at intervals since, 
initially, some people do not hear or 
understand. The woman should be warned 
that the afflicted arm must never be used for 
taking blood pressure readings, for 
immunization, vaccination or injections of any 
kind. Shaving under the arm is a "no-no" when 


t 



The Canadian NUI1I8 June 1976 


21 


6. and 7, "Wall Climbing" is an 
.ercise that gets a little easier every 
tJe, according to volunteer Myers 
ho advISes patients to "try to climb a 


little higher up the wall each day 
Soon your arms will be straight over 
your head .. 


"'" 

 - 
"i t ( 
, 
--- 
.J / 
i-" 
\ / 
. 
. 
. 
.---- or- - 


..... 


eeling is absent. She should also be 
'autioned about oral contraceptives because 
)f their possible role in the nourishment of 
)reast cancer. Breast self-examination should 
)e retaught. The monthly t3SE should now 
'nclude careful palpation of the area around 
the incision. Recurrence sometime appears in 
the incisional site itself. Women with breast 
cancer must always be on guard for 
symptoms, 
Follow-up care should be discussed. This 
usually includes quarterly examinations during 
the first two years followed by semi-annual 
examinations Blood work and X-rays are 
usually included. The informed consumer finds 
and remains in contact with a physician whom 
she trusts. 


7. Early months at home 
GOing home brings the woman face to face 
with several questions. "What should I tell my 
family, my friends? Am I different? Do other 
people see me as being different?" There is a 
good deal of testing and experimenting with 
the erwironmentthrough communication. "Is it 
noticeable?" "Do you think people will know 
which side?" Self concept is built up gradually 
and functions in relationship with other people. 
. The woman should purchase a 
'permanent' breast form several weeks to a 


month or so after surgery. Before doing so, she 
should check to see whether her medical plan 
carries an extended benefit which helps pay 
for prostheses. Some women feel that 
hospitals or community health centers should 
make forms available for display and for 
purchase at cost. She should find the nearest 
center with a surgical or mastectomy fitter, 
phone for an appointment and not buy until 
she is completely satisfied with both 
appearance and comfort. 
In answer to the question "Willi ever get 
over this feeling of incompleteness?" The 
answer is "Yes, by talking and being with 
people, over time." This does not mean that 
the person will view her body change as good, 
but she will accept it, and see it as a "fact of 
life. . With the resolution of some of the strong 
feelings related to her surgery, the woman is 
able to gear herself for the tasks which he 
ahead. 
Additional Treatment. For some women 
there is no period of health following surgery. 
The woman must immediately come to grips 
with the fact that the disease still exists and 
lives within her. Further treatment is necessary 
when surgery has not stopped the disease or 
when many positive nodes are present In the 
axilla. In some centers, chemotherapy has 
become the first treatment offered after 


surgery. Because this era of experimental 
therapy is just dawning, every drug now known 
to be effective against cancer has some 
possible side effects. Further surgery such as 
ovariectomy and adrenalectomy may offer 
methods of endocrine manipulation. Radiation 
may be used to manage palliation of 
symptoms to improve the quality of the person s 
life. Immunotherapy, still in the experimental 
stage. may represent another arm to the 
therapeutic program. 
Much more than emotional first aid is 
required if the woman is to keep in touch and 
work through her feelings during this time. 
Communication should be open, with 
discussion and decision-making concerning 
treatment jointly involving the woman, her 
family and concerned health professionals. 
Ambiguity or uncertainty about any aspect 
of diagnosis and treatment IS intolerable. Many 
women report that their greatest frustration is 
receiving one message verbally and another 
message nonverbally from people around 
them. '" knew that I wasn't getting the straight 
goods" and "I saw a different doctor every time 
and was never told anything much" are 
common complaints. Women need to be 
educated about their right to informed consent, 
They should be given support in their desire to 
be treated as equal partners with members of 
the health care team. 
Women wish to be treated as mature, 
intelligent adults. One successful business 
woman with terminal cancer recently stated. "I 
was more or less told that I should be a good 
girl, go home and let someone else worry 
about it." According to another woman; 
'" was managing my household and 
working part time. Yet whenever I went 
for a checkup, I donned a hospital gown 
and was wheeled into the room on a 
stretcher and examined lying down. 
People talked about me as though' 
wasn't there. When it was a/l over, I was 
wheeled out." 


B. The next ten years 
The five year survival period formerly 
applied to all cancers is no longer considered 
valid for mammary carcinoma, According to 
Kushner; 
Breast cancer is a chronic disease. just 
as diabetes is a chronic disease,.. We 
can relax and breathe easier after two 
years 
 the period where more than half 
of the recurrences and metastases first 
show up. And we can breathe even more 



22 


The CanadIan Nurse June 1976 


deeply after five years But the definite 
time for measuring breast-cancer 
survival is now ten years. 3 Obviously. 
women must be on guard for ten years: it would 
be cruel to suggest otherwise because this 
could .result in unnecessary deaths. 


Conclusion 
Confusion, controversy and 
misunderstanding still surround our present 
state of knowledge about breast cancer. 
Research into the causes of the disease and 
modalities of treatment continues around the 
world and could, it is hoped, produce a major 
breakthrough any day. 
In the meantime. there is a great deal that 
nurses, working closely and constructively 
with their women patients, can do to combat 
the apprehension and pessimism that colors 
our thinking about this disease. Early detection 
and prompt treatment are still the best 
methods of reducing mortality. If a mammary 
carcinoma is detected when it is still less than 
one centimeter in diameter, there is a 90 to 95 
percent chance that it has not metastasized. 
By the time it reaches four centimeters, the 
probability that it will be confined to the breast 
is reduced to about 60 percent. 
Obviously, public education is a key factor 
affecting survival and nurses are in an ideal 
position to accomplish this important function. 
Nurses also encounter many women who 
have reason to suspect that they have breast 
cancer or who have been diagnosed as having 
breast cancer. When this happens, they have 
a unique opportunity to respond with the 
understanding and support that these women 
need. 


Ada Butler (B.A.Sc., M.S.N. University of 
British Columbia), is assistant professor with 
the U.B.C. school of nursing in Vancouver. 
This article, which demonstrates her special 
awareness and sensitivity to the critical 
stages and common problems faced by a 
woman with breast cancer, is based on more 
than a year of systematic data gathering. The 
author reports that, in order to gather the 
information contained in the article, she 
searched the literature, conferred with health 
professionals in many disciplines, and 
interviewed and worked with many women 
patients with breast cancer. 


Photos courtesy of the Ottawa unit of the Ontario 
Division, Canadian Cancer Society. 


References 
1 Miller, Jerry. Editorial overview: reducing the 
death toll of breast cancer. RNABC News 
17:5:8-11, Oct. 1975. 
2 Kushner, Rose. Breast cancer: a personal 
history and investigative report. New York, Harcourt 
Brace Jovanovich, 1975. ... 


.Source: 18th Seminar for Science Writers, 
American Cancer SOCiety, March 27, 1976. 
(president Dr. B. Byrd) 
"','Source." 11th Annual San FrancIsco Cancer 
Symposium, November, 1975. (Dr. L Brady). 


Ma 



 Q) 
Q)- 

 0 
Q) '" 
._ c 
>0Q) 
0- 
i...: .c 
<1> 0> <IS 
_c_ 
C::;:;(/) 
<1><IS
 
oQju 
:>.c.<IS 
.J::. o.ï..: 
C.o..r::: 
<0-0, 
",o,"Oci 
",OCD 

E-5
 1 
O!Qj,E.2 
o.c-Q) 
..._[0.0 
Q.o
c: 
C:-Q)Q) 
,- 
 E 
 
>'CIO O 
.c 00(1) 


:g õ 
... 0 - 
O! 0 
.- 
oc.<lS c 
E ë '8.g 
...Q) 
(I):':::"O.c 
.c 10 c "" 
I-Q.IO
 



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 


< 


\ 


I 


-" 


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 


1 


-. 


.. 
.-, <lr \ 
'- .\ 
 
...;,-,. 


I 


\ 
.....:. 


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. 


I 
.4 


.ò' 


, 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 
ð. .. 2 


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 


.G' 



 ' I f 
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 


0.2 


o. 


I 
I 
 


GA 


I It. J 
ð + 2 I. 


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 
Antihistamine 'Decongestant 
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, 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 
be cautioned not to operate vehicles or 
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 
antihIstamines can produce blood 
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, 
biconvex tablet 7.4 mm In diameter with 
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 
I 

 .J 
I ' 

 
&; 
... 
IU/Ì 
I I 
r-I 


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 



,.....- ...,....--oiIII 
r 
J 
- 


I 
I 
... 
J 


- 


... 
.." 
,.....-...,;::""111 
.. 
- 



 


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 
NURSING 



 _"'.11' 
...!ÓÌ8Il ,..
, I I 


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/mustrated/1975 


$15.75 


From Lippincott. 



'HE 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 lIIustrated/1974 $21.50 


(l'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 
expanded, 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 


@'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 $8.95 




 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., 0, 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 iIIustrated/1974 $18.75 
Barbara Bates, M.D. 
Also available. . . 
PHYSICAL EXAMINATION FILMS 
A series of twelve sound motion pictures, correlated with the 
content of A Guide to Physical Examination, (Write to the 
Marketing Coordinator, A/V Media for information.) 


@: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 (ASC) 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/lllustratedl1975 $9.95 


for the Practitioner 


@. 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 


Gj 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 Lid: 
Please send me the books I have circled. 
123456789 


10 


11 


Name 
Address 
City Provo Postal Code 
o Payment enclosed, ship postage and handling paid 
o Charge and bill me 
oWIIChargex Accl. No. 
o = Master Charge Exp, Date 


Position 


LIPPINCOTT'S NO-RISK GUARANTEE: 
Books are shipped to you ON APPROVAL; if you are not entirely 
satisfied you may return them within 15 days for full credit. 
Prices subject to change without notice. 


Lippincott 


J. B. LIPPINCOTT COMPANY OF CANADA LIMITED 
Serving the Health Professions in Canada Since 1897 
75 HORNER AVE. TORONTO, ONTARIO M8Z 4X7 (416) 252.5277 


CN 616 



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 


, 


r# 
I t 

".. 
f 


'" 
:=ol'1f' vbfC1::, 
-, 


I 
J I 
--.J 


.. 


- 


41..uc.AI.. \"-Cl'D,.J
 
.
\ .j,u;:" ,t oç 


.... 


;::: 
:::: 


let nltr 


I, 


." c 



o.... 


....... 


... 


^ z r - 
1:] 
 u,-'1 f"'c
, 
c..... I1 N t ' l L ll
CfíoN5 
" t 
If'\
' Uf 0 
........ 
r. '"\''' ""f"" 
"7] '-^5 Qnd dar. 
, _",t bE cleo, /" 
, 
c
lr.,. 
.,Q" \ÛI"" \'
5 C -Hot.- 
I . c -.I' , hl.
C! ''''l.
 Inr-'
"te.. 
f>!C, 4vcd 0,..1 :5ten ,e. In
 I / 
'Ie, . ; me 
ó 
fit' . v" +\1e fdf;t-1:> 
 
- 

'reð .1 eel , 1l. da'.!: , w..n -tilt. 

.t':r.c Int t .tLr 

 <<10> Ie, cd u"'ó
r, 
 


g 3[ . 
dt:-__,c\1\. 

..,' 
-Jp' 
...
 
..'" E:J C....L :. ''\.
C IO"'i) 
,
 
Gr
np:' I 

,. 
cd I 
J 


---- 


...... 


I 
,. 
.... 



 



 


. , 



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' 


-- 


..,.,....
 


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. 




 
f
 


I 
 



 1"c.... r-f)t 
.....

 "'rW"' ,,""'r: 
r,"<'Å .... \'." 

 pa' \;c 


'" 


.....Ot If -ie 



 


"ðLl 
. 


c.: 't 
I' 'E:l .or V)(Ind 0 
I
 ^ 
. 
'
r 


-"""', 


oNnen 
r= f'" 


rl""" 


I:....l 
NIC).\.... 
 'fi:.c.,..-.L>....
 

 ed .. t 'l\
 o
 
c\c< 
t:'r \0 .::".,dlr
 


d or -ì..-rt' 'oqer û,- I 
:> c:sr1 ....]h\,Ot1t
d 

 ....n
 It:"t.. ," -the. 
.
I an} I 
r "1.nt'r no ...ò"f.,.
dl 
.., ..,)Qt
 +
r.. IOf"CIE:
 I 


r "p 



 Ator C"""nð 5 
O<\\i'r'f:i'I"<N'''0 
fo<'C.,
 


f,- "I "'" ,,-AL . "'_CC'T"u"'
 
ttl cdlu
 .
n i of) 
( ',r>d.,. _""fa,,,..,. 



 !ì.,.., v. -t...... ;OrCef.5 t,.o....... H."", 
D D tlr.î 
 "IJI ....... -ira"".t" \'e.....,.. ,,
("1 ca\' 
""\-''' 
...l. 
::\ ""'" J no. tc 
c\'" 

 .-c:.-ce'F.... ::>,de. (r Tne 
Itl'}er :'>\le ....t.C> I 



 

 
r-:-1 



f' r \ 
-c 



In
,. :).n...-\ -('or 


. <;'" îOl\d o
 , 

 O--"'-"ûl1 Coli 
7orccp'" ooo-;c. 
..c.r+a.f1t'..... 


IE..(
IC.A.L l ."'i[.C"1.oN51 
I '\ 
ð 
 lo 
-uf' Dr 
.,>1<>( .e (;o\
ct " 


e 


E \ 
 
"mu
to .rr 
--' 
I :
\:":::
 

 I ... W ",Q.., on f)ú(}d
 


-i OV 
 

d ,<;no 0 
rf: ....ntH 


, '\.'. . 

 


llrìer 


,e. 


,to I 


<Z- 


----- -- - ----- - -------' 


" 



 '" 
.)
 - 
. t I rt I 
, . 
, . , 


. 
a.. J 


\ 


Go 



) . - ... 
\ ' 'I 
. 
IJ --- 
. ..,- 
I -- , 
':\ 
\. 
... 
-- 
\-1.:' . 
. 


. 


'- 


"""' 


... 

 


.. 


"""'--- 



44 


, 


The Canadian Nurse June 1976 


I 


f 
, 


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 



 


0E.f' f:;ù(' g 
.sç.rc,1 .d Qro- .." t 
vI +.
r 



 dj,,,- 
....rNof'd '" 1.- J 
-t-n<. I I I 0" 
 
, 



Il "'",' 

 


.'p 


.. 


r nt' Il'1el 
'-eo" \
 . 
 
Qf1d 
 [ 


j tc 
"dt'ed 
-..-d",d 


I' 


'" 
/P" 
<,. 


- 


- 


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.., 


. 



 


- 


. . 


.. 


-" .......... 
e.- 


. 


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. 


_.
r:"" ... ? :J[ ...>'J('
 
. 
 . I" Y. - '. 'W 
I,.;, . .. s.j.. 
Q,. " . . . . .
 . ". . .
, o. '. . -C' 



T 


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
 
'- Dupont reg t m 
r . 
=w It.. 
I. . 
III. . E 
J 1 L t .' .. 
II , " , F P 
 
t , T 0 Z 
- 
, LPED "1 
r +- PECFD !: 
. EÐrczp e 
+- PI:I,.OPZJ) 7 
L .. ...r.D'I'I:C e 
L I: .. .. . .. " .. S 
, <: 1( 
1 

 .. 
...- 
I .. 
-
 .. 
I '-v- ... - 
I I ....-... 

 - - 
...L. . 
t ... , 
ST1:,"U 
· 
.U;: 
..... 
-' 


. 


... 


fro 
... 
'. 


,- 


--- 



 


. 


-' 


.; - 


----" 


--- 


Clothes that take care of the people who take care of Canada. 


]Jl\lt(
() 


Designer for the Professional in Uniform. 
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 
BLlrco, one ot the finest names in Unitorm
 and Shoes is proud to be in CanadLl. 
Please look tor Barco at the store nearest vou: 
UNIFORM WORLD, 3 Coumbe St.. Renfrew. Ontario; 226 Bank St., Ottawa. Ontario; 641 Bay St.. Toronto. Ontario; b!)1 McCowan Rd.. 
Scarborough. Ontario. FLORENCE NIGHTINGALE, 15b James St. South. Hamilton. Ontario. ROSE-LEE UNIFORMS, B37 Sherbrook. 
Winnepeg, Manitoba; 265 Kennedy. Winnepeg, Manitoba. ROSE UNIFORMS, 10175-100A St., Edmonton. Alberta. 
DORIS UNIFORMS, bIB 3rd St. S.W. Calgary, Alberta. VOGUE UNIFORMS. 116 Bth Ave.. Calgary. Alberta. IMAGE UNIFORMS, 73-1 
W. Broadway, Vancouver. B.C. Cariboo Shopping Center. Coquitlam. B.C LADY MAE UNIFORMS, 742 Johnson. Victoria, B.C 
JACQUELINE'S UNIFORMS, 134 W 16th St.. No. Vancouver. B.C 



48 


The CanadIan Nurse June 1976 


XtlJ11eS 


illl(l FilCeS 


.' .... 

r:--
: 


r'f' 



 


.... 


\ 
1 


1 


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. 


( )r' 


'"" 


. 


\ 


,- 


. 


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 


-- 
"'" 


,-. 



 



.:? 


.. 


!!9f 
4'111ì
 
ß",Þ'l"'
, 





 
.
\t."'
 
",$.1\
 . 
. ,... 
'd;..... 


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 


;;] 


\ 
I 


. 


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 


""" 



... 


--
 


-, 
. 


',-
 


,
- 
,"---- -. 
\0 l" 



..... 
. .\,," 


') 


"- 


"', 



 


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 


.. 
;1\ 
/" ,.r 
..". Fe"! 


.'IC 
, 
r:lcl'.:I.c 
CAREER ClASSICS 


Ä 
-

 
.. 
"\. 
\ 
\ \...
 L 

.. \ @- 
I \\ 


\ 'LL 
t!f!lIII"'" Ir-- 
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
6tr2' 


/ 


ø 


G-\
 


-t
 
- - I 

 
..... 
\ <
 ( 

I ( 
I \ 


I 
/ J ; 


- , 


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 


J
"1I 


..,,
 
- 


unifolml 
legi/lel ' d 


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 ... 
.i,t 
I ' 


. 
. Þers 



 
,... 
)- 
.. 
,\ 
t 


PROCT(K I; GAMBL[ UR.1U 



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 
\ . 
:. ' · · \
8 
, .W214
 · 
1\ .-: .
 
., 
'/ . 


. . 
 


 
..y )1

: · 
, 
 ---............ 
 .,- 
 
\.

. ................/
 

 
 
r-J
 .. -. .'C. 



 


. 


. 


. 


.' 


t

 


. 


. 


. 


. 



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 
 
. < 
I,
 
L 

 "........ 
.' 
". .. 
... .:;i.

 
, 


. I 


\ 


-- 


. 


--Q, 
, , 



 ... 


. . 


,. 


.. , 
. 


. 


GET 
INVOLVED. 
WITH THE 
CANADIAN 
ARMED 
FORCES. 


!iT 


. 


At Last... .
 
a Canadian supplier \ V ' 
fOl' nurses needs . 
No W'ØtrJIII9 -'>>uI ecør.n.A. No'*"'IOPfIJI. 


'HIH 1::\ I::R\ ORUI::R. 
fR II "'bite viDvl POCKET S.-\\ER for 
I pt'ns. sci,,
rs.. 
tr. C'he-ck box OD 
coupon 


STETHOSCOPES 
'l R"E!t 50 TETHIl!tl1IPES... 5 
culo'Ur.. E.rcept,.rnral6uw.M 
tromm....on. adJlUlable 
bghtWf!,ght bmauraû. 
replaceme,,' parts at-mlable 
m C<mada. ..1. Silver, ..15 
Gold, ..90 Blue. ..n 
GTe.... ..g. Red S9.00 
eac.. IrtclouJe. ....,iøls 
e"graved fre 
Ul.\L HE-\U "TETHII..,CUPE 
.-Impl. alljr, 1ue" 8o,,'les 
ti07lI1as exlro large dllJphrogm 
AdJ1'.table 
hrome b,,,,,arob ..U. '15.95 ..ch. 


SPH\"G
IO
IA:\O
IETER 


Ragged and depl!1Jdable, Wllh 
"'..._ Ant'road ga_Qe cal.brated to JOO 
. m '" lele", toach-t1:N/-lIold 
) ;. 
 - ("lI.l/ HQJltÚomf!ZI
TedmsE' 

 .9

 lOyearg>UJNmtee. .115 
I 

 S24.95 ellCh. 

' 
 Inclu.des InitliJÜ f'JlgTUved 


. 


OTO
COPE SET 

 Un ,G l""7nØ'7Iy;afme.t 
r _ n.slnment. Exceptional 
, .U.m.hII 1011. pouer.ful 
. ma 'urPlO 3.standard $L 
; 
;.., , ",,"; 
.

Cbal/.n.. 
ndutkd Itelal rorrymg ros
 
..... e... I .,d" th ...il clolh -309 

 556.011 each 
SCI

ORS &. FORCEPS 
II..TI::RB.\'U.\Gt'..ll....UR.. ' , . 
'm..:ol"r t.ry "urs _ '", 
 
!fanufQrfllrt J of frt1a> t .,...d and , 
t 'I sm 'artlclerf' 
Þ699 
 S2.bO 
:
:;i ; . :
:

 p 
III'FR.\TI'G !-oU....IIR.. vi 
,,\/. ".. "';t ... 'tmQ/u bWd
s 
lIìf ) 5 ...harp blunl S2.k5 
.f'h 
.706 ) 
harp harp S2.f6 ra('h 
Þ71O
' "IRIS... .r' S3.65 each. 
HIRl'I::I''' 
fi'll"!;;t Slam] Stt't 5 "long. 
 
h(> "Forf'ep
"ï
-I 
 ralght.box lock S-I.35..('h 
he'h. For<'E'ps 1t7
5 Cur\
. box lock S-J 35 rar-h 
Thumb Dr.."nto:.7 
IStralto:ht. ..,rraledS3.J5 each 


:\l"RSES WATCHES 
I dept dable. al/rael ".'ch Full 
nu.mt. 1'':'' n u lutf! fat R i 5'L e-' 
I" md hand ClarmfU! ras . .Ionl II 
I back J. .. led m "''''',. h
u:1r. 
If 'die roJ r OMllTO f It 
SlX.:.o u tan< 



\ 
J1 


1,"nTl TII".\L 'l R"F..: \\riteonyourCompan} 
leut'rhead for our.!..J pg. t'at o
t". Quantjty 
di )Ufi .ilab' '. 5O<<nt h "dhngchar
for 
ordt>...... I...." . 'Ian 15.00 
----------- 
nrd
r '0. It
m {ol Yuan. 
iz. Pri<< 


HJlIT\ \\..lIll'.\L"l PPI \ l'lI. 
1'.11. RII\. 7l6-". BRIK"I\ \lLLt'. I" T. K6\ 5H 


I 
I "-rad to. 
t !"\trt"f"t. 
I (ïn: Pro\." 
. P05taJ ('odto: Iiiiïii 
------------- 



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 
rates 
For All 
Classified Advertising 
$15.00 for 6 lines or less 
$2.50 for each additional line 
Rates for display 
advertisements on request 


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 
Ottawa, Ontario 
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( 
\
\' 
 

 
 7 
 IE1'l" 
. ,\. ./ \I Ý 
r,{"'J' 0
! 
 \lI11iF\M Z}1IE 
\:J" "\ 
'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

e 

d


 
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
 
C
 [j t2 

 
 

 """ 
.... 
 
..,.. 
 ... 
'; ft! 
L .... 
'6 é- 

 
 
-1J\10 (, ,,
 
lfACH\
 


Quebec's Health Services are progressive! 


So 


. 


. 


IS 


nursing 


at 


The Montreal General Hospital 


a feaching hospital of McGill University 


Come and nurse in exciting Montreal 


r-------------------------------. 


laD\ 
\U
 


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 



(
 tor h
q4 

.,.. 
 

.
 

 to 
QI 
 
- -- 
.2 
. ,. --. .. g 

"'o,,
, 
C $. 

 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 



" J 
r 
\ 
\ 
I 
.... - ) 

 
- . -\ 
...... "- ... 
.._". 
n. 
lenge! 


of providing health 
care for the 
Indian people 
"'> 
of Ca nuda J;

 -,
 
, -:-;Þi 
 " ...... ,-'" -...." ./ 
I l 
 .- ..;" ."'
' 
/,r . .,1, \ 

''''''I 
;>
 ! 

 
 1 '
;' 
I + Health Santé eI 
 
and Welfare Blen-étre social 
-- -- 
/, \, 
,----------___ìì."-.. 
I 
I 
I 
I 
I Please send me more information on career 
I opportunities in Indian Health Services. I 
I Name: I 
I Address: I 
City: Prov: _ 

_______________J 


64 


" 



 


" 



 


ó' 


- 


-.Q-< 
... 


........ 
-.ç 


\ 


_ ...; , If .
 
.

. 
. 
".}. , 411 
 
th' 


"' 


, 


. 


, 
, 


, 


, 


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\ 


. 


J 


.. 
... 

 
... 
-- 
" 

 ..... 
. 
 
-
 
."- 
.. - '- 
-- 


o 



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 


... 


>t 


.f'" 
'-.. 


.-..... - 


.J 


- -
 - I. 


e 


:- 


ç 


'
 


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 


CillR8\ r 
DRUG 
HAI\OBOOI( 


Falconer. Patterson & Gustafson: Current 
Drug Handbook 1976-78 
You'll find the most recent clinical information on about 
1.500 drugs in common use in the Current Drug Hand- 
book. Its tabular format lets you grasp pertinent facts at a 
glance, and it's fully indexed by both proprietary and 
generic names The drugs are grouped under 16 
categories. such as Antiseptics and Disinfectives, Antihis- 
timines, and-new to the 1976-78 handbook- 
Chemotherapy of Neoplastic Diseases 
By Mary W. FalconeT. RN. MA; H. Robert Patterson. PharmO; 
and Edward A, Gustafson. PharmO. 279 pp Soh cover. $6 70. 
March 1976. Order #3567-9. 


Patiert 
Ass&. 
dnd 

 
byfhf> 
Nv 
Frat 


Gillies & Alyn: Patient Assessment and 
Management by the Nurse Practitioner 
This brand new text is ideal for developing your skills in 
interviewing. physical examination. laboratory test in- 
terpretation, and protocol in the management of patients 
with chronic illnesses such as hypertension. diabetes. 
osteoarthritis. arteriosclerotic heart disease. obesity. al- 
coholism. and chronic obstructive lung disease. 
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 
Edition 
Here's a modem look at the challenges of nursmg leader- 
ship 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 administrative and managenal respon- 
sibilities of nurses. methods of 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 ntusld Soh cover $5 15. Apnl 
1976. Order #5528-9. 


The 
_" _. 01 
PA ; TCAKE 


Howe: Basic Nutrition in Health and 
Disease. New 6th Edition 
From chemical conversion of food-to modem diet plan- 
ning. purchasing and storage-this text cOllers all the 
material necessary for a better understanding of basic 
nutrition. There's plenty of information on diet therapy. 
common misconceptions about food. and weight control; 
and the appendix includes an alphabetical listing of mod- 
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. 




 

srd 
røø 


- 



 . 


.......... 


.øØ" 
.. 


Simmons: The Nurse-Client 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 This 
revised edition includes new guides on obseTValion of 
anxiety. assessing the milieu, theoretical approach. crisis 
interoention. descriptive data. assessment of the client's 
learning. and assessing of the nurse '5 learning 
By Janet A, Simmons. RN. MS 248 pp. Soft cover $6.70. Apnl 
1976 Order #8286-3 


.1'" 


".. I' 



 
.o

r



o

!.'
t




NY CANADA LTD. Pncessubjecllochange 
I-;;;;'r
;';;;'; 3Ckta, appT ;;;',


;;:;";;;' 
 lIUI/l:: - - - - -;
 e Pri ';- - - - - - - - - - - - - - - - C;;;:;-6-' 
I I 
I I 
I I FUl lNAME I 
I AU: AU: AU: POSITION" AFFILIATION (IF APPLICABLE) I 
I HOME-ADDR ESS I 
I __ _ I 
'- ,=-
k




rs
 
.ta
 -= 

.
'_ =-b

 _ 

_ _ __ __ ___ PROVIN 
 __ __Z

__I 



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 


Mte 


, 
1M '* 


I 


-------------------------------------. 


I 
I 


IT'S EASY TO ORDER REEVES NAME PINS FOR YOURSELF OR FRIENDS! 
f':::: 

C"'m -.:-:= b'::w Pé':::c=
:
 
...... m chart. clip IIIIS sectoon ond IIIIch to aJUIIOII 


METAL FRAMED. _. Smooth plastiC t)i.Ck- 
.-cund with c:lßslC. chstlnc:tive polIShed metal 
me Beveled and rounded edges and corneB.. 
Smart pl"OfessfOl1.al apØear3nce 
' . PLASTIC LAMINATE: Slim. broad. yet IIght- 
. 
f:s


:c


:= 
. matches lettenng. bcellent 
Iue 
II MOLOEO PLASTIC. -. S,mple .......rt Smooth BJacio 
. leal1pla5tr<:deeplyengra'tl'l!d,lacquer-filled Ok Blue 3LIne5 
Edges and comers Rentty rounded The o White L.ettenns_ 03.1905..29 
or.gll'\ill nurse sty5e. _ .atwa :r.ö correct. (.....1MMe S590nlyl 

 -------------------- 
SCISSORS and FORCEPS 

":;'

:Je: :::
. 


1 




ETe:
.-,:


.


'ght. DGoId 
:JOlrshed. satin Of Duotone finrsh comb'"'"a 0 Slhref 
satin background with polished edging. 


Fl'3me- 
o Gold 
OS,...., 


3....
 
4....
 
5..... 
1%. 


LISTER BANDAGE SCISSORS 
3..... ..i.."..... rmy. hlndy. slip Into 
umform pocket or purse ChooSe ,ewelers 

 ",lei or ilumll1l chrome plate finISh. 

 No, 35OO3Y," Mini, ."..,.2.75 
No. 4500 4',. SlZ', Chrome only, . , 2.95 
No. 5500 51,1'" size, Chrome only. . . 3.25 
No. 7027'/4'" size.. Chrome only. ..3.75 
For ,nKravec! initials add 60. per instrument 


KELLY FORCEPS 
C+--- So hlndy lor e..ry ......' ldeollor clampo.. 
. 
 oft tubin etc. Stam'ess steel. 5
" 
No. ð-72 
traiøht, Box lock . . . , , 4.69 
No. 725 Curved, Box Lock. . . . . , . . 4.69 
"' No. 741 Thumb DressinR Forc.p, 
Semted, Straight, 5Yz.. , 3.75 
For encraved Initials add 60'1' per instrument 


I 
I 


MEDI-CARD SET Handi.st ref.r. 
ence ever' 6 smootf1 pJ
IJC cards (31t." J. 
SW'J c"""med w,th inlol1l\ltlOll. EquiYa- 
lone... 01 Apothecary to M.tric t. Hous.hold 

æ.. Temp. cc to DF, Prescnp. Abbr.. Urin- 
alysIS. Body Ch.m. Blood Chem ,li"r T..ts. 
Bone Marrow. DIS.... 111C1b. PerIOds. Mlft 
Wgls., .Ie. In whit. vInyl hohle,. 
No. 289 Card Set . . . 1.75ea. 


\
::.s.::
=
ampad on back of 


t
 
, 



 \ \ ;0: 
\
 


POCKET SAVERS 
Prevent mins Ind wear' Smooth,. pb- 
able pu,. wh.t. vinyl Ideal Iow-aIst 
groop Rifts or f...".. 
Nt. ZIO-f liar '"It), ""' CDmpar!metl1S 
P

k
tol

:$
 cam.celJS. . 
III. J1I GlfIJ Delux. _. 3 anpt 
change pocket & key chaIn. . . 
Packet of 6 for $2 98 
Nurse!' POCKET PAL KIT 
.., . 
, 
Handiest 'or busy nursn Includes whIte 
 
Detua:e Pocket Sive'. with SY.t"llster SciSSOrs 
(both shown abmel Tn-Calor ballpoint pen. 
plus handsome IIttll' pen "ght .11 silyer 
finIShed. Cho..e compartment. key chlin 
No. 291 Pal KIt. . . 6.95 ea. 
Initilis enlnlved an Shears. add 501 
.
 
...,--
 TIMEX PulSDmeter WATCH 
l' " Ðepenclable T,mex Nunes' Pulsomete,/Calenda' Watch. 
:::r:e:
eout

I

:e
::: 
 O:e
:, 
lulnmous, white strip. Sbllnless blc:k, wa1er end Iim. 
resistant Gift-boJ:ed. I yeJr warrantee 'lib.. ftITJ"Ñ 
to _Urn. No. 237761 Nurses' Watch. . 
19.95 ea. 


\ 


. 


""" 



..,. 
PIN GUARD SculpllJred caduceus challlld 
 
to your protmtOnal letters. each With plnbac:kf 
safety catch. Or replaa eIther wIth class pin Gold 
finish, gift box.d Choose RN. lPN or lVN_ 
No. 3420 P,n Gu.rd. . 2.95 ea. 


@1 


I
 


EN AM EL ED PI N S B....tifully s<:ulplured stabJs 


;f'
im

:.






 
,'fvr
 
NA HA m coupon. 
No. 20!1 Enam. Pin 1.95 ea. 


Bzzz MEMO-TIMER Tune hot packs 
\I 
heat lamps, park met..._ Reme_ to che", vital 
 

:
 r.;3 



'\ 
gtr60
rnl.

 :" 
SWISS mode No. M-22 Timor. . . 6.95 


. 
.. 


. '8 


'.. 


\11 


QUICK DRUG 
REFERENCE BOOK 
SImplifies 2400 drug ........ & .sag.., Includml 

nØ ::.

 =;::;,e
 ::
or= 
Info. 
No. 3791 QDR . . . 9.95 ea. 



 SAT1SFACTION GUARAN""EED' AI 


bottom fight. Attach extra sheet tor addltlORll pins 
lOT( SAVINGS 01 Z 10ENTICAl. PINS ..... co_lilt. 
__it_.,..... 


o Black 1 LII
 
o Dk Blue Lott.".. - 0 2.69 04 49 
o Wh,te 2 Lines 
Lette"ng 0 3049 0 5.79 


3 Line!. 
Letter,ne 


o 4,29 06.99 


1 line 
Lettenne 


OU902049 


2 LIne!. 
Lettering . 0 2.29 03.69 


,.. 


c-. - 



 


'J 


\ 


.
 


... 


free Initials and 
Free Scope Sack with vour own 
. 0) 
LlttmaUD Nursescopef 
Famous Littmann nurses 
diaphragm stethoscope . . 
a fine precision instrument 
with high sensitivity for 
blood pressures, apical pulse 
rate. Only 2 OlS., fits in 
pocket, with gray vinyl anti. 
collapse tubing. non-chilling 
epl)xy diaphragm 28" over. 
all. Non-rotating angled ear 
tubes and chest piece beau- No, 2 I 60. Nursescope 
tlfully styled in choice of 5 m
l.udmg Free 
iewel-like colors. Golðtone, Initials and Sack 
Si'vertone, Blue, Green, Pink.' Duty Free... 16.95 ea. 
"..PORTAJlT, N .' Medolbon . slylmg includes tub... in coIoß to malth 
metal..rts If desired. add SI. .. to pnce _, add ..... to Orde, 
No_ 216O!!) m_ 


fREE INITIALS AND SACK! 
Your Int,als engraved FREE on 
chest piece, lend Individual 
distinction and help prevent 
loss FREE SCOPE SACK neatly 
carries and protects Nurse- 
scope. Heal')' frosted vinyl, with 
dust-proof press-type closure 


LITTMANN COMBINATION STETHOSCOPE 
MIJ.lmum sensitiVity from thIS fine profmlOnll InstnJment:. Con- 

:
t 
r=:

r.:
n:I
mc;:
t

e::- c

:
:I,,:I
 
d,",,
ragm, 1 Vo. bell Re...... I. non-c
11I sl.... Gray vmyl !ublnl. 
Two ,nlt..ls .ngr. m chest r - 3 mE 
 SACK INClUDEÐ 
No. 2100 Combo Steth .. _2.50 ... Duty Free 


CLAYTON DUAL STETHOSCOPE 
loghtwelght 
a' scope imported Irom J_: higtrest 
sensltjYlty tor al)ltal pulse rate. Chromed blRlUrab 
chest plec. with 1 Vo. bell and l!1t. dIIphral"l, 
grey ..t
fllpse bJbinl 4 oz.. 29. Ion,. Extra 
ur plugs and diaphragm included T.I Inltl.1s 
...graved free fREE SCDPE SACK INCLUDED 
No. 413 Dual Steth . . , 17.95 ea, 
Duty Free 
LOW-COST STETHOSCOPE 
!lur lowest cosl precIS'" st.thoKopel S,nli' cIoapItral"lll
. dlaJ 
Choose Blue. Green, Red. Sliver Dr Gold tubing end chestþiece. sl
er 
bi.....'.1s mly 3 oz Three inotials engraved free fREE SCOPE SACK 
No. 4140 Clay. Steth .,. 11.95 ea. Duty Free 


<A 


LUGGAGE TAGS 
OR PLAQUES 
B"g
t enlorful I..... x 2
. plasbc 
chips With your name address deeply 
eng'aved 13 "... up to 2S 1.1t... 
spaces pe, "nel 101 WIth bead chlln 
led lllru 2 holes SO otw.ys faces lilt . . . 
or pl
 wrrsion with self..adheslW! 
back to mooot m flat surtace. Choose 
Red. Dr.... reflow, eoco.. Blue. Gl'" 
or Black Altach wordml desIred. 
T -300 (bead chain) or 
T-400 (self'adhesive).. . 1.98 ea. 
E
ch additional item with same 
wordinl. . . 1.50 ea. 
:.:....J.>.,-- 


-- 
:.=:-.. 


-- 
os __ 
---.. - 


....... 


-_.
 


L 


.../u- , 
./ 
MRS. R F. JOHNSON ) 
SUPERVISOR 
18 


- 


CHARLENE HAYNES 


.. 


a-" 
MRS. \10
 
OHN. L.P.N. 


'--' 
.1. 


.. 
510 
AI .....-a .... Af8IJ CIIII:II 


NURSES PERSONALIZED SPHYG. 
 
Now in Fashion Colon! f - 
A superllanero,d sphn espec..'1y des'l'1.d 
'or nurses by Reister. preclSMX'I cratumell 
In w_ Germany Easy-tHItach Velcro" cull, 
IIgtrtweigtrt. compact. fils into soft $1m 
le.fther Zipper us,e 2
" 14" 11". Dial- 
calibrated to 320nn, IO-y.., accuracy 
l\Iarlllteed to :!:3mm. Semced by 
RHWS if ever reQUired Your ntl.1s 
"'I'aved m manomet., and eolel 
stamped m case fREt Choose BlACK 
with chrome metal manometer or 
BlUL GREEN or BEIGE WIt
 plastic 
....._ hous..., blbing, cull and case 
an enlor-coord,nated (specIfy m coupon1 
No. 106 SphYl. . , . 39.95 ea. 
Duty Free 


'- 



 


BLOOD PRESSURE SET 
An IIItsland,,,, aneroid SIIhYI mode 
on Japan _..lIy for R..... Meets 
all U.s. Gov. specs. :!:3mm accuracy. 
1I\I.....t..d 10 years. BLocI< and 
chrome ..........t.,. cal to 300mm 
Velc,o" i'ey cull, blocI< MlnL soft 



7
 IZ1

 ':':.&1 
e... needed. CIIyton No. 4140 
--- St.thescope Isd...) and Scope Sack 
:s =
mlsee:':
r

 I

f.
 
prlCtlcal, dependabl. kot JlSt fight 
'or every IlUrst! 
, No. 41-100 B.P. Set . . . 
Duty Free 33.95 set complete 
!lqhyg. only No. 108 . 27.95 With case 


( . 


CAP ACCESSORIES 



 
CAP TOTE keeps you, caps cnsp ond cl... 
f'ellble clear pllsbC. white trim. llpper tarrying 
st,op, ""'" loop. Stores flat Also for wiliets 
curle", ett: 8..... cIII. 6. hIgh 
No. 333 Tote . . . 2.95 ea. 
GOld init. .dd 6Oc. 


-- 


....... 


-----..... 



1 


MOLDED CAP TACS 
=us"1'= ='M.;

::S:c:;ia'1":g 
Gold Ca<kIceus The n..te' way to fasten bands 
No, 200 - Set of 6 Tacs... lA9 puset 


") 


{lli1 .

 
11li1D
 
P1m 
----------- 
TO: REEVES CO., Box 719- C , Attleboro, Mass. 02703 
DRDER ND ITEM CDLOR QUANT. PRICE 


METAL CAP TACS P... of dlinty 
"""'1'",,0111}' TICS _ plppe", holds cap 
=. s
u,:eI
;d
bP= ;:.tatpf.
J,n

 
Caduceus or PI..n Caduceus. Gift boxed. 
No. CT-l tSpecify Init.). , , . . No. CT.3 IRN 
Cad,) . . No. CT-2 (Plain Cao.l. . . 2 95 pro 
. 


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 


Master Charge and BankAmericard charges are welcomed on 
orders totalina $5. Dr more. Please submit compJete Card 

Uu':






#' 


:nterbank N). Expiration Date. and 


. 
. 


Send to 


Street 


City Slate _ . _ .Zip .. 
------.---. 



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. 


') 



 


...... 


,. 


, 


... 


) 


" , 


. 


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. 


, 


- 


". 


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. 


..- 


" 


...... 
- 


... 

 
'" 


.) 


." 


I':) 


l 


1 
. 


'....... 
- \ 


, 


Criss Rogers fields a question from 
the audience. 


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 


Xe\YH 


-/- 
""r 
, . 

 
";oJ - 
A. - .. I 

, . I; 
=- 

 . 
- 
If I w- -"" 
,.. .. 
- - 
\. 
 .....-,},.
 . 

....-!. -- 
.- 


-; 


... 


f 


.- 


I 


r 


, 


'" 
!r 
ß 
ti 
'" 
Co 

 
o 
is 
:> 
éi5 
>- 
D 
o 
Õ 
J:: 
"- 


- 
" 
.

 


_.
 


. 


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 



. 


.... 


1 


I 


- c= 
...............[."t 
-
 



12 


N
lJlleS 


i\II(1 


Fil ees 


- 


.- '" 


:.
 


-
 


t 
............ 


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) 


,...- 


" 


POSEY 
QUALITY 
PRODUCTS 


t 


\... 


'. 


Posey Footguard - rigid outer 
shell supports the foot, helps pre- 
vent footdrop. Removable "T" bar 
stabilizer helps prevent rotation. 
liner easily removed for launder- 
ing, #6412 (complete with T Bar) 


" 



 


Posey Key Safety Belt-designed 
for the difficult-to-control patient 
Set belt around the waist to a 
comfortable size and the buckles 
lock onto the webbing. Key neces- 
sary to unlock, Washable, #1334 


.. 


,., 


Posey Comfort Vest - non-slip 
waist belt adjustment won't tight- 
en or loosen. Allows patient to sit 
up in bed or roll from side to side. 
Excellent wheelchair support. 
#3614 (Breezeline) 


P 
o 
pO."Y 
. 
Y 


Send your order today! 
Enns and Gilmore 
2276 Dixie load 
MÏS5iSSi.UP, OnÞrio, 
CMYd.a L4Y 1ZS 
(41&1 274-257S 



 


... 



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. 



: 
 
 
 
 
: 
 
 
 
 
: 
::" 7 \ 
 
 
 
 p 
 
 
: 
 
 
 \ 
 
:j.::::" : .I 
 
 . 
 : . : : . :- . : :- 6 
. . . . . . . .. . ... . . . . .. .. 
................. . ... :.:. .:-:->:-:-: ..:.: : : :-:-:.. 
:::::::::::::::::.:. :-:.:- .0.- . . . . . . :þ:.:.:-:-:.:.:-:. 
............. . .. . : : ... ....: . : .:. : . : .:. .. tiP..... -.- . . 











: :::
::;
:
::
;
.:
::.: 
: 
:
: 
 :
: 
 ':
:: ::
::::: 
 
 


 

 

 
 
 
::::" 
. . . . . . .. ............. .
.... .. ,........ 
. ..
<.:-:-:.:-:-:-:..;.. .:. ..:-:-:-..ex-:.:.. -:.:..- .:.:-:-:-:.:-:-. 
: ..................... ... ... ....;..>. :.... ......... ... .............. 
. ::::::::::.:::::
:::::
::::
:;:::::. :::::;
.. .::::=:=:::=::: ..
:::::::::::::::-:-. 
. ... ,/'J' . . . . . . .. .... 
h......... · . . . . . . . . . . . 
...... .....-:.....:-:.:-:-:-: :.:-:-= ;r.w-............... :-:-:-:-:-:-:-:-:-:-:.:-...- 
. .. .... ....... ..... . . . ... . ...e. .................... .......... ............... . 
. ...... ........:... . . .... :.
. ..:.................... ...........:.:.:.:..................... 
.:.:.:. :.:-:.:.. ..JJ...... .fI.............:.:.:.:.:.:.: .:.:.:.:.:.................:.:.:.:.:.:.:.:.:...... a 
. . .. ..... 
....... ..................... 
.... ................ . . . . . . . . . . . . .. . 

:
: ::::::
::: :: 
:
 :::: ::
:
:
:
:::::
::::::
:
:;:;:
:
:;:
:
:
:
=:. ':
:
:
: 
:
:::: 
: ::
: 
: 
:
:
: 
: 
:
 :
:
:
:
 :
:
:
: 
: 
 :
:
:
:: 
:
: 
::::::::::::::':"" -. , 
.:.:.:.
. .. .

..:.:.:.:.:. . :. . :.:
 . ....
.:.:.:.:.:.:.:.:.:.:. . ..:.:.:.:.:.:...:..:.:.:.:.:.:.:.:.:.:.:. :.:.: .:.:.:.:.:.:......:.:.:.:.:.:.:.:.:.:.:.:.:.:.... . 
. ... ..... / ....... þ.......... .. ... ............ ............. 
::.:::::.:...:.:. _.: :.:.:.:.
.:... x .
.. . -:.:
:.:.:.:-:.:.:. ..:-:.:.:.:.:.:.:.:.: .::: :::: :.:.:::.:...:.:.:. :.:.:.:.:.:.:...:.:.:.::::::::.:.:.:.:.:.:.:.:.:.:.:.:.:.:.. .. 
. .. . .. . .. . ...... . -p ..: ....... .................................................... - . . . 
.......... ....... . ...... ........... .................... ................. 
. .. . . . . .. ......... ... 
:,-
 . . . .. ................................... ............................. ....... .... . . . ............................... 
.:.:.:.:.:.:. .': '.. ...... . . ....:. ::::-=-;ø:::::;:.:.:...... .......................:-: -:.:-:.: -:.:-...........................'..-: -:.:-: -:.:-: -:........................... -:.... 
?:::':.
: :::: ::

::
::::
 ..- .t.-;
W;.;;: :-
.:
:$;:::::::::::::::::::::: :::::::::::: :::::::::: :::::::: ::::::::: :::::::::::::::::::::::::::::::::::::::::::::: :::: ::' 
.. . :
.. .:.. .:::::ý; /.IZW..1'iØ(.::-.-::::::::: :::::: ::::: ::::::: :::::::::: :::::::::::::::::::::::::::::::::: ::::::-:-::::::::::::::::::::::::::::::::::::::' 
-:::::. ::.: :::-} ;-::"// 
"':-;
::::::::::'::-

::..',,:::::::::::::::::::::::::::::: 
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::: :::::: 
... ......... .."/ 
?==........ ............ ...................... .................... ., . .. . . . .. . .................. ... ... ... 
l


f .:





 --:.. .::;
::











;
















;. 







 
 

















 





 





 

 
 
 
 
 
 
 

 
 
 
 
 
 
 

 
 
 
 
 
 


 
 

 
 
 


 
 
 
 

 

 
 
 
 
 



 

 
 
 

 

 

 
 
 
 
 

 
 
 

 
...... ... .(.& ..................
.......... ..
 ................... 
 .. .............................-'!...... . .. . .............................. ... 
I... . 0;.. -;-; ...............;... ............
 
 .. . .... 
... ............ . ( -'.... .................... 
. . . "J' ... .
 · . . . . .._ . . . . .. .. ......... . . . . . . . . . . . . .. . . . .. ................... 
:.:.:.: : 
J' m ......-.........:.:.:...:.:.:.:.;.:.:......-...... .. -:.:-:-:-:-:-:-:-... . 
.:...... ........:-:.:-:-:.: . :-:.:.:-:':.:................:.:.:.:.:.:.:.:.:-:- 
.. . ... .. 
 ."'................. .,.............9.. .............. ...................... . . . .. ...... .....,............ . . . . . . . . . 
....... .. . .
.. .
. --. . .......rI'........ . . .. .
... ...... ................ . . . . . . . . . . . . . .... .............
.......... ......... 
I,'... . . . . . . .:.:.:.:. . .....:.3.:.:.......
........ . .... . .. . .:.:..... . .: .:.:.:.:.:.:........... .......:.:.:.:.:.:.:.:.:.:.:.:.:.... .............;...:......,:.:.:.:.:.:..,.... 
. .. . .y
. . .
.. . . . . . . . .. . .. . . . . . . . . . . . . . . . . . . .. .. ....... 
 . . . . . . . 
.: X. a A.:.:. >>.... .t.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.... ::-:-:-:-:-:-:-:<.:-:-:.:.:-:-:.:-:.:-:.:..:-:-:-:.:.- .. ....... ..:... .....-__.. .
... ..:...:-:.. 
. 
 . :..r.r . 
:: :).:-" .
:::
:. :.: .:.:.:.:.:.:.:.:
:::::: :::::
: : -: -: -: . :- :-:-:- : -:.:- :::::: : : : :: : :: : : : :::: :-:- :- :-: ':' .. :.
: .:.::.... ,. : :.
:::::::::.:.....:.:. :.: .:'.-: 
: .....
. .tI........:.:.:.:.:.:.:.:.............. ............:.:.:.:.:.:..............................:.:.:.... .... . ......................:.:..
.:.:.:..c 
. . . . ,. .......... . .. . . . . . . . . . . . .. ....................................... . . . . . . ...... .. .Y... .. ... 
.. ........l'. ...............................,........ ó'.:.:.:.:..................... .......e..-'...:.:.:.:.......................... ....
.:.................... .... 
. .... . i ..'. ... . .. . . .. .. . .. .. .. . 
 ........ ... .............. .....
....... . . . . . . . . . . . . . . ... ..-.......,....... .." 
.11 · .... .I'. ...................................... ............................ q:. . . . ................................ .................... ...... 
.
 . .." ..... . . . . . . . .. . . . ........ . . . . . . . . . . . .. " ........... . . . . . . . . . . . a ... ... . . . . . . .. ... 
...:...... . 

.. ...........:.:.:.:.:.:.:.:.:.:.:.:.......... ..-:-:-:-:-:-:-:-:-:.:.:w............-:.:-:-:.:.:.:.:.:.:-:.:.:.: . .,.....
...:...:.:.:.:...-. 
........ .. ... .................. ......................... . ... . . ._......._.....
Y................. . .. ....................... ....... e......:................ 
.. ." þ . ...
 ........... .. .... . . . .................. 
............. ....
..:................... . . . .. _ WI ... "................ . .. . ...... 
.:..:.. ".- ...:.:.:.:.:.
.:.:.:.:.:.:.................. .:.:-:..:<<<.:.:.:.... ........:-:-:-:-:-:-:.:.:.:-:-:-... .. . .......:.:.:.:.:.:.:.:.:.:.:...... 
....... 
.. ..:...........
..... .... .......:.:.:.:.:.:.:.. . ... ......... .
.. ....... 
....................... ... ........ ...
..:.:.:.:......................._.... 
:.:.:.:.:.:..... :/ ." ...................:.:.:.:.:.:................ . ......:.:.:.:.:.:.:.:.:.:.:.:.................:.:.:.:.................. . . .. ..... .a. ... .......... 
.... . ......
 
 .. ...................... .... ............. ... .. .... . . . . . . . . . . . ................. . . . . . . . . . . . .................. . . . . . . . ..... 
:.:.:.:.:.:....
. .... .........:.:.:.:...:.:.:.:...:.:...............:"...:.:.: ":":.:.:.:.:.:.:.:.: ...... ..:.:.:..:.:.:.:.:.:.:.:.: .:.:.:.:......... ...:..... :.:.:.:.:.:.:.:....1 
............"'.",./../--"-... :.:.:.:.:.........!................. . .. . .. . .:.:.:
.
. .......11..................:.:.:.:............................. .... . .:.:.:.:.:...:.:.... ..... ......ß.1J.J 
. . . . . . X-:->>: . · · . . . .. . . . . . . . . . . ;-.. . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . ..-"......: · .
J 
:::
:
:::;:::;::::-...;:::::: · ..:.:.:.:.::::::::::::::::::::::::::::::::::::.:;:::.' .:
::;:l :
:
::: :::::::::::::::::::::::::::::::::::: :::::


:;:


;:::-.:-..;;:-=

-":.
:::
:
 



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 . . ......::: ::::$:
::::::' ::: .
:.:..;

:::::::::::: 
'ilscharged, They both thanked me for all I'd interest in emergency nursing and belietin the :.:.:.:-...... ." ......:-:.. ,... -:-:-:-:.:.:.:-: 
Jneforthem while he was in Emergency. Mr. importance of emotional support of . ....:.:.:.:.:... '.:.:.::.:. :.:.:.:-
.: -:. :.: -:.': -:. 
. 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 ',' :':':':':.:..:. '.:.::-:-: -:.:- :-:-:
.:.:-: -:-. 
.:.:.:.:.:.:.:.:.:.... ....:.. ..............:.:.:.:.:. :.:.: 
letween night and day." specializing in emergency nursing. . . . . . . . . . . . . :? . . 
 . . . .. .. 
. ....................... .". ...... . ......... ..... 
Thinking back to that evening, I tried to ..... ........................ .'. ........... ........' ..... 
call exactly what I had done which seemed -:':':'. .:.:.:.:.:.:.:.:.:.:.:.:.:.
:.:.:.:.:.:.: .:-:.:.: :.:.: 
.... ...................... ...... 
jO mean so much to Mr. and Mrs. J. Besides . . .. . · . ... . . . . . · . ....
 · . . . " ." .".. .. 
..:-: .:.:... ..:.:.:...:.:.:.:.:.:.:.:Y;.:.:.:.:.:.:.:.: 
...: ... .. 
Jiving him the necessary physical nursing .-:............ ....................... .......... 
I I h d . I I . I . . . . . . . . . .. . .......... "'. ........ .. ... 

are, f
t I ad one Irtte e.se but be 
lIe
ty .. ....:-:.:-:-:-:-:-:.:.:.:.:.:.:.:.:.. . .. . .:.. . ___..... . 
 .
... .:.:.:.:.:.: .:... ........ 
rt t M J d d t f h f . 
 .... ..... - . .... 
"uppo Ive 0 r. .an conSI era eo ISWI e .. . ..... ............................. ............
 ..... .......... ..' . ..... 
. . . ........................ < -: <..:..:.:-:-:-:::::::::::::::::::::::::::::::: :: . ::: ::::::::::::::. .:.::::::. 
 
 :.:... ::.:.:-. .:.... .:.. 
. . ....... ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . ....... ....... ..... 
 

 .. . . . . .,....... ...... .... .... 
.................................. . . ::<< 
 ....... .... 
.. . . .. . . . .. .. .. .. . .. .. .. .. .. .. . . . .. . .. .. .. .. .. .. . .. . . . . . . . . .. . . . . . . . . . . . . .... . . . .. ""-. -----. . . . ." .. .. 
. '.' :-:-:-:. :-:-:-:.: .:-..... .'. ........ ........ ............ ...... ......... ...:.' ':". :.:.:.:.: .:.:. :......:-. . . ....; ..

 . .. '\.........
 .... .,.. . I 
.'::: :::::::::::::::: ::::::: :::::::::::::: :::::::: ::::::::::::::::::: ::::::::::::::::::: :::::::: :::: ::::::::::::::::' .,::..:. 
 :
. .
-:::::::" 
:. .

: '. 
.................................................. .' .., .
" .-.......... &. -.::::.. .... ).... 
. . :..:..:..:..: ..:.. :..:.:.. :..:.. :. :..:.: ..:..:. :..:.:.:.: . :..:..:..:. : .: .: .:.:.... . .. ..... .. ..... . .. .. ... ..... . . .. . .. . . . . ". . .. .. .. . : ". ..: . ..: .: . : . : . : . .. ..:.:::.. .. -:
.:.:.:

 -.:.: . :.: .:.. . 
.............................. .. .. .. .. . .. . . . .. . . . . . . . . . . ............................................................................ ............ ....... . 1% ....... 
..:..:..:..:..:..:..:..:..:..:..:.::::::::::::::::::..:.:.:.:.:..:..:..:..:..:.:..:.:.:..:..:..:..:.:..:.:..:.:.:.:..:.:.:..:.: .:..:.:..:..:..:..:..:..:.. 
... .:.:.:.:.:.:.:..:::::::::::::::
 . .. .:::: .. : . ... . . .:.;.
.. 
......... .................................................. ...... ..... ..-. 
:.:.:.:..:.:..:.::::::::::::::::::::::::::::::::::::::::::::::::::::::::.:::..:::..:.:.:..:..:.. :.:.:X
,=:.:-:-:.:.:.: ..:.:.::. .
:.:.:.:.:.:::::<.=-:.::::::::::::
::. · .:=.:.:. 
.:.............. ............. .............. ......... .............. ........... ......... ....... ..:....: ...:.:.:.:.: iIÆ ... . . ...:..:................. ... ...................1(;.................... . .:.. 
.. . .. . .. .. . .. . .. .. .. .. .. . . . .. .. .. .. .. .. . . . . .. .. . .... . .. . . . .. . .. . f · · . . . . . · .-. . . . · · ..... . ... 
................................................................................ '- 1 ..... .... .... ............... .................-.. .... .................................
..... 
: :.:..:.:..:..:..;..:-:..:..:-:..:-:..:..:..:-:-............... .:....:-... . -: -: -: -: -: -: -:.:.: .:.:.:.:- - . .... >. -:.:-:-: -: < -: ..:.. .:.:.:.:.:
.:.:.:.:-:.:.:.:.:.:.x...... · 
. . .. . . .. .. . .. .. .. .. .. . . . .. .. ............................... ................................. . . . .. . .. .. .. .. . . . .... __.... . ..... .....
 .a.. .......... 
........,"".......... ... . . .. .. . .. . ., ,.......... . . . . .. . ... . . ................................................ .... ...... ............ .... ....
. .-, . -.. 
'I!.......
. .........:.....................:..... ..................... ................................-......-.... .......... ..... ...... ..

...................:.....:......-:-..... .......
..... 
I... ... .-.. ..........' e.. .
........e................................... _.. .......................__........ ...... .. 
,....... ........ ... ... ... .. ..-.. .. ..,., 
 .................................................-....-..".-.. .... ........................................ ... .. . 
. . .. . . . .. -"- . .,.. . "'.. ... .............................. ... ... .
.......L.......... .......-.. 
 .,..... .. 
...... . .......... . ...........:... . ...:'.. 
 ,.-:.....................-..........................._....... .. .'!............r......................;..... . :::,.. 
 '. 
'.:.:. .: ...:.:.:....................... ., ....:.:.:. ... ....:...:.:.>:.:.:.:.:.:.:.:.:.:.:.:..:.:..:..:.:.:..:.
.-...:-...:.:.:.:.:.:.:...:.:.:.:.....:.......... :
.:.:.. .. 
. . . . . .y.,..................... ... . . ... ... . . . . . . . . . . . .. - . . . . . . . .. .. . . . . . "x · . .. . . . . ... . . . ..... .......... -=.. . . · 
.:.: .:. ........y............ ..... .". :............;.....:-:-:-:-:-:-:-:"'..:.:.:.:.:.:-:-:-:-:-:.:-:-:-:-:-:.... ... .. ........................................ . .. ,, 
 . ....... 
. . . ............ -:-: . .. .................... .. ...... . ... . . .. . . . . ""II . . . .. . . . . . . . . . . . . . . . 
.... . .:-. .:.:.:.:.:.:..:.:.:.:. ... .......................................-:.:....11..............-:-:-:.:-:-:-.-: :-...:. ... .:":.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.. .
:. ..: 
.:.:. :.... :.:.:.:.:.:.:...:.:.... .a ".:.:.:.:-:-:-:->>:.:.:":.:-:-:-:-:-:.:'-.".:.:.:-:.--:-:-:-:..-:-:.... .. :.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:. ,
 
 
fI . .. . . . . . . ......._. . . ........................ .Va-. . . . . . . . . . ... ........................ .: . , . 
.. . . .. .. .. . . . . . .v. .. . . . . . .. . . . . .. . .. .. . . . . . . 
 . ........... e . .. . . . . . . . . . . .. . . . . .. . . . .... . 
 
:.:.. .:.:.:.:.:.:.:.:.... . ..........:.. .' 
 .:- :-:.:.:-:-:-:-: -:.:-: -: -:. ". .:.:.; -: -: -:':-:'. -: -:... . .:.:.:.:.:.:.:.:.:.:.:.:.:.:...:.:........... .... 
. ... .. . " .. . . . ... .......... . ... . . . . . . .. . . .. . . .. . . . ..
 ........ . . . . .. . . . . . . . . . . . . . . .-.- . .......... .... 
....... ................. ....... ...... . ................................................................... ....................................... .... 
 
. .....:.. a. .... ....... -.. .:...:.:.:....... .......... ................... ... ....................... . ... .. . ... .!. . . .. 1. ..... ... ..... .... ...... .......... .... ........ ...:.:.:.:.:. a. 
_..::: .:' 
::::


:::
:::
::.:::.:::. :::: ::::
.
:
: 
:
::: ::::::::::::::::::::::::::::::::::: :::::::::::::::::::: :
:::::=., .... ...::::::::::::::::::::::::::::::::::::::::::::: ::. \....1 
'=:...::: 
. .. .".................. . . . . . . . .. . . . . . . . . .. . . .. . . . . .. .. . . . . . . . . .. . .. .. . . . . . . .:;...........................!..... ... . . . . .......____. :-:
..I 
.....'-'.....'--.. .... .........................................................................................._......._.... .................... ... ....... -. ....N ....
...I 


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 


I- 


. 


, 


Y'''' 


CJ) 
Q) 
"- 
CO 
o 

 
CO 
Q) 
a: 
CO 
+-' 
c.. 
CJ) 
o 
I 
CJ) 
..c: 

 
CJ) 
Q) 
> 


>. 
Q) Q) 
J::. J::. 
...... ...... 

 cD 
CO ..... 
J::. 
 
,g 
 . 

 'ë.. E 
c::: (/) Q) 

,g.s 
'0'0..... 
=Q)Q) 
J::.Q).t: 
(,) c::: CO 
ÕE"ð 
..... Q) 0 
Q)J::.- 
..0...... 0 
E............. 
:J 0 (/) 
c::: Q)-O) 
O)C:::c::: 
c::: 0.- 
.- >.
 

 c::: c::: 
o CO ..... 
C, '0 2 
......'S(/) 
:JoQ) 

{5
 
CO _ 
 
EêO w 
(/) J::. (/) 
co......'O 
(/) Q) 
 
- 0) '[: 
Q)'O....... 
êi>
..... 
- .s<' 
 ëi5 
. OJ::. 
'<<5 c::: ...... 
+:;
c::: 
, 8 
 0 
, 
$
 _ 1 
>0 0 
0_. 0 
zEc::: 
E 8'
' . 


t: 

 
(!) 
::.... 
.s 
o 
.... 
o 
a 


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 


1\1\s 
1 
i\1e, 


"- 
a.. 


, 


k 
, 


-- T7 " 
! '? t: 


'\ 


, :1 


"" 


') <
 
'\' 
r
 
\
 


Sh efr ( 
i 


L. 


a 
::7 


ht:-\'QI 
'0 '\'5 oN 

 \ O
\f)
 
rf\ ' 
0: 'po..by. Þ i ,( 



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 


\
 


0.. 


l 
 l\\L 



 



. 


Jt..
--"'" 


.r 


-
- 
.... ,... !" ... 


\- 
\
y. 
_1 


_ -r 


..... 


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). 


8y 


b\,øw"'- 
'n...' w.. \ 
bet" I 


,>tJÞ, 
}\J $t 


----:-- t4e xr
 
\
I
 I ,. 

 too
 -r c:o, \. 
 P -, 
nO 
\-u l
 

 .l 
 
. 
A 
\ :.... 

 


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. 


Ð 
t he. 10] r.cW\ 
. 
ThiS t
 


flJ 
- . 

 " 
"^ - 
..., I q'r
r , 


 . 
() , . . .-, 
) 
". 
1 ! ifl !
 I 
. . '!\t 
\ "? 
 
, !'lot \ 
 b
J. 
- . 
---......... \ h 15 0- 
+ e. r-t 

 q 
'\, 


- 


\ t 
ç::!, ..r' 


w 


()y1 



 
. 



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 


I 


Loò 



. 


e{
VQ..def' / 
f 
3
e"; 
\:.. I . 

41 
\; ( YJI 


ty>e. 

f) 
Ü 

t 


í ! 
--.. leI 
I 


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 


L,t k I< oiS, I .I 
Clark
 i I 
-1-0 s. 
e 
f 
I 911' f 
k 
(L, f a.ll q 1 
biG< d i-h lone 
L 


nt.rs 


. 
\
, 
'. "'" 
.
 
'" 


OQ 1) 'f 


tl. 5 ' 
· 9/
f 
 
i · Q:.-- -
{I) 
, 
I 
I 


.... 

 



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 


---- 
'e X ------ 
r-a.. u 
1 rÐ I),,) 
+
n+ o..f)J 
fl t
e 


fl.h" 


<l.. 



t 


X rat! P . 
I It. ì,U'5 

 IOVCld 
el' Q. Yld 


Of} 


the 


.. 
oorn 
. 


<- -
 
...;. 
.....J" 


11.(;' 
led 


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. 
 


':) 


. 


.... 


- 


I 



 


. 


... 


\ 



, 
- 


I 

 


I 
 
3: 
:; 
ê 
-0 
;7 
o 
Õ 



. 


ea 


er In 


\ c:IN.IcAI ,I"" : 
4a.aø.fiU'EoA."III ....
 


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 


-.. 
,Iwtd 
f1I 
.-.. 


- <- 


D 


EMERGENCY-ROOM CARE, 
3rd Edition. 


J:'
f:.. 
..' 
"e
: 
'Î
Y1? . 
...!t, 


. 
". 




 


; 


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 
implementing of treatment with the best and latest tech- 
niques. The use of mental checklists and other fast-solution 
memory devices is discussed, as well as immediate and 
thorough assessment of incoming cases and coordinated 
emergency-care response that must often succeed in 
minutes if it is to succeed at all. 


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 
of putting a problem-oriented charting system into effect, 



eat 


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 
will enable the emergency department nurse to properly 
assess the patient and implement a sound plan of nursing 
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 emergency nursing 
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 


I 


tÞN 

 

 

 

ry 


HOW TO COLLECT 
AND RECORD 
A HE L TI-' . ECORD 


This is a unique primary health care book that fits 
into the POMR methodology by focusing on the health 
history-the initial component of the POMR data base. The 
format is unique: it can be used by all personnel involved 
in direct client care; for 01/ clients whether well or ill; and 
at any stage of the client's development. Use of this format 


establishes base line data, makes the data accessible and 
retrievable, reduces the need for multiple, repetitive inter- 
views, and affords greater consistency in data collection 
and recording. This Health History promotes a comprehen- 
sive multi-disciplinary approach to health care, Techniques 
for establishing an environment conducive to effective 
interviews are discussed along with interviewing procedures. 
Numerous examples demonstrating effective practitioner- 
client interaction are included: how to listen to the client; 
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 


J. B. LIPPINCOTT COMPANY OF CANADA LTD. 
Please send me the books I have checked for 15 days 
'ON APPROVAL', 


o Ambulatory Care Manual For Practitioners. 
o The Practice of Emergency Nursing. 
o Emergency-Room Care, 3rd Edition. 
Paper, $12.50 Cloth, $17,50 
o Clinical Protocols: A Guide for Nurses and Physicians. $8.75 
o How to Collect and Record a Health Record, $3.95 
o Dynamics of Problem Oriented Approaches, Abt. $7.50 


Abt. $12.50 
$15.75 


Name, 


Position. . _ . . . . . . . . 


Address. . 


City. . , . 


, . . . Provo,. '..' Postal Code. . . . , 


o Payment enclosed, ship postage and handling paid 
o Charge and bill me 


o Chargex Acct. No. , . . 
o Master Charge Exp, Date, 


LIPPINCOTT'S NO-RISK GUARANTEE: 
Books are shipped to you 'ON APPROVAL'; if you are not 
entirely satisfied you may return them within 15 days for 
full credit, 
Prices subject to change without notice. 


Lippincott 


J. B. LIPPINCOTT COMPANY OF CANADA LIMITED 
Serving the Health Professions in Canada Since 1897 
75 HORNER AVE, TORONTO, ONTARIO M8Z 4X7 (41&) 252-5277 


CN776 



30 


The Canadian Nurae July 1976 


- 
· .1 .. : 
@ @@Fl

@Flt@ti@Fl with 
e@lit
 


.ø' 

,' 
'-' 

 


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) 


At Last... 
 
a Canadian supplier ,;r.; >- 
for nurses needs - .1(' 
No worr)'IrI9 abour ,"'. - NodulytolWf. 


\HIH t:\ ER\ ORUt:R. 
f R E E \\ hit. vinyl POCKET SA \ ER for 
1.1. IM"n!!l. 
ci"1!oOn:. ett. ("hf>(," box on 
I'oupon. 


STETHOSCOPES 
M RSES STETHOS{'OPt.s 17! 5 
colours. Exceptlcmal sound 
transmiuJOn. adjustable 
lightweight btnauroLs; 
replacement partl at-'wlable 
inCaMda,II
nSuver,II
15 
Gold, 1I
90 Blue, 11492 
Green, 11494 Red. $9.00 
noh, i'llClune. initiaU 
engravf"d frpl'. 
In AL HEAD STETHIISfOPL 
.4mpllfif:s allfTf:quencles. Rnutes 
section has e:ctra largt: diaphragm 
AdJU3table chrome binaural.. 
4U 515.95 ...h. 


SPHYGMOMANOMETER 


Ruqqed and d.pendabk, u,th 
Aneroid gauQI! raJibroted to JOO 
m.m \.elcro touch-and hold 
r......""'\ cult. Handsnm
 zippf:!red caSE' 

 < .9.-7.
 10 "earglVlra..tee. 11115 
- ,. '. $24.95 .aoh. 

 Includes I1Utials f'nqruLf'fl 


n.'" 


OTOSCOPE SET 
r .,'0_ 
m. .---' 

 


One of Germanl/'s fmest 
i7lstrumertts ExceptIOnal 
,Uum;natÙm. pOU f!rful 
fflIlQnllymq teflS. .f standard Size 
spl:'rub.J S,zt' r butft'nf:s 
mrludt'tl "fetal furryl1lY {a..sl 
1l7luf lJ rth soft clnth. IIJ09 
$56.00 each. 


SCISSORS &. FORCEPS 
I.I!'>Tt:R 8A '0 \(;1-: S('J,,
(JR<'; ' , .... 
-I must fur el.t'ry "urst' \.. 
\lanufacturf!d uf frnest steel and 
tÏ7ush d In 
anitury chrome 
:

 E::: :t
 V 
 
IIPt:R-\ TI'G !'>n!'oSIIR'ò r 
Stui7lleU 
tt'd. stralqht hlwfes. 

Î05 5'," sharp blunt $2.1i5.ach 

Î06 5" _harp ,harp $2.115 .aoh 
t#710 -IIZ" IRIS "õfis"'fJr... 53.65 each. 
HIR('EP!'>. 
Fnrf!st Stamless Stilet 51 ., lmrQ 
 
K.II
 Forc.ps Nî24 Strai!(ht. hox lock 5-1.35 .ach 
Kt'liv FOrlt'pst#725 CurvE'd. box )()('k S4.35ell.ch 
Thumh Dr(''''!'!.m
 t#7-11Strallo{ht. "'E'rrdtt:'dS3.35 E'.coh 


:\LTRSES WATCHES 



 
-t dependabk. I.Ittrarlwe watch. FuU 
numbers fin whitf! face. Red Sli I-'ep t. 
sl'{fmdhand. Chrflml'ctlS*f. stamJ.,..,& 110 
 ) 
:o;h,t'l back Je1LEUed movement. black 'I., '. 
It'uthf'rstrap. 1 yr guarurlh'". II.QOO. "i.rtI 
51
L50 IDtus 9Jcf'nts ifl o,Ltuno ... 


1'
l1n flO',-I. 'l'R
E
: Wnt. on your Compam 
lE'lterhead for our 24 pg. ("ataloguE'" Quantil v 
di"òcounts available. 50 ("fOnt handling chargE' for 
ordE'rs les"ò than 55.00. 
----------- 
Order '0. Itpm ('01. Quan. "tile Price 


HII In 'UlIIC \I SI PPI , III. 
P.II.IIII'\ Î2ti..... IIRllfl\\l11 L'''T. 1\6\ 5\
. 


I 
I 
nd to: 
I "ttrpf't: 
I ("ih: Pro\-.: 
. l'OfoiUI ('ode: _ _ ---I 
------------
 



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 


" 


--. '... 
.. 


..zt 

. 


.. 


" 

 
. 
... 


I 


.. 
v 
..... 
, "I!I' 
,
 . 
- - . 
""" 


.... , 
, 
'\. , ) 
) 
III. 
, 
\. 
4 
... 
, 


Photos by Suzanne Emond 


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 


. Bandalds is a registered trademark of Johnson 
and Johnson Limited. 


f 



 


-) 
'"'I 


- 


I 
, 


- 


. 


-- 


-... 

 


"-. 


r 


'7 


...... 
....---., 


, 



, 


\ 


, 


I 


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 


l 
! 


, 


. 1 


, 


-- 
.... 


,. .:^
," 
-;".. 


-- 


.. t 
.' , .) 
. .I" I. 
f \ ,
(.;., t.. 
. 't. . 
I 
r " " 
\ 
')' , J
 
I 


" 


.. 


\ 


..þ
. 



 . 
,\ " 
...- .. 
,," . 

 
. 



 


.\ 


"4'""'-'- 

 


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 


I' \ 
1 
\.. - 
=- 
. \ 
- 

\ - . 
.0 

 
.. , 


: L;
 '. 

 
" . 
.. 
\ .. 
. 
..-- II( 
t l 
..:1. J 
i - (.., - 
," J
 I f t 
&'- f J 
. : 
IJI 
.' 
, t 
I 
If ) 
..- ... 


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 


" 


" 


J-_. 

,. o>'A 


. -----f'_ 
,... -, 

;"
' 
b 

" 
,. '.'1' 
." -' 
 .. . 
. · 1 
, .' 


.. 
.. 


/. 


" 


", 


l 


-- 


. 


) 


A 
... 


\ 


--d 


\ ". 


"-. 
"- 
" 
" 


'0( 


.. 


... 


, 


. 


1 


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
:UU 


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). ... 


---- 


,..- 


-- 



 



 

 ---- 


" 
" 


'" 



 .
 
..... 
 


------=- 



 


/ 


. 


.. 


.. 
.. 


.., 
C 


I 


t' 
---+ 


- 
.. 


Hidden Answer: Surgical Nursing 


, 


J 


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! 


. 


\ 


. 



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 


\ 


.. 



 


, 


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 
, . . 
t *Reg.TM 
\ . 
:. ' . 
· \
8
 . 
' I · I

:
 
1\. ;

 
" 
, /. 


. . 
 

6 
.
y 
j

 . 
.
 - 7'-. .
 
\.
""'ì\.. 
./
 -,
 
 
r.J
 .. _. -,,= 


* 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 



, 


J ......, , \ 
. \ 

 '--" --. 
 

 ..... I 
\ <"-1/ 
\ r
 
: 

 ,t 
::: 
t w. ... 

 .-
" 
..... 
I :1 
... .. 
,.. 


, '" 
t- 


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. 


.- 


,. 
j 


t- 


" 
I- 
". .- , 
,i"n.... 


-- 


f ' 


.. 


--- 


"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. 


. 


Attach label from 
your last Issue or 
copy address and 
code number from it here 


New (Name)/ Address 


Street 


City 


Prov.lState 


Please complete appropriate category 


Postal Code/Zip 


o I hold active membership in provincial nurses' assoc 


reg. no.lperm. cert.llic. no 


o I am a personal subscnber 


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 
and Welfare 
Canada 


Sante et 
B,en-ëtre socIal 
Canada 




\ð. tor hea
4 

 "..,
^ 
 
j;,
 

 .< .. tIQ 
... 
. 
 
QI (I) 
- .. -- 
.a -- ,-'" -^ g 

. .
" 
- -,', k. 

.
 
 


For detaoled informatIOn 
on available positions, 
Interested applicants 
are invited to complete 
Clip and mail this coupon today the attached coupon 
r-----------I


- 
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 


@ 


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 
I 
I 
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.) 

i'_ %
 
:t '111\ \- 


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 


, 


... 


, \ 


.. 


/ 


.., 


Arctic th 

arrn 


/\ 


· · · · when 
somebody 
cares. 





 


. . 
I ,'t' 'j' 
It. 
'
 :,\ .' 
/7 \ 
 
 \
I: '; )y : 


' 
 
, 
- <:'r..,,\ - - 
 
...... , --J-.'. 
 H 
j'
... ',- (f r''':>' 
'\ . 
r '""' ./'
 . 
 . '-

" 

 / ..A
_ '" 
. -/f, -, . 
' )1 '." ';' "" l&f'k send this 
( -f:<<;:' .,' -..
 coupon today. 

-
 .h---------
 
, I ,y" / 
l " 
I ,; J. t', /. 
 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 


c
 I I 
l;! " . r J j I T r\ .
 \ 


1 1 I 


L J f 


\.. r . .. 


11 1-0. 
:> 


... 


. 1 - 


... 


'\ 


ÆNA 


J 


CNA 


1JoNf()1 ; 
,-" 


1 
I 


CNA 

 


I 
NTfr 
1.:;. . 
,--- 


- 
. 
 
,..........., 


-' 




 





 1r

 1r I



 
 


.. 


C) Style No. 7561 
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 


NE. 


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- 
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 


\ 


\.... t-<= r' 

J' 

 


- 


rr\ 


.. 


\ 


.", 



 I Burroughs Weflcome Ltd. 
:..rn. laSalie. Que, 


"Trade Mork 



- =; 


(
 

 


- 
 


\. 
7:\ 

 



 SSES STARTING 



 

 " 
'. . 
" "
;::"'''';'''' 

\ .. , ' , ". " 
: ' r 
" ... ...-1.... · -: -\I>
': d -- . -' \ '. 
.' '.,
 .... , . .' 
.' .. \, -...t.........
'"".J. -..,"'. . 
: \," . \ :: ':
., ,___.-
-: ":r,. \., ....-I..iol.J......
..........1........
...... ' 
"0 -.. -..---. ""...- ... . ....,...........a.J,J...1 
, ", ..............-.-.... "'0 ....,. .", 
'\. \. . "', '\ 
" :.......,:. 
 
" t ':..... .", . 

 '.'- . 

 
10- 
.. 


 


. 


THE 
CLINIC 


. 


Style 411 


"
"
' . 
..' 



 

 



 


. 
, 


"'III ".R II1II C S 11'''' 06' . C....MAoDA ..AD( ... .. 



T . 


- 


SHOE 
p, M-
 il\,VJh.ai,@ 


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 


,." 

 


'-'" ..., 
'" 


R -) 
> 


L'.\-t 
CV 


r 


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 


.-t>>'-HI)(>>(-( it't- 



 


... 
, 


 
\. \
 
'0.. \ 
I. 


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 
STERILE 
. INEXPENSIVE 
OB DISPOSABLE PRODUCTS FROM HOLLISTER 
Nothing to get ready. nothing to clean up when 
you're through, With every Hollister disposable 
you use, you are ridding yourself of the cross-con- 
tamination hazards of reusable instruments 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 
CORD 
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 
CircumcIsion Tray) 


FOR 
NEWBORN 
IDENTIFICATION 
the Disposable FootPrinter 
conSistently delivers 
high-quality. permanent 
prints on Hollister Newborn 
Identification Forms. 


IF=- =-------- 
/ ------=---- - 


", 


.....
 


'.
 
'\
 


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, 


h spital 


lelepr Ie 


street address 


---::::-:; 


-..::::.:---.-.- 


D DISPOSABLE 
FOOTPRINTER 


MAIL TO 
HOLLISTER LIMITED 
332 CONSUMERS RD. 
WILLOWOALE,ONT M2J 1 P6 


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 


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 wish at no 
extra charge. 
LEATHER COAT DEPARTMENT 
Famous brand of genuine leather 
coats in latest styles æd 
colours - plain - fur trimmed - 
';ta.D
 
APPBL 
FUR CU. LTD, 
Manufacturers of 
FINE FURS 
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. 



. 


.. 



 


., 


J 


ill 


- 
("l-!o,,}.!,D 
- 


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. 



L'eggs@ Nurse White Pantyhose 
available only by mail. 


Here's something specially for you. Famous 
L'eggs Panty hose in Nurse White. And 
they're available in Sheer Energy' Panty- 
hose to give your legs all-day support, or 
regular L'eggs Pantyhose, with their super- 
stretch, super-fit. 


......... 



; 

..., 
, .
 



 


As Nurse White 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 for any 
reason, we'll refund your money or send you 
a replacement pair of L'eggs, whichever you 
prefer. All you do is return it to: L'eggs 
Guarantee, 1775 Sismet Road, Mississauga, 
Ontario L4W 1P9. 


How to order your Nune White Pantyhose. 
Check your size on the size chart, liIIln the order form. enclose a 
cheque or money order and mail to this address 
l'eggs Nurse White, P.O. Box 8116, Toronto Ontario M5W 188 


For best fl!, find your height and weight below and choose the appropriate sIze 
Re g ular Pan ly hose Sheer Enern" 
Heiiht Avera2e Size Oueenslze SizeA SizeB Oueenslze 
4'10" 110-130Ibs. 
4'W 105-135Ibs. 
5'0" 100-130 Ibs. 131.180Ibs. 100-140Ibs. 145.180Ibs. 
5'1" 95-135/bs. 136.185Ibs. 95.145Ibs. 150-185Ibs. 
5'2" 90-140Ibs. 141.190Ibs. 90.140Ibs. 141.1501bs 155.190Ibs. 
5'3" 90.145Ibs. 146.195Ibs_ 90-135lbs. 136.155Ibs. 160.195Ibs. 
5'4" 90-145Ibs. 146-200Ibs. 95.130Ibs. 131.1601bs 165.195Ibs. 
5'5" 90-145Ibs. 146- 200 Ibs. 100-125Ibs. 1261651bs 170 1951bs. 
5'6" 90.145Ibs. 146.2001bs 105.120 Ibs. 121.165Ibs. 170-190Ibs_ 
5'7" 95-145Ibs. 146-195Ibs. 110.115Ibs. 1161651bs 170.185Ibs. 
5'8" 100.145Ibs. 146-190Ibs. 115-160lbs. 165.180Ibs. 
5'9" 105-140Ibs. 141-185Ibs. 120.1501bs 155-175Ibs. 
5'10" 115. 135 Ibs_ 136-180Ibs. 125.145Ibs. 150.170Ibs. 
5'11" 130-140Ibs. 145.170Ibs. 
6'0" 145-160Ibs. 


Determine Ihe price lor Your Order 
3 pairs 6 pails for 
price of 5 
$ 7.45 
$ 795 
$1995 
$19_95 
$1995 


12 paIrs lor 
price of 10 
$14.90 
$15.90 
$39.90 
$39.90 
$39_90 


Available Styles and Sizes 


$ 4.47 
$ 4.77 
$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-----------------------------------------------
 


'", 


. 


- 


oS 
...--- 


........ 


;:. 


. 
;I" 


-. 
p, 


..... 


Nurse White only color available-See size chart 


Available Styles and SIZes 3 pairs 6 pairs for 12 pairs for TOTAL 
price of 5 price of 10 
L'eggs-Regular $ 4.47 $ 7.45 $14.90 
L' eggs - Queensize $ 4.77 $ 7.95 $15.90 
Sheer Energy' -SizeA $11.97 $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' sales tax SALES TAX 
CON N 576 TOTAL AMOUNT 


NAME 


ADDRESS 


CITY 


PROVINCE-POSTAL COD F 



-----------------------------------------------
 



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 


Ne'
s 


f 
I 1 
'" - 
, 
, . 
-- ..--- 
- ; 


.. 


! 


. (#rO' 
\ 


'k, 


\; " 
. 
 
, "'. 
, . 
 



 


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 


, 


" 


/ 

- 
. 




.
 

." 
, . 
\, 


I 



 


., 

 
" . , 


I (>. " 
o
 ! . '.' '.... 
. 
 
> , . 
o 0; 
. 0 \ 
I t 
o . 
 
 I 
, 0 \ ....
 

I:O; 


 
O"
 

 " .' 


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." 


\\ 


\ 



 , 
t 
-. .' . . ; :;-- 
. , 
'" , . . - --- f 

 .. 
.to ,.- 
t . .. \ 


\ 


l 


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. 


... 


\ 



 


"t 



 


f 


, 


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". 


. 

 


.., 
. , 


. 


.. 


ì' 
". 


, 
, I 


I 


" 


.. 
 

 
 ..
 
6. 
..
..., , ".." 
,,\,..,. .., 
.. .... ...,'
 .., 

:.:..\. :
............. 


1 


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 
.= 
I .-J 
I 
I 


169 A


, :o':;

i:=

-'BhI. 1 o Gold 
IIshed. satin or Duotone finish. comb'nI"1 0 S.ftÆr 
satin background with polished edg.nl 
II METAL fRAMED . Smoothpqstlc back. 
.. 
d::


.r:


I:
I
c: 
";,'t.mart professtOl1al appeoirance 
. PLASTIC LAMINATE- Shm, broad yotl'Bht- 
. 
f



:
=c
.:

:

 
matches lettenng. Excelk!nt value 
. MOLDED PLASTIC. .' Simpk! IS smart Smooth 
l ean P[astiC deeply enera
. JacQuer filled. 3 Lines 
gesandcomeBgentlyround
 The Lettering.. 03.1905.29 
original nurse sty
 .. always correct. t___,1abte 559 onl,} 
------------------------------------- 


SCISSORS and FORCEPS 




:
e: :.t;.I.. 
LISTER BANDAGE SCISSORS 
31.'2" Mil..semlr. Tiny, handy, slip Into 
uniform pocket or p
e_ Choose Jewefel'1 
--{;. lold or gleam
 
h
 plate finish 
C!"
 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" 
- J No. 25.72 
traiRhI, BOl Lo.k . . . . . 4.69 
... @ No. 725 Curved, BOI L
k . . . . . . . , 4.69 
No. 741 Thumb Drnslnl Fo
ep, 
Semted. Straight. 5' z". . 3.75 
FDr enll'lved initi.ls add 60.. per Instrumlnt 


MEDI-CARD SET Hond,.,' roler, 
ence e...er l 6 smootr plastic cards (3'h" I' 
S
") crammed with In'ormatlon. E(JJI'Q- 
'""",es 01 Apolheury 10 Mo.ri.lo Hous.hold 
Meas. Temp_ "C to of, Prescr.p. Abbf, Vnn- 
"ysi" Body Ch.m. Blood Ch.m .lo..r Tes\>, 
Bone Marrow Ðlsease InciA:). PerIOds, Adult 
WEts,.1<: In "'"I. .my! holder. 
No. 2B9 Card Set.. .1.75ea, 


:

r
sl
:':õ:
amped on ba.k of 


t
 
. 


. 


. 
'" 
\ 


NURSES BAG F,...I blook 
" thick genuine cowhide, beauflfuUy 
crafted. stItched and riwtt construe. 
.tOn Wltsr repellant Roomy mtenor, 
With snip-in washable liner II1d c0m- 
partments to organize contents Snap 
:1
:rtol,=g



 us:;, 

 
x 12" Your mitilis KClkI embossed 
FREE on lop_ An oublond,", 
..Iu. 01 superb quollfy 
No. 1544--1 Baa (with liner,. . 42-SO el. 
EJ1ra liner No_ 4415. , . 8.50 



 
\ 


14K G.F. PIERCED EARRINGS 
OOlnty, deleoled 1.20 I2K Gold Filled udu.eus wIth 141\ 
=
 I:: f::S,o:'oo
lt;::W



I:::tt
 GIN 
NO. 13/035..,5.95 per pair 
:::-- 
. """"/"Æ
_ 


1 


CROSS PEN 
Worill-limous "'"polnt, Wllh 
sculptured caduceus emblem Full name 
FREE enlreYed "" "-,elllndud. name WIth c:o
 
R
fills avail everywhere. Lifetime guarantee 
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 
No. 3420 Pin Guard. , . 2.95 ea. 


<@[ 
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>:, --- 
he.t lamps, þar'l. meters Remember to check vlta1 ... 
 j 
signs. live medication. etc. Lightweight. compact.. . 
ny," d,Ü ..Is 10 buu 5 10 60 m'n_ Key "ng_ 
 ' 
SWISS 1IIIde_ No. M,22 Timer. . , 6_95 .. 11\ 
>> 
 -.. 
TIMEX Pulsometer WATCH 
Oependable Timex "ursa PIIJsometer CJlendar Watch 
:r"t:
eou




,s a;"


e
S: 

,Ð:
e CI
: 
luminous, ,,1l1te strap. Stainless bKk. water and dust. 
resistant Glft-boJed. 1 year warrantee Initials Urn". 
In IIxk free. 
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 


3 L'ne! 
lenerJ"I 


04.290 699 


) LIne 
Lettennl. 
2LIne5 
lenennl 


01.4902.49 


o 2-29 0 369 


." 


, - 



., 


. ) 


h 


I 
, 


'- 


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 
metel ",<1'< If desired, add $1 u_ 10 pn.. Il1o..; add 'M" 10 Order 
No_ 2I60Mi"'"""", 


FREE INITIALS AND SACK! 
Your intials engraved FREE on 
chest piece; lend individual 
distinction and help prevent 
loss FREE SCOPE SACK neatly 
carries and protects Nurse- 
scope. Heavy frosted vmyl, with 
dust-proof press type closure_ 


LITTMANN COMBINATION STETHOSCOPE 
Maximum sensitivity from thiS fine professIOnal Instrument Con- 

:
t 
re




enr.;;'em
I=ln
'yst

e:- 

r:

nai

 
diaphragm, 1\14" bell Remoy.able non-chdl sleeve Gray vinyl tublnl- 
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
 
No. 4140 Cra,. Slelh , . . 11 95 ea_ Duty Free 


LUGGAGE TAGS 
OR PLAQUES 
Bnpt c:olorlu' I
" I 2
" blosll. 
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 
or Bild Attooh word,n, desired_ 
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 


J 


IN 


= 


CHARLENE HAYNES 


- 


\-\OL;
-\ 

 
\ ; . \ 'OHN. L.P.N. 


.1. 


AI'" 
PIIStic 
51. 
AI ........ .... uhtJ caIdI 


NURSES PERSONALIZED SPHYG. 
Now in Fashion Colors! ,
 
A superb aneroid sphy'C esp<<.ally des1ped 
'or nurses by Reister. preCISIOn craftsmen 
'" 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
: ;
ked
:

IS 
engraved on manometer and eokl 
,limped "".... FAEE. Choos. BL\C
 
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 


"----- 


,'
 
, 

 


./ 


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. 


------ 


"'-' :> WHITE CAP CLIPS Holds .lpS 
'.- firm'y In ploc. ' HlllI-to-find wIIo1. 
Ie pins, 
.....
..... 
 eMmeI on fine spline steel SII 2. and four 
..... 3" chps Included In plastic sßiØ box.. 

 No. 529 Clips 85. per bol (min. " boll" 


w
 
fYPlJ 

 

 
----------- 
TO: REEVES CO., Box 719- C, AttleborD, Mass. 02703 
DRDER ND. ITEM CDLDR QUANT. PRICE 


METAL CAP TACS 'air 01 dlinly 
,"w.lry-<JJlli1y TItS woIh IIlppen, holdo up 
:::1 '
U!.I
.d:CU
= 
J.'OIYf
J.

 
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 
I 
. 
I 
I 


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
 ii!lre welcomed on 
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 


IDNi
 


-.... 


1 


fQ(mer!)o W.rbMOTr '" 
A Subs>draryot atllOf'\3l t het ßJ 
 uclear par 
675 NIIi".ee de Loess<! 
M"""<eal377 Quebec 


...., 


--- 


'- 


'--- 


----- 



 


lit 


...... 


"' 



 


..... 
':'-- 
-!- 
- 
..... 

 
'" 
. 


4f1Ø11!:;;.4'I'" 
-- 
"",- 
.0: 
 
.: 
.. 
.. 
.: 
l 
f 
i 


." 



For that crisp look 
of Autumn 
Buy White Cross
 
Available at yo9 I
 
favourite store .-- - 
 

. 
r ;;;, .-J 


HS 801 
Stripe Jersey, 
60% polyester 
40% nylon 
White only 
Sizes; 4-16 
Sugg. retail 
$25.00 


Stripe Jersey 
60% Polyester 
40% nylon 
White only 
Sizes: 4-20 
Sugg. retail 
$25.00 


Menufactured by: Hampton Mfg (1966) Ltd. 
125 Elmlre St., Montreal, Que. 


'" 


HS 806 
Stripe Jersey 
60% polyester 
40% nylon 
White only 
Sizes; 3-15 
Sugg. retail 
$24.00 


Same style also 
available in 



 


Same style also 
available in: 


HS 828 
Fine Cord Jersey, 
60% polyester 
40% nylon 
Colours: Sherbet. 
mint, blue, 
yellow, pink. 
Sizes: 4-20 
Sugg. retail 
$27.00 


HS 829 
Fine Cord Jersey. 
60% polyester 
40% nylon 
Colours: Sherbet, 
mint, blue, 
yellow, pink. 
Sizes: 3-15 
Sugg. retail 
$26.00 



Tha Canlldlsn Nurse August 1976 


19 


. 



 ". 


.
 

- tG 


., 


, 


,,;& - 
 
 ."i _, "^":" 
. 
 .......
 _ !mI 
- -- .." t\_
 
.:..,;... ..... -':'
.. 
 & 

 .. ,. -- . 
 -..: þ 

t)it!..""- .
;, 
,ø.

1 , 

 
\tS\;-

 
OJ \1 \
S'
 
 
,Ii 
 .... t-_ 


,,

\t 
, .
 


,;. ..
. 

';;;
 
\\ <. 
'\. · ..,,
, '\.. J' t 



. 


z 
Ii 
"Ó 
0:: 
o 
E 
w 
.. 
0:: 
0:: 
'" 
N 
" 
<JJ 
>- 
D 
'" 
o 
Õ 
L: 
a. 


. 



/R( 
"" 


,." 


<t 


.. 


.. 


- 


, " 


. 
'" 

 


,....,..-. 


\ 
. 


. 


..... 


\ - 
\ 
 

 
 
 
· n JLI(Jì.tALTH .., 

ø
. IRSES lIKE 
p
 JUSTa I

 


'\ 
3

",-\ 


. 
J l 


. 


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 


,fI 
. ,,
 


r 


PuBLIC 
NlJRS
lrH - 

 JUS"''SS 
- Otl 
'. ;II" 
S 
 
NØ1V 


ÑBllC HEALTH - 
(@N




 
 

1 1- 
., 
 
,
 :p , 
 
- '
:
/ 
J 


! 


" 


..... 



\.. 



.,..- 


20 


The Canadian Nur.. Auguat 19711 


'II 


.
. 

ir,fJ 


'.' 
 
t ,JJ' J 


" 


\ 


 'lLtp"i _" 
 j 
1 
, {-'t
", 3">'f<:\; c-1 
. h;} Ã "\,:...f"
--. J". 
.Æ1.i/J.' " . L
"' . Ji:l'. l ' 

 
y
.;.,


 


,r.ìi I' 
 .. 
;'}-
(a{
 
........
."" 

 


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. 
("'''-I ^ rtol_,,
t_C" u,.ðro I"'\ffi,..i
lI\I u.,al,....l"\rY"'I.a1"4 


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." 


....., 
... 
/........ 3 
L 
>.j 


Patrick Watson 



The CanadIan Nur.... 


"L 
 
\ 
\ '\ 
'\ 
""'II , 

1 , 
 
, 
...---.-- , 
, - 
f 
- .. 
. 
. 
 
c 
--f\ " 
I , 
,.. " 
- j ,.' \ 
I (1 
. 
- 
- - 
- 
t '"---- 
f 
 
I I 
 
... " 
..... 
......:- \ 
-; 
\ I ,) 


I 


"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 


. . 


! . 


'"':"\ 


.., 
'" '" 
- 
,J. 
. 
:
/
 
. ' , "" 

' 




 
f 
, 
-:; I 


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. 


. 
 "- '
 
 "" o 

-2: e.>- 
 .: ' 
'_ 
-_., ,- 
':":,

 'I.<

,- _
-'
'::.c':.,
 
 
I h-' ><T)' j' 
 
 "" 
 ,-" 
r>' 
'-'h'4" j ""..,. b' . .. ,;.' - _ ' 
I-f;
Y
 y 
. 
.. r . , 
O
-
J J
 - 
Y
4 .:..
'
-- 



 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. 


.. 
1
) 


"" 


...- 


1f 


.> 


.-. 
 
, -
- 
.. 


. þ' ,. 
t ' 
l 


, 
, 


.- r 
Ii ( 
,/, - \1 
.' "- 

 
 
- 

 .... 
. 
 --- 


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. 



1-- , , r 
, 

 . 
t 
 I' , l
 
,1 , J 
... \ 
, j 
-'" 
, 

 . 



24 


The Csnlldlan Nurse Augusl1976 


" 
# \ 
.... i t" 
. '" 
 \ : 
\ .. :
:=.
 . 
rr 

 '. . : i 
": , 
- ,,' - . 
. ... 
 J
 
 
'. '
 
. .- 'fl"'. : ( 
J " ,- 
....I" --I I( I - 
,&I. ,...J f 
. , ; 
G "It- - f 
, ---. 
..' \ . 
- 
I"- .. 
,,
...... "- . 
. 
--.. ... ..... 
 

 
,
 
\ ... , 
1 
 '/
 
-; 
.' J - ..... 
. 
I> f. 
 
\ -, ..: A "1; 
.......- .' , "- 


. 
.... ' '1IIr" a'
 ' . ì 

 ... 
\ 
., 
r. n. 
... .. '. 
 -' . 
 

 
f. ù, 
, 
;, -- 
1- 
- 
 :=:- 
, ' .... . 
 
... . \ > n 
..... _....
, , 
.. , , 
- 
 

 + 

4' ,.,,' 
.. 
.... ,. 
.,' 
, ". 
. ---- ,I' 
i. ... 
 ....... 
I 
'- 
I I 

 , 
i, ; 

 , 
 
I J I}o 

 , 
I 
, , 
 
.... r , G' 
'- '""\"'.... 
) - . '"\ . \ - 
r .... \ \
\\\\\ J 
... 
\ 



The Canadl.n Nurae Auguat 1976 


25 


...' 
\, 



\ 


... 


" 


.... 


tI/ 


.J' 


v 
.... 


" 


( 


" 


',,,, 



 


" 



 , 


-
 
 
-- 
ãæ - "- 

 
r 


, 

-.........:... 
.' --.. 
-'-
 


. . 


.A. 


. 


. 


- 


- -1 


..... 



 


:(\ 
i 


'- " 
f 


,,'""; 


-a \1
S\1e G é h 
Pst- @S'\l1f\ D
:Û
 . 
FlS Sf) \àF
\\t;'i 


t\ 


"One song leads on to another, 
One ("end to another friend ... .. 


\ 


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 


- 


A 


..:f 


'\ 


.L. 
... 


'? 



í 
" 


-1 



- 


..... 



 



 


Introducing a a a 
your new executive 


t ... . 4Ò) 

 . 
- " 

.,. .' 
It.,,, ' I) 
I 
 


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, 


L-- 


.1 


..... 


,;.!
 r..' 


I 

 


I. 


,,
 
I

 
"'. 


-- 


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 


-- 


27 


-IQ6Tr-pt; 


 

19 


- 


- 


0 
.. 
À- - L... 
>" 
,. . ..... 
./- 
.--I 
---. ... 


I 


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 
nllrcinn m
nl"'\l"\\AJor rønlliromønte: mnro 


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. 



,r 


28 


r 
I 


The Canadian Nurse August 1976 


. 
. 


,4 


- 


:... 



 .- 


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 


- 
" - L 
.. - 
* 
- . - 
 _ T
 


from the meeting of CNA directors 
in Halifax Jun
 18 -19, 1976. 


................................. 
. . 
. . 
. 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 . 
. . 
. . 
......................... .... . 



32 


í 


The Canedlan Nurse August 1976 


< f 
\ (, Oç rv }' '0
 
- '.. , 
, \ . I 
.... 
, , 
"L ' ' . . 
.( " . 
.
 . 
o . "- ., . 
'-- :T , ,(' 
 

 k 
 . 
, .. 

J <- 

 
.... 
-.... 
., . 
.. 
 
:.. , 


 
.,. 
 -. 
.
 .... ..... - .. 
. - 
'" .,.. .J. ::;j -:#
 
:;., ,\ - 

 -- 


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. 
IllES IN CRISIS. Lippincott, 250 Pages. 
1974. S6.95. 
Kaslenbaum, R., Aisenberg, R. THE PSY 
CHOLOGY OF DEA TH. Springer. 509 
Pages. 1972. S15.00. 
Kyes, J, J., Hoffing, C. K. THE PSYCHIATRIC 
CONCEPTS IN NURSING. 3rd Edition. 
Lippincott. 600 Pages. 1974. S9.75, 
Leininger, M. M CONTEMPORARY ISSUES 
IN MENTAL HEALTH NURSING. Little, 
Brown, 196 Pages. 1973. S7.95. 
Meler, R. R. DYNAMIC PSYCHIATRY IN 
SIMPLE TERMS, 4th Edition, Springer. 
192 Pages, 1970. S4.50. 
Morgan, A. J. THE PRACTICE OF MENTAL 
HEAL TH NURSING: A Community 
Approach, Lippincott. 250 Pages. 1974, 
S6.95. 
Morgan A, J., Johnslone, M. K. MENTAL 
HEALTH AND MENTAL ILLNESS, 2nd 
Edillon. Lippincott. 359 Pages. 1976. S6.95 
Shader, R.1. MANUAL OF PSYCHIATRIC 
THERAPEUTICS: Practical Psychopharma- 
cology and Psychiatry. Little, Brown. 
362 Pages. 1975. S8.95. 
Starr, B. D., Goldstein, H. S. HUMAN 
DEVELOPMENT AND BEHAVIOR: 
Psychology In Nursing. Springer. 436 Pages. 
1975, S 1 0.50. 
Uihely, G. B. THE NURSE AND HER PROB- 
LEM PATIENTS. Springer, 192 Pgs. S5.50, 


Bates, B, A GUIDE TO PHYSICAL EXAM- 
INA TlON. lippincott. 375 Pages. Profusely 
Illustrated. 1974. $ 1 8.75. 
Brunner, L. 5., R.N., M.S., Suddarrh, D. 5., R.N., 
M.S.N. THE LIPPINCOTT MANUAL OF 
NURSING PRACTICE. Lippincott, 1457 Pgs, 
Illustrated. 1974. $21.50. 
Bushnell, S. S. RESPIRATORY INTENSIVE 
CARE NURSING. Little, Brown, 354 Pages. 
1973. $10.95. 
Capel, P. T., M.D., Case, D.B., M.D. 
AMBULATORY CARE MANUAL FOR 
NURSE PRACTITIONERS. LippincOII. 
333 Pages. Illustrated. 1976. S 14,50, 
Chow, R. K, CARDIOSURGICAL NURSING 
CA R E, Understandings, Concepts, and Prin- 
Ciples for Practice. Springer. 400 Pages, 
1975. $12,50. 
Clarke, D. B. INTENSIVE CARE FOR 
NURSES, 2nd Edilion. Blackwell. 199 
Pages. 39 Illustrations. 1975. $9.75. 
Cosgriff, J. H., Anderson, D. L. THE PRAC. 
TlCE OF EMERGERCY NURSING. 
Lippincoll. 488 Pages. Illustrated. 1975. 
$15.75. 
Eckert,C. EMERGENCY-ROOM CARE, 3rd 
Edition. LIttle, Brown. 459 Pages. 1976. 
Paper, $ 12.50. Cloth, $ 17.50, 
Fischer, J. E. TOTAL PARENTERAL 
NUTRITION, Litlle, Brown. 454 Pages, 
1976. $25,00, 
Hansen,G. L.CARING FOR PATIENTS 
WITH CHRONIC RENAL DISEASE: A 
Referen
e Guide for Nurses. lippincott, 
132 Pages. 1972. Paper, $4.75. 
Hudak, C. M. CRITICAL CARE NURSING. 
L,ppincOlI, 351 Pages, 1973. S9,95. 
Hudak, C. M. WORK MANUAL FOR CRITI- 
CAL NURSING. LippinCOII. 99 Pages. 
1973. Paper, $3,95. 
Hudak, C. M. CLINICAL PROTOCOLS. A 
Guide for Nurses and Physicians. Lippin- 
Coli, 461 Pages. 1976, Paper, $8.75. 
Mahonev, E. A. HOW TO COL L ECT AND 
RECORD A HEALTH HISTORY. Lip- 
pincott. 133 Pages. 1976. Paper, $ 3.95. 
McFarland, M. B. INTERPRETING CARDIAC 
AR RHYTHMIAS. Springer, 128 Pages. 
1975, $5,25. 
Sana, J. M., Judge, R. D. PHYSICAL 
APPRAISAL METHODS IN NURSING 
PRACTICE. Litlle, Brown. 402 Pages. 
1975. Paper, $9.50. Cloth, S 14.50. 
Skillman, J, J, INTENSIVE CARE. Little, 
Brown. 609 Pages. 1975. S25,OO, 
Skydell, B., Crowder, A. S. DIAGNOSTIC 
P
OCEDU RES: A Reference for Heallh 
Practitioners and a Guide for Patient 
Counseling, 248 Pages. Paper, $6,95. 
Sweetwood, H. THE PATIENT IN THE COR. 
ONARY CARE UNIT. Springer. 400 Pages. 
Illustraled 1975, $ 13.95. 
Wallach,I.INTERPRETATION OF DIAG- 
NOSTIC TESTS: A Handbook Synopsis 
of Laboratory Medicine, 2nd Edition. 
Litlle, Brown. 529 Pages. 1974. $8.95. 


Blair, C. L., Salerno, E. M. THE EXPANDING 
F AMIL Y: CHILDBEARING. Little, Brown, 
276 Pages, 1976. Paper, S8,95, 
Broadribb, V. FOUNDATIONS OF PED- 
IATRIC NU RSING, 2nd Edition. Lippin, 
coli. 500 Pages. Illustrated. 1973. Paper, 
$8.95. Cloth, S9.95. 
Broadribb, V, MATERNAL CHILD NURSING. 
LippincOII. 702 Pages. 1973, $ 12.50, 
Clark, A. L., el .11. PATIENT STUDIES IN 
MATERNAL AND CHILD NURSING:.A 
Fam.ly-Centered Student Guide. LIppincott. 
305 Pages, 1966, Paper, $5.75, 
DeAngelis, C. BASIC PEDIATRICS FOR THE 
PRIMARY HEALTH CARE PROVIDER 
lillie, Brown. 397 Pages, 1975. Paper, 
$9.95. 
Fochtman, D., Raffensperger, J. G. PRIN- 
CIPLES OF NURSING CARE FOR THE 
PEDIATRIC SURGERY PATlENT,2nd 
EditIon. LIttle, Brown. 327 Pages. 1976. 
Paper, S 12.50, 
McKilligln, H. R. THE FIR
T DAY OF LIFE: 
Principles of Neonatal Nursing. Springer, 
128 Pages, 1970, $4.50. 
Petrillo, M. EMOTIONAL CARE OF HOSPI- 
TALIZED CHILDREN: An EnvIronmental 
Approach, LippincolI, 259 Pages, Illustrated 
1972. Paper, $6,25. Cloth, $8.50, 
PIII,lleri, A. NURSING CARE OF THE GROW- 
ING FAMILY: A Maternal,Newborn Text 
lillie, Brown. 445 Pages. 1976. $15.00, 
Reeder, S. R., et .11. MATERNITY NURSING 
13th Edition, Lippincott. 706 Pages. 
lIIusHaled. 1976. $ 14.75, 
Waechler, E. H.,et .11. NURSING CARE 
OF CHILDREN, 9th Edition, Lippincott. 
834 Pages, IIlustraled. 1976. S 17.95. 
Ziai, M J. C. A., Cooke, R. E. PEDIATRICS, 
2nd Edition. lillie, Brown, 1021 Pages. 
IliuSHated. 1975. Paper, $ 1 5.00. COlh, 
$22.00, 


Up · ncott 


Representing in Canada: 
J. B. Lippincott Company, 
Blackwell Scientific Publications. 
Little, Brown and Company, 
Springer Publishing Company,lnc. 


All books sent on 15-day approval. 
(Postage and handling paid by publisher if 
cheque accompanies order.) 



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 
r^fr"...""h_r ""_llr
ð "r'2"'II
tðC'" fit intn ",'U.r 


v 



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. 



 ./ 
Àß
 
'0" -'\ \, , 
" ..... , 
.- ." " ..) 
, ).., - 
I' ,. .... . 
I 
0 \ ..,4. 
 
...., '1) 
...... e' 
"", 
;,/ 

\
 I ... 

, ..I 
"'" 



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,
" føøt h'lf1 Anrll 


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 


\\ IIH E\ ER\ URDER. 
F R E E \\ bite vinyl POCKET SA \ ER for 

n8. .d880rI. etc. Che('k bo,.. OD 
toupon. 


o 

 

 
m 

 

 
)> 


STETHOSCOPES 
"l-RSE
 "TETHOSCOPES on 5 
co/ou.. Ezcepl101l4! 'OKnd 
tran.milllOn. adJ1Utable 
lighttLe.ght bmaKrals: 
replacement part. allulable 
m Canada. 
4I4 S,lver, M415 
Gold, 
490 Blue, M4!1'l 
Gre.n, 
494 Red 19.00 
each. [..clvd.. ....titJU 
engraLedfree 
Dl- AL HE -\D STETHOSCUPE. 
Ampllfie. alJfreqK''''''''. Bowie. 
.ecl.on hw Extra large diaphragm. 
AdJKltable chrome bmaKrals M4JJ US.9S each_ 


SPHYG
OMA
O
ETER 


RKgged OM dependable, WIth 
"'R'_ Aneroid gQlI.ge calibrated to SOO 
:' mom 
'elcro tOKch and. hold 
--:-...- n,,;f Handsome zippered ClUe 

 <, 9
 10 yeargKOrantee. 
lJ5 

' _ 12.1.95 
.('h. 
..... Include3 lFutlall ngra'L d 


OTOSCOPE SET 
?-- 
If \ ..._,,-_ 
!l! 
-
, 

 


Ù71e , Gte rma It 
n trum E
nepl mal 
,UlI.mlnatllln. pOll. r/u' 
",rr.qn' YlRg leFl J standard size 
ula :t I haUenf" 
/.Ilt'd \If tal can-yl a ClUe 
I, "d I ,th surt (. ,th IISu9 
156.110 each. 


SCISSORS & FORCEPS 
'1f 

 


II" rFR B-\ 'lI-\l.F ..n....lIR... 
-t m sr r r l ery ""t,: 
\loTlufactuTt:d fit n !ìt stt'el and 
,-.......hed I sf1
ltar!lchro
f. 
.099 t' $2.60 
tiïOO S3.00 
.lìïO"l SJ.75 


lIPFR \ TI". ..ll....lIR.. 
"'c.J [f t'l. rGlqhl b/"dt 
 
Jt7U;) ,=)I sharp I'lunt Sl.bS ea('h 
>7116 5 sharp sharp $2 l<5.ach 
"-10 -II ." IRI
 ...1'1..c;.nr" 13.65 p&ch_ 
FlIRCFP.._ 
F., :.1 :t1.
l1Il 
,:, Sft.a J " It"nJ 
 
Kpll) Forcppo;; Jt7::!-I 'traIKht. box lock S-J J5 earh 
Kplh Forcpp'" _-;25 ('ur\ptj. box lock S-J.35 earh 
- Tlh [)rp ng- IIi -I 1 
 ug-ht ..prra dS3.J5 .at'h 


, " 


:\TRSES WATCHES 
-t dt:pf' dable aUrar t: U1(JI. I Full 
h h Red 1> 
St -find hand Cia r,,,"fJ ras Wl1ln
 
s' .t back Jeu'<!Ued mG ement, black 
'''''Ither fitrap 1 yr yuaro'J'Jl I ti9, 
SU1,.50 I plus 9J Cf. 1'171 Ontano 



, 

, ) 
11' 


1'..T1TlllO' -\1 'l R..F..: \\rlte on your Compan\ 
letterhead (or our 2-1 pg catalogup. Quanti(y 
discounts a\. ailahlp 5 rent handhng charge for 
order.. It .... rhan S
 I() 
----------- 
Order ,"0. hem "'01 Quan. 
ue Prit'e 


HUIT\ \\HII\' -\1 "l PPI \ (ll. 
P.lI. BO'\ 720-". BROn\\I11 t. lI'T. Ko\ 
\' 


I 
I 
end to: 
I ""trrlPl.: 
Ilïh: Pro, 
. Postal rod.: .J 
----..------- 




 


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. 


( 11//1 


1I11 \/, 


.. 


'"' 
'1\ 


/ 


It 



57 


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. 


, 3cJ
- 
,.,. - 
...... 
, 
.... '.... 
 
Þe:r.s 

 l 
..... 
\ 
.. 
,\ 
t 


Sa\'es 

rOll ti Il1e 
Pampers construction 
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. 



P'
 tile 
r
 Çí
 
ra__I'latc 
.. :..-. 


I, 
I' 
II 


II 
1 
I 
I' 


I 
,I I 
I 
I I 
I I 
I 
I I 
III 
/1 ,1 
'I 
I I 
j II I 
I 
I L14 P 

 I , I I I i p
 r 
lA/I-.. B. 
j ! 
I ! I 
I, 
! 
I; I II 
I 
I 
II 
II 


II 


II 


II 
i ., 
1 1 I 
/ 11111 : 78 KING ST WEST 
../ (, 
?R_c:
:_
.

.!

IO_
5V IN6 


. 

 I 


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. 


\"\. 


t ' 
\. 


.. 
. 


.. 
, 


- 


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 


/ 
I 


.
 
.

 


- 

 


r
 



 
.
 
- '.. 
:-
..: 
-"...., 


. 



 
 


..t
 H 
. i t'} 
.... ... 
ffA 


I 


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 



 
.o

r
s


o

!'
t


T
ANY CANADA L YD. Pncessub,ecllochange 
I- Toor;;' 

 3
daya ;; o
al. enr 
r-;;


 author: - - - - --;. ;;-.. Print: - - - - - - - - -- - - - - -c
;;-I 
I I 
I I 
I 

 I 
I I 
I AU: AU: AU: -POSITION. AfFILIATION (IF APPLICABLE) I 
I HOME ADDRESS I 
I _ _ _ _ __ _ _ __ - I 
1_

k 
losed-Sau
 
 
sta 
_ 

. O.D ._ 
bi

_

_________
O

__ __Z

__I 



62 


The Canadian Nurse Augusl1976 


1\11() ioyiSl101 


- 
,- 
I ' j:,-:W 
t.-'fY' 
-'-'... ' .;.;. - , . 
1*' : \
4>} 
, ';" 4 "'" 

 ,r 
., 
 - 


. 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 
· 
l\



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 · 
\ . 
:, ' · · \
8: · 
, · 

14
 · 
1\ o. .
 
.\ 
, /. 



 
.' ..
 

:-. 

 
/
--..

 
".J
 .. -. .
 



 


. 


. 


.. 



flA. 


. 


. 


. 



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 


We feature a complete collection 
of. sizes and color. for men and women 


image uniforms inc. 
''Professional Career Apparel" 


r 
matt'" chafge 
-...--..-.- 


734 WEST BROADWAY, VANCOUVER 
FAIRMONT MEDICAL BUILDING 
mr 11 


.',
.H
) 


Vancouver. B.C. 


VISIT OUR CONVENIENTLY LOCATED 
STORE OR WATCH FOR OUR MOBILE VAN 
SERVING HOSPITALS IN BRITISH 
COLUMBIA 


I. 
If 


, """I
' 
--a.J, 


- 


...... .. _Mo' 



;;;:; r; 


.
'.;;.F" 
. '.1U...... 
.., . un .. 
.,'''''It...,jij iío". 
>to.,;....... ,t.... . 
.,.... .. 


JiI"", 


i ' 


II 


-)I 


, Un!"Jrrh
 \\1 
 
.....,.......... 


'b. >"'k'
 "I-KJ ____
 
.-3..ÞAI!Ct 
---- 
.M.-'C;..

 
.. 
 v.g

.u 


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
-1t 
C
 [j r.:! 

 
 
!4.1 ::::.. 
is 
 
\- 

 


 
 
-1..-}O (, "'
 
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-- 
CJtß

/J)
S i 0) t
 .,,2;!:OL!ci 

è' 
 

 -7 
 )?\E1'!
 
r, 
J' r\ L' ./ 
 \J -wiT P'J.IlÝ 
\:7" .""\ 
 5ERDEC:.nt lE 
r:;;:

 
'
d's. 1Ja

Ð
 


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 


,;;,
,,:"'i" 
. .
.j. 
!.:.: 
l"
" 
,.,#; J ø:; 
,r,-=:.. ,._f-;..

. 
, :::: # .;....' 'f'-; ..
 . 
( !' ...:.....-:. .',.- ;'-.. 
,', ...... :"'i.!.

..:t '.. 

 .,' ./.;,: ;,...;;..:- ..; 

 . . ",I";!' 
 fl.- .,r 
,": 
; ,:.:;.. .:':F.v
:r' 
I .: '.-=-;' " 
-"'ï;" 
I:" \
 ., 


worth 
looking 
into... 


.... 
t . I. 
.,.; 
. 

 
 . . 


.;.;
':> 
oj-. ,- 
, .. /'. :\4:-< ' '. ,. 
... . ........ J .--J.... :.:.".,.,.. J
' 
 
, Icr...;t.' r.. . jo'(.":. - 
..f ". L}- 1 .'7'AF. , 
 1 
':æ-:.' '., , 
1;/ :) Y "" I .; ,ljf

:zIo
 
','
', 
\ r _:;;J . :1!.Þt.f.. ..: ,., '. 
\ V 
/'
' 
:";.
}.


. . 
'\ / \ / 


 \ ..ti.. 
>, 
I \ / 
I \/ 


I 


O[[upotionol 
health 
. 
nursing 
with Canada's 
federal public 
servants. 


.. 2 ea' 


,..... 


,---------------
 
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. 


I3:Ð:J 



9 76 The Canadian Nurse 


ES1502861935 F 10 1. 
I!N I . 
NURSING LIBRARY 
OTTAwA ONTARIO 


KIN 


," 


.. 


'. 
,. 



 


, 




 


\ A 


A Style No. 47492 
Sizes 3 - 15 
Royale Corded Tricot 
White, Pink .. .about $25.00 


I
 I \NHITE 
H
 SISTER 


- 


See our new iiñë of Whites and Water Colours at. fine stores across Canada 


{( 
 .( 1) 
r( r-- . 

 -- , \ 
\ \ 
. j} 
\1 ( 
, - , 
, '- 


1'1 
t I ! 
,t 
a i I , 
" 
':
 'I' 

i '!i!: 
I,
 


I 
/ 
f
 



 ' 
, I 
! 


C Style No. 7466 
Sizes 8 - 18 
Royale Corded Tricot 
White. Blue. . . . . . .about 525.0 


B Style No. 47436 
Sizes 3 - 15 
B ROyaie Corded Tricot 
White, Blue. Pink 
. . . . . . . . . . . , . .about $20.00 



For the lllany faces of your cHnica[ experience: 


Luckmann & Sorensen's Medical-Surgieaf 
 Gillies & Alyn's Pé}tient Assessment and 
Nursing: A Psychophysiologic ApproaOh Management 
e N ractitioner 
In the two years since its pu
lication. more tr 1 f" ) ')f his brand new texÇb
 and Irene B. Alyn 
yourcolleagueshavead.dedacop
ofLuckmq &SG:>e e .plains the five vit"Lskill
 1 practitioner must 
to their professlonql library. 

_B 
 U 1 clear! ster. It teaches 
 


,o.' physical examina- 
written text consoli<!Mes nearly fit' of the c nt ti'lrlikt{1g ,I. It clarifies the 



 pw ,",social assessment. 
medIcal-surgical purS ing 1nto J3. single e Ity-tead "SOtJr
""'Ei:; Including how t<} e 

b
' ,; 
. tion is necessary. 
book. The autho"" , 'ðlonI Y e>1&,lain t
e g

ràÌ'-concep'b; i h
terpretati6o.of data.
ved fr..' laboratory tests and 
related to illness, s h as homoostasis-7thew @!So 
ve spe
. ami ations is Ì'evie'wed. P',.cflcal guidelines, 
precise instruction r\ the nursing and 
tal q
 
 technl
 bjectives 
ra sugge d for interviewing 
patients and your roleïn health care delivery{,1j1el'tfs de- patients.lndi u chap\er
 discus!; t anagement of the 
tailed discussion of nursing 
asures in disorderS of each of ambulatory patient with 
yj)ertensi çt)holism, arthritis, 
the majorsyst
ms, inc
din . g
e cardiova
cu 
 . r
ratory congestive heå(t failure 
bèSi ríd dia
tes. 
and neurologic systerT1t' T.hé.'
ophysiol 0 ease By Dee Ann Gilßes, R ,E , Dept. ot'\:,ducation, Health 
states is emphasized tlil'
ghO\>It.' -:...
 and Hospital" Governi :c m
orr-"of Cook County, 
By Joan Luckmann, RN
ès, 
j\, ant! KarE:I' Creason Ch;c
d 
Il..e.B. A . PhjXtJniv. of Illinois College 
Sorensen, RN, BS, MN, both-óf the I.. of, ..ish i'I ,ton, of
rsing-. Ctircagb. 236 pp.lliustd. $9.80. April 1976. 
Seattle. 1634 pp. 422 ill. $21.35. Sept. <1 0 Qr #- 05-9. / Order #4133-4. 
"!" f I I 
Th N " CI "" f N rth ' · ri ::! f 
 ytnn's TètXtboo
 of Medical Physiology, 
e ursmg IniCS 0 0 _ mtt. Cj!t 'ámÎm I i ) ' 
 
Here's the hardbound periodical that 

s a I SIi . e 
 G.J1 
 . '
1j' J . _ 
for itself in your reference library....-E æ !$sue' .b!. tf1is-te
 aö
Ji t,
 YSlology textbook for medical s
u 
spected quarterly brings you an in-de-p t xa

fone \.\ 

:s...
IS!A'SO a erb r
nce for nurses. In Jt
 
ortwo important aspects of nursin
 prac ic
e September '\.th,\
y-rer'l; th edltloß)tll
book retains the char 
1976 issue will include a symposiu
 onAI,-D?olism'Qnd brug 
 )act
nstlcs tt1 av.e mad':P"rt so usef
l.. It s orga.mzed by 
Addiction-an epidemic problem i 
 worl
1I oi$*ss, and ,dY---$ystems.. In 
ele
a.nt C\jmcal physIology to 
t d ' t S 0 d h b ht h ì. f I show the rJ1 a ms on hlch'{lfè'depènds. The coverage 
gues e I or usan u as as r t 
,. care u 11 f II b I . 
 I ,., .. b t 
selection of today's best articles 0 y,paAe.J'!m . 
s

re u y a an
ed to vide a og
ca: t, 

sltlon e wee
 
December 1976 issue will feature: sy posia 
 . I 
\ctlons ançJ to Insure t 
 r)6 t IC IS slighted or over 
Rhythms, guest editors-Gtleryl Tom a Dorothy Lanuza; / I 

haslzecj
 In

nded a htudent !
xt. the auth
>r h
s 
and Orthopedic Nursing, g
itor-B rbara Bu . pollsh.ed his writing for b er rea
 bl. ,a
d phYSiOlogic 
years subscription will áÍso' .....e the c 
nti-U,Jne_ 
aterlal of a more general\
ature.ls n ted In a larger type 
1977 issues. I 
 
7 sIze than the more 
IY 
e
JaliZed . ta.. . 
By respected nursi ' " ,. I
 P 
Lished quarterly: ..
 \ By Arthur C. Guyton, 
Q" U
iv. of MI SISSlppl, School of 
March, June, Sept., a 'i .. . 1M nd Co tains no adver- Medicine. 1194 :t '804IJC
,Y5. Jan. 1 
. Order #4393-0. 
t
sing. Averages 185 ,. .IU5 . td. $ 5 ',years S . ubscrip- ' s I 
J ,\l C " ---:-- al M a n g ement of 
tlon. 'o1:lf r 
OO03-9. 0 ?mon us. . 
f
 jlJ:1 
 
; 
 .S
lzur 

.GUI eforthePh}'jiilan,. . . 
Murray's The NorñiarLun 
 : Tb&Ba s for

 

 I
 classlflcatlo pa
rns,. differential dlag- 
.. . -. 
 ' s. and- and neuro
dl(Xloglc procedures are 
Dtagnosls and Tre.dt of u
 ry Disease... \;. '
iptly..disc sed in this authoritative practical guide to the 
This el?quen! VOlu
,? ate 
 'at
 < data on 
 
ftf} m
a" e t 'òf epilepsy. Valuabl
 material on therapy offers 
including dlscovefles
 a Ort1I
, phYSIOlogfsts practl estlons ()('I new antlconvulsants, dosages and 
biochemists, anctrimmunolðgi . Its reve
 insigl;1ts nt \. side effec : what to monitor; and how and when to change 
pulmonary disease-pathogen,ési!?, Qiagno.
tiç proced J :: 
 medication. The emotional. behavioral, social, educational 
choices of therapy, a'ì9 natúral ffist

ased þn a and rehabilitational needs of persons with epilepsy are 
thorough, precise explanation of nor. 
t
 . e-a.!1ð func- emphasized. Many clear illustrations, tables and case de- 
tion. Clinical applications are cre y d 6lftCf1 
.
 - scriptions amplify the text. 
By John F. Murray, MD, Uni of lirorlrià 'S'Chool of By Gail E. Solomon, MO, and Fred Plum, MD. both of the 
Medicine. San Francisco. 334 p .161 W:.. 'ìfí
_èoIOr. $14.95. Cornell Univ. Medical College 152 pp. IIlustd. Softcover. 
March 1976. y; Order #6612-4. $7.75. March 1976. Order #8495-5. 




 
.o

r
S

t
o



t




NY CANADA LTD. Pricessublecllochange. 
r



 3
yapPro
 







----



---------------


 
I I 
, 

 I 
I ' I I ' 
. POSITION a AFFIUATION (IF APPUCABLE) 
I AU: AU: AU: rlOME ADORES !. , 
I , 
L



-=

"
?




'
'_


_

_________
O

____

_..J 



2 


The Canadian NurS8 September 1976 


-r..;;::: 


I
 

 


,,..u 
.... 


Cl4SSES STARTING 


'\:.
>.. . 
" '....... 
. 
\ 
\. 
\ 
\. 



 

 " 
 }J\ 
. ..

'./ 
.. 


-. 
. 

 
. 
. . .. . . . 
. . .. .. a 


THE 
CLINIC 


" 


1111AD1I111A1'111C !life:. ...., OfF . ,.ANAOA ....ct '" 


-- 


SHOE 
".k
ÌI\.
@ 


SOME STYLES ALSO AVAILABLE IN COLORS 


SOME 3Y2 -12 AAAA-E, ABOUT' 25.95 to 34.95 


For a complimentary pair of white shoelaces, folder showing all the smart Clinic styles, and list of stores selling them, write: 


THE CLINIC SHOEMAKERS. Dept. CN-9 7912 Bonhomme Ave. . St. Louis, Mo. 63105 



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 


\.' 


" 


" 


( 


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. 


11(>> 1-(- ill 


}J\ 
'. 
 
>-.

: 
Îlt
 
 
 } 
t
, 
.....Ja. \ 
.' .::

': 
.

.
.:J 
f(,.- ., 


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. 



f)J: 1 , 

"ilV --;! , 
'" \ 


UNIFORM 


A Style No. 47223 
Sizes 3 - 15 
Rib Royale and Gabardine Royale 
100% POlyester Knit 
White, Blue, .about $35.00 


B Style 
o. 47259 
Sizes 3 ':-15 
Rib Royale and Gabardine Royale 
100% Polyester Knit 
White, Blue. . .about $35.00 


desi 
 ner's 
A · 
LIMITED C 01ce 
EDITION 


A PROUD CANADIAN NAME 
· HE F. . N .. · 


./ 
/' 
./ 



 


,\\ 


I \ 1 
1 1 \ \ 1 : 
\\ :1 1 \1'1 
111\ II 


\ 


II 
I 
, 


,
i 
f .I;i)l;; 


, Jf; A 


o 


} 


\ 
( 


;\\1 


L; 



6 


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 
a new pamphlet covering parents' and 
teachers' roles, sex education in the 
school curriculum, unusual teaching 
problems and special concerns. 
Cost: 35 cents from Public Affairs 
Committee, 381 Park Ave., New York, 
N.Y. 10016. 


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. 


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' 8SS0C. 


reg. noJperm. certJlic. no. 


o I am a personal subscriber 


Mail to: The Canadian Nurse, 50 The Drivewav. Ottawa K2P 1 E2 



The Canadian Nursa September 1976 


7 


L'eggs@ Nurse White Pantyhose 
available only by mail. 


Here's something specially for you Famous 
L'eggs Panty hose in Nurse White. And 
they're available in Sheer Energy' panty- 
hose to give your legs all-day support, or 
regular L'eggs Panty hose, with their super- 
stretch, super-fit. 


r 



, 
\\I

'; 



 



 


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 for any 
reason, we'll refund your money or send you 
a replacement pair of L'eggs. whichever you 
prefer. All you do is return it to: L'eggs 
Guarantee, 1775 Sismet Road, Mississauga, 
Ontario L4W 1P9. 


How to order your Nurse White Pantyhose. 
Check your size on the size chart f,lI In the order form enclose a 
cheque or money order and mall to thIs address_ 
leggs Nurse WhIle. PO Box 8116. Toronto Ontario M5W 1S8 


For best hi, find your heighl and weight below and choose the approprlale s,ze 
Re gu lar Pan !y hose Sheer EnerD 
Helghl Average Size Oueenslze SlzeA S,zeB Oueenslze 
4'10" 110.1301bs 
4' 11" 105.135Ibs. 
5'0" 100.1301bs 131 -180 Ibs_ 100-140Ibs. 145 180 Ibs_ 
5'1" 95.135lbs. 136-185Ibs_ 95-145Ibs_ 150-185Ibs_ 
5'2" 90-140Ibs_ 141.1901bs 90.140 Ibs 141.1501bs 155 1901bs. 
5'3" 90.145Ibs_ 146-195Ibs_ 90.135lbs. 136-155Ibs 160-1951bs 
5'4" 90.1451bs 146-200 Ibs 95.130Ibs. 131-160 Ibs 165-1951bs 
5'5" 90.1451bs 146-200Ibs. 100-125Ibs. 126-165Ibs_ 170-195Ibs 
5'6" 90.145Ibs. 146-2001bs 105-1201bs 121-165Ibs. 170-190Ibs_ 
5'r 951451bs. 146.1951bs 110 115lbs 116-165Ibs. 170.185Ibs_ 
5'8" 100-145Ibs_ 146.190Ibs_ 115-160Ibs_ 165-180Ibs_ 
5'9" 105.140Ibs_ 141-185Ibs. 1201501bs_ 1551751bs_ 
5'10" 115.135Ibs_ 136-180Ibs 125-145Ibs_ 150.170Ibs_ 
5 '11" 130-140 Ibs. 1451701bs_ 
6'0" 145-160Ibs_ 


Determine the price for Your Order 
Available Styles and Sizes 3 pairs 6 pairs for 12 pairs for 
price of 5 price of 10 
l'e s- Re ular $ 447 $ 7.45 $1490 
l'e s - ueenslze $ 477 $ 7_95 $15.90 
Sheer Ener . -Size A $1197 $1995 $39.90 
Sheer Ener . -Size B $11.97 $19.95 $39 90 
Sheer Ener . - ueensize $11.97 $19_95 $3990 
Onlano residents add 7
 sales tax 


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-----------------------------------------------
 


j. 


.. 


....... 


" 


< 
- 


.-.c. '1 


......... 


- 


íi '" 
':Aa. P · 



 


Nurse WhIte only color available-See size chart 


Available Styles and Sizes 3 pairs 6 pairs for 12 pairs for TOTAL 
price of 5 pnce of 10 
L'eggs-Regular $ 4.47 $ 7.45 $14_90 
L' eggs - Queensize $ 4.77 $ 7.95 $15_90 
Sheer Energy' -SizeA $11 97 $19.95 $39_90 
Sheer Energy -Size B $11.97 $1995 $39.90 
Sheer Energy -Queensize $1197 $19_95 $3990 
(Check V right box) TOTAL PURCHASE 
Ontario residents add 7'10 sales lax SALES TAX 
CON N976 TOTAL AMOUNT 


NAME 


ADDRESS 


CITY 


PROVINCE-POSTAL COD F 



-----------------------------------------------
 



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 
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% J 


/IN 
'If 7Lp...fu-L 


.-------------------------------------. 
IT'S EASY TO ORDER REEVES NAME PINS FOR YOURSELF OR FRIENDS! I 
Choose style you wonl, shown "&hI. P"nl name !and 2nd bot1om '. AlIlCh ext.. s!leet lor odditlOllal pIns I 
'me rr de$"ed) CO! dolled lInes belew. Check .ther '",. '" NOTI SAYINGS ON 2 JOEIITIt.U. 'INS. .... ......,oot, 
box.. CO! clllrt, clIp this secllOll .nd .lIlCh to coupon ... .. .... II IOSL 


I 
I 
1 LmERINC.________________ 
I 
I 
I 
I 


I 
__ 2nd UNE:______________I 


I 2 PIIs 
UfStWIPT10J BAatGlOUllll lET1tRl1lC PIItES. I ,. = 
All METAL.. . neh, t"m. b"'cred. L 1 &I1 twe ljlhl. I 1 0 Duotont I 0 Black I I L,ne 
169 'oooIh ed
, rounde<j comers. Choose 0 Gold 0 Pol;shed 0 Dk Blue Lene"na . 0 2.69 0 .A9 
sa
:

.:;:

t=:

:I
:imna DSllver DSatln o White 2LIt\eS 
. METALFR....EO...S..-hPIrnICback. Frome o Wh,te !l)Black Lene,,"g. 03A9 OS.79 
.. 
nd With classic, distinctIVe polished metal 0 Gold 
 Gre:
 Dk Blue 3 Lines 
s


'f::.=

n::
Re5andcorners. OSllYer 
:
DWtllte Lettennl.. 041.29 06.99 
. PLASTIC LAMINATE. _ Slim. broad. yet IIght- DWt'ute D g
:. 1 Line 
. Ight Engraved through surface Into 0 Med. Green IQ ue lettern1& .. 0 IA9 0 2A9 
mtrastml core color. Beveled border 0 Med. Blue 0 Mute 
rmtches leneJlng. Excellent walue. 0 Cocoa 2 Lines 
Letterlnl.. 0 2.29 0 3.69 
D MOLDED PLASTIC. .. Simple is smart. Smooth 
I 
=
Pa

t

=


r:?
c:q
fiUed 
;
=nl" 031905.29 
original nune style _ .' atways correct. C.nllM* 559cnf)" 
---------------------------------- 


CHIQS(, 


SCISSORS and FORCEPS 





: :.t;
: 
LISTER BANDAGE SCISSORS 
3%" ....i-sciss.... Tiny. .handy, slip into 
unirorm pocket or pufJe. Choose jewelers 
.L gold or gleamlrw chrome plale finish 
QID No. 3500 3W" Mini,...,... 2.75 
No. 4500 4""" size, Chrome onl, . .. 2.95 
No. 5500 5\-2" size, Chrome ani, . . . 3.25 
No. 7027\4" size. Chrome onl".. 3,75 
For enlnved initials add 60, per instrument 


3V," 
4V," 
5V," 
7'Y4" 


KELLY FORCEPS 
So handy lor every ......1 lde.ller clamptrw 
NO.o
::
;.
Jt'

 ....::". 


, 4.69 
No. 72S Cu",ed, Bo. Lack, . . . . . . . 4.69 
No. 741 Thumb Dressing Fon:ep, 
SerTlted, strought, 5V," .,3.75 
For enlrawed initials add 60, per instrument 


t
 
. 


MEDI-CARD SET Hand;..t reler- 
ence ever! 6 smooth plastic Clrds (3
" I 
5110.:") crammed with information: EIJlIYa- 
lentlts 01 Apothecary 10 Metric 10 Hoosehold 
Yeas., Temp. oC to of, Prescrip. Abbr_. Unn- 
"ysis, Body Chem, Blood Chem, Liver Tesls, 
Bone Marrow DISease IneW!_ Periods, MJlt 
Wgts, etc. In willie vinyl holder. 
No. 2B9 Card Set. . . 1.75 ea. 


\
r
..X31:ö:
"mped on blck of 


,
 


POCKET SAVERS 
Prevent stains .nd wear! Smooth. pli- 
.ble pure wIIlte vinyl .....1 low-cost 
I'OOp g;l\s or 11VorS. 
.... 21M liar 11ft), two compartments 
;:

1ò'

:$
 caduceus. . . 
.... 791 alft) Delu.. Saver, 3 compl, 
chango pock_I & key ch.;n . . . 
PIcket 016 far $2.98 


Nurse
' POCKET PAL KIT 
 f 
Handiest fOf busy nurses. Includes white 
Deluxe Pocket Saver, With 5
" lister Scissors 
!both shown above), T ,,-Color ballpo;nt pen, 
plus handsome 1;l\Ie pen h&hl . . . .11 SlIvw 
finishtd Change cønpartment. key chain 
No. 291 PlI Kit. . .6.95 ea. 
Initi,)s enlraYed an shean, add 50_ 

 TIMEX" Pulsometer WATCH 
Dependable Tlmel Nurses' Pulsomelar/Calendor Watch. 
:r
:
t






:e:
:= 
.O:
eCl
:t 
luminous. whlta stnp. Stamless back. water .nd ckJst- 
resistant_ Gift-boled, 1 year warrantee. ..itìIb "If'I'I. 
I. bc:k Fro.. No. 237761 Nurse" Wit"" . . 
19.95 ... 


. 
--" 


PIN G U A R D Sculptured caduceus, ch.ined 
to your proressioMl letters. e<<h With pinblck/ 
safety catch. Or replace either With class pin Gold 
fin;sh g;1t boled Choose RN, LP
 or LY't 
No. 3420 Pin Cuard , . . 2.95 e.. 


t
 


ENAMELED PINS Beaut;lolly sculptured status 
insignia. 2-color keyed, hard-fired enJmel on gold 
AI (\ plate. D;me-sozed. pin-bacl Specify RN, lPN, L'iN, or 
I 
,., 
A on coupon 
No. 205 Enam. Pin 2.49 ea. 
Bzzz MEMO-TIMER T;me hot p.cks. 
II 
heat lamps, p;Mk meters. Remember to check vital 't:Þ 
S;K\1S, gIve med;...lion, etc. L;&htwela\ll. compact . 
n Y2" diaJ. sets to buu 5 to 60 min. Key rilll. 
Swiss made No. M,22 Timer. . . 6.95 



. 4 '8 
.., 


\ 


Co 
;1 
s .. 
. 


QUICK DRUG 
REFERENCE BOOK . 
Simplifies 2400 drug names & usages, ancludinl 
.enenc ws. brand names, dosaIes. hazards, f roven- 
tlonS. 420 pae:!S, cross Indexed A wealth 0 l'1andy 
info. 
No. 3791 ODR.. 9.95 el. 


(, <.[b 
....: 


,- 


) 
r 
, 


. ) 


.......... 



 


Free Initials and 
Free Scope Sa
 with your own 
LittmaUD Nursescope! 


Famous Littmann nurses' 
diaphragm stethoscope . . . 
a line precision instrument, 
with high sensitivity for 
blood pressures, apical pulse 
rate. Only 2 OlS., fits in 
pocket, with gray Vinyl anti. 
collapse tubing, norH:hilling 
epoxy diaphragm. 28" over- 
all. Non-rotating angled ear 
tubes and chest piece beau. No: 2160. Nursescope 
tifully styled in choice of 5 m
l.udmg Free 
iewel-like colors: Geldtone, Initials and Sack 
Silvertone. Blue. Green, Pink.. Duty Free ...16.95 ea. 
.IIII'ORTAIIT: Ne. ' MedallIon' styling includ.. tubIng ;n colors 10 matcl1 
molal ..rts "deSired odd $1 .. 10 p"ce above; odd . M" to Order 
No. 2160!!II CO! coopon. 


FREE INITIALS AND SACK! 
Your intials engraved FREE on 
chest piece; lend individual 
distinction and help prevent 
loss. FREE SCOI'[ SACK neatly 
carries and protects Nurse- 
scope. Heavy frosted vinyl, with 
dust-proof press type closure 


LITTMANN COMBINATION STETHOSCOPE 
Maximum sensitivity from thiS fine professional Instrument. C0n- 
venient 22" overan length, weighs only 311.z oz. Chrome blnaurals 
fixed at correct angle Interna' spring. stamless chest p,ece, J..." 
diapfuagm, 1 'Y4" bell. Removable non-chlll sleeve. Gray vinyl tubll\&. 
Two ;1111;... e"lr. CO! chesl p,
 SACK INCLUDED 
No. 2100 Combo Steth. i>>

"-,Duty Free 
CLAYTON DUAL STETHOSCOPE 
lightweigllt ....1 scope ;l!Ipt)rted Irom J_: hl&host 
sensitiVity for apical pulse rate. Chromed bll1aurals. 
chesl p;ece WIth 1 \10" bell .nd 1 %" d,.phraKln, 
RTey anlH:OII.pse tubing 4 oz., 29" Ioog Exlr. 
 
ear plugs and diaphragm included Tn imtials 
 
enRTawed Iree. FREE SCOP!: SACK INCLUDED 
No. 413 Du'l Sleth , . . 17.95 e., 
Doty Free 
LOW-COST STETHOSCOPE 
Our IO"est cost precision stethoscopel Single ckaphragm n '%'" daaJ 
Choose Blue. Green. Red. Sliver Of Gold tublnK and chest piece sltver 
bmour.ls. only 3 Ol Three ;nit..1s enl'aved Iree FREE SCOPE SACK 
No. 41.-0 Clay. Stoth ... 11.95 ... Duty Free 


LUGGAGE TAGS 
OR PLAQUES 
Br;øht cololful I.... I 2
" plastIC 
chips with your RIme/address deeply 
engraved 13 I;n.. up 10 25 letters I 
spates per IInet Tal with beld cham 
led thru 2 holes so .Iways lac.. oot . . . 
or plaque version With self-adhesive 
back 10 mo...t CO! flal surt.... Choose 
Red, Or.nge. Vellow, Cocoa, Blue, Green 
or Black Allach wordIng deSIred 
T-3QO (be.d ch.in! or 
T -400 (sell-adhesive) . . . 1.98 ea. 
Each additionll item with same 


"'-- 
..." 
...-- 


--- 
.... 
--- 


- 


MRS. R. f. JOHNSON 
SUPERVISOR 


J 


........ 
II. 1. 


=-- 


CHARLENE HAYNES 


.... 
- 


-

 
\ ,'I' OHN. L.PN. 


, 


1. 


NlIIIitit 
511 
AI ...... willi AfeIr caIdt 


NURSES PERSONALIZED SPHYG 
Now in Fashion Colors! 
A superb aneroid sphyl. especially designed 
for nurses by Reister. precisIOn craftsmen 
'" W. GermanI Easy-IO-attach Velcr" cull. 
ligll\we;gIIl. compacl. lits ;nlo solt Slm 
leather llpper case 2"6" 14" 17". Dial- 
...hbrated 10 320mm IO-ye.r accuracy 
guar.leed 10 :!:3mm SerYiced by 
Reeves if ever required Your initials 
erwraved CO! manomeler .nd IIOld 
stamped CO! case FREt Choose BlACK 
with chrome metal manometer. Dr 
BLUl GREEN or BEIGE WIth plastIC 
mana houSlfW. tubmg. cun .nd case 
.11 color-coordln.ted !specify CO! coupon) 
No. 106 Sph,g.. . . 39,95... 
Duty Free 


......-.. 


4 



 


, 


, 
. 


/ 


BLOOD PRESSURE SET 
An outstancbnc anerDld sphyJ. maoe 
in Japan _..111 lor Reev... _Is 
:::.


' sro"'j

"'"I,=r
d 
chrome runometer, tit to mnm 
Velcr" grey Qln, blact< tub;nø. soli 




e
: xlJ
Se
ed 

n
 
ever needed. CI.yton No 4140 
_ Stelhoscope !solver) ..d Scope Sack 

 :
,':1



r
e
.r:
I,"

 
prlCt;cal, dependable kll JUSI "&hI 
far every nurse l 
No. 41,100 B.P. Set . . . 
DutY Free 33.95 set complete 
SphYl. only No. lOB. 27,95 wIth case 


.D 


CAP ACCESSORIES 
 
CAP TOTE keeps your caps crisp and cl... 


::'e

I::rsior':"
:.'m

; -;I
: 
curlers. etc 8
" dia. 6" hl&h 
No. 333 Tote. . . 2 95.., 
Gold mit. .dd 60". 


....... 



 



 

.- 


-- 


MOLDED CAP TACS 

:
 "..= 

rr.u


::S:c
a'l":'
 
Gold Calkrceus The nealar .,y 10 laslen bands. 
No. 200 - Set 016 Tacs .. . 1A9 per set 



 

w1 
fl\'m 
----------- 
TO: REEVES CO.. Box 719-C, Attleboro, Mass. 02703 
OROER NO. ITEM COLDR QUANT. PRICE 


METAL CAP TACS P." 01 d.lnty 
je"'ry-quallfy Toes ..rth RT'ppers, holds ...p 
bands seanly. Sculplured mel.I, IIOld finISh, 
appro!. %" .HIe Choose RN, LPN, L'iN, RN 
Caduceus or PI..n Caduceus Gilt boled 
No. CT-l (Specify I"il.), . . . . No. CT-3 (RN 
C.d.) . . No. CT,2 (PI.in e.a.), . . 2.95 pro 


Use extra Sheellor additoonal ;tems or ordeß 


INITIALS II desIred; _ _ 
TO ORDER NAME PINS, fill 001 all i,,'ormal/on In 00., lop 
left, cl;p out ano mach to thIS coupon. 
I Pi.... .dd !iDe hlndllng/poslllll I 
I enclose $ ) on orders tell"'"1 under $5.00 
No COD's or billing to individuals. Mass residents add 3'1(, S. T. I 
Master Charge and BankAmericard charges are welcomed on 
orders totahna $5. or mare. Please submit complete Card 

';'


7


d:#, 

:
terbank I). Expiration Date. and 


. 
I 


Send to 


Street 


('tv 


c;,tat.. 


liD 



10 


The Canadian Nurse Saplember 1976 


Ne\ys 


- _.. 
.." (
 


.ç;, 


fV\R 

,), . 
, ,
 i!' .
 
i\ 1! 
 

 ... 
...----::':"- 


I 
k
'" 
i
: 


T 
\.' ' 
.
À
 


"'f. 
-\ j' 
,.. 



 


.. 


! 
......,å 


\. 


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<- 
..ç;.. 


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." 


"'f
- 
" 



't 



 
. 



 


'
, 
\ 


Co 


. " 


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 


'( 


... 


...
. 
,. <,/."': 

TI. "_ h 
'
J. 
-?(). 
,',,'" -... - . 
-,,
.";.
.j.
,,
 

 
, -r......;: . 'C..( 
.:
 ?:?:-.. 
 1;'. 


" 


,,-'Y 
. 


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 


Xl>>\YS 


"', 

 
i 
 
) . ..
 ;., 

,. 
f 
\. " 

 r 
I 


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." 


('llll>>ll(lill- 


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. 



y 
g'!()4 




l 


o 
,\
 í 
- 
i.]' ;;) U!['1:
 íI&' 


" 


\ 


O ALl 

t(l 


J 


f(E:r) D 4 

 II 
't.- 
"n 
U ClJ
I't'y 
æ 
'II"I( 

 
1M 
 "4Qs 
I 
l 
IE 


f{
1) 
. I)t\ll 
-4.. 
l' "Go, Sf... It> 

 l' 
Dl 
It> 
It 
4"" J:t\ 
I "'ItQ....
 
l 
t 


,,4t l 
tf
V 

' 



":: 
Ic....". 
1
 


-"::: 



I)ö 

 
ll 

{I
 
4b '40"' 'y. 
" 


 
,
 


........ 


"ç.l)ö 

 
ll 
..

 


II 


'" 




, 


" 


COLOUR CODED 
The colour outside tells you what's inside. 
This means Instant product identification. 
You - the Nurse - can now work even more effectively and effici 
r"t 
QUALITY GUARANTEED 
Only the finest avaIlable materials are used In every Kendall ProrJu 
· Highest quality packaging outside 
· The Kendall quality you've come to expect inside 
An unbeatable combinatIOn' We guarantee it! 
ECONOMICAL 
Prepackaged, sterile dre
,>ings are convenient and pcon')mlL 
· Saves valuable nursing time In dressings changes 
· EhminatE'- cumrersome wrapping and autoclavrng of.... " "'rr-
 
· Helps t,.. rec.Jce drec-sin1s waste wIthin rour hospital 
Ask your Kendall Repre-....ntative about all your Health Car- r 



 



 



IJ 
'/.)4(( 
V- 

 
.
11 'Þ-io
 
1J4
 
Ir.'- 
 
8tlffli
 l 8t....... 


t
 


\ 


.
 


.:: 


.... 


v 


KenDAll 
Innovators in Patient Care 


&. 
 . I - 



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. 



4 


-. 


............ ....-..-.. 
... "11'0 


,- 
- 


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. 


'9- 

. 


, 



 


, 
.,t,. 


,..... 


.. 


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. 


ì 
j 
, 


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 


AVAILABLE from 
UNIFORM WORLD 
(Mail Order Division) 
P.O. Box 296 Renfrew, Onto K7V 4A4 
or shop in our branch stores 
TORONTO SCARBOROUGH OTTAWA 
641 Bay St. 691 McCowan Rd 226 Bank St 
Inquire from our mall order divISion In Renfrew 
about 00. Mad O.der ShoppIng ServIce 


(, . 

 

 . 
I 
" . ,; l_ 

 


o 
White Cross 

 



 


A-sa 1252 
Plain Warp Knit 
90% polyester 10% nylon 
Colors: White, pink, 
sherbet, mint and canary 
Sizes: 3 to 17 
Sugg. Retail White $31.00 
Colours $32.00 


B -HJ 343 
1000'0 polyester Rib Knit 
White Only 
Sizes 3 to 15 
Sugg. Retail S34.OO 


Same style also available in 
C -HJ 366 
Double Knit 
10000 polyester 
Colours: Blue, Pink, Yellow, 
Mint 
Sizes; 3 to 15 
Sugg, Retail $36.00 


D -HS 813 
Window Pane Design 
Warp Knit 
100"10 Polyester 
White only 
Sizes 4 to 20 
Sugg Retail $38.00 



16 


The Canadian Nurse September 1976 


@ 


The first and last word 
in all-purpose 
elastic Itlesh bandage. 


, 
, 


Quality and Choice 
. Comfortable, easy to use, and 
allergy-free. Widest possible choice of 
9 different sizes (0 to 8) and 4 
different lengths (3m r 5m r 25m, and 
5Om). 







 
rJ.... 
l" 
 
"'fj'] ...- '"' .
..."'"': 
.. '1 ,->on 
r. . I--
L
 
1 (,lu 
 i1 "';; l "" r, 
 I 

 tJrIJL
r
r 
ë 

 -

q

 
t!" -- 

l, c. b. 


Highly Economical Prices 
Retelast pricing isn't just competitive, 
it's flexible, and can easily be tailored 
to the needs of every hospital. 


t 


Technical training 
. Training and group demonstrations 
by our representatives 
. Full-colour demonstration folders and 
posters 
. Audio-visual projector available for 
training programmes. 
. Continuous research and development 
in cooperation with hospital nursing 
staff . 


- 


..... . 


.,JfC
- 
....'it. ',f
.... 
"tit".. .t' 
;'
:
.o:.. .......... 
.
. _

1
"" 

 :;:a!

"':i:.!p.
 


it 'ft ,'" 
....MO.... 
tjllh'''
 
t
. '
M 
..... '.. -11""" 
." , 


For full details and training supplies, 
contact your Nordic representative 
or write directly to us. 



@(;1@)O@ 


PHARMACEUTIQUES LTËE 
PHARMACEUTICALS LTD 


2775 BOVET ST., LAVAL, QUEBEC:TEL: (514) 331-9220 TELEX: 05-27208 



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 


-,:..:::z 

4 

; 



 \:'"' 
".
." ' ;:' 

t' " 
.T 0..:;:: ...' 
" 


....9 '
 


. . 


Risk Factors 


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 



 
 
s," 



, ..", 


'" 


\0 #". 


II; 


, 


., 


- 


.... 



 


. f 
, 


_. 


/... 


'" , 
-, 


.. 
oò\o, 


-' 


'<< 


, 


1 


. 


. 


The Canadian Nurse September 1976 


Gtlgn
q Q

 

f

-P
 
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. 


'" 


. 


.. 


\ 


" 
" 


'. 


" 


. . 


" 



. 


, 


\ 
" 


-- 


. 


. 


\ . . ' " 

 . 
-
 


. 


r 


.. 


.... 


.,,
 .-; > \ , 
\, 
. [ 


"'\, 


t . 


, 


, 


f' 


1 


..At 


or.. 


\.. """"---" 


::- 


\ 



The CanadIan Nur8e September 1976 


21 


, 


'It 
\'" 
, 



 Iv
 
S 


-. 


, 

 


J 



 


"W' 


; 


, 


i ..., 
""" ^' 
- 
. ... 
... ....,. .
 
...... . ".I1'1t ,..,. -- 
.. 
JO' 

 


,. 


I 


... 


\ 


"- 


... 


."""".-...-.r ...,. 


...... 


... 



 


t '-r IJ. 
r 
. 
... ._. ..1 
'"! . . , - 
, 
1 , . 

 << 
-.. 
-:t , , " 
þ- 
1- , r 
. .', 
'. 
" .... 



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! 


'\ 
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 
Ylg'l1T heélrL to luV\g 


j 


R ìg\'li atrì UWl 


t': 


AV') 



...... 


j 


.er 


....... 


FOS5q oVé\le 


þ) 


,. 


t' 
 PG\..pi I\a'('
 YY\lJ5
Ie.S 


,
 Le{=t veV'itncl
 
\ IV\tv
veV1tnc:u\CiI\' 
e.p1.uW\ 
- Rignt veV\tv-icle 


r 


TYicuspid valve 


- 


J1',J 


JV\ reyiol/' veV\a c.qVé\- 
syeat Ve.\V1 froM boÒj 
.G\ V1ð. leSs 



 


- 
t 


RiGHT __ 
1;E"ART 



 
Q- 
0' 
X' 
é 
'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 _ 


.
, . 
f - t · " 
,1;' \ / 
1};
 v . 
__ I 'ff 
::'
 jI 
("- " .,J , 

 
-
 
- 


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- _______ 

\(o
1' ______ ((IÍ!I'tI'i veVltri c.le.. 


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 


r'
 ,. 


'
' I 
'
" 
;r. 
 
.t, j

:' 
 
 
, ,
 ',- 
 
I . 
- --J) y 
-:-.:14 
 
, 
<. 
 7
.j 


I I H I' I 
 !; III L =---=-- 

 "(
 . 
S
 " . 

:: III F r=, l 
' 
!! IIII.
 ,to II lP)
 ,\
 111 1 
II II, 
"I 
" g 
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 


r-" 


- 


" 
".. 


I, 


..... 


Photo courtesy Sunnybrook Medical Centre 


.' . 


. f
 . I I
' 
;

. 
,,: \ .,. , 
.<< ,,.z. ....,1 . 
{r
.: 

--1.i 1" 
.

 JL.-1t,.. ..- 

 _
r_ 


' 
 '!- 


" 


;, 


" 



 


'
 


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 


J"'.' 
 
1"'\..-_: / ' 
.

 
'f
" \ '7,. 
,r,
. .' 
/ff,
 " 
-:.:..J
 jJ , 

- 4 
'Jr ,

 
44i' 


Patent ductus arteriosus 


. 
I) 


... 


0{'"). 


... 


.0- 


h
..,.....-.....T",," dl.oC. t"'i 
o..t\,,""o
..- 


... 


0- 


Coarctation of the aorta 


Ventricular septal defect 


.0- 


. 
I) 


-0 


.... 


I 
" 


- \" 
_. 
, 
I I 
b " 
... 
 
0 
Tetralogy of Fal10t 


Reprinted with permission from the illustrations of Congenital Heart 
Anomalies in Ross Clinical Education Aid No.7, Ross Laboratories, 
Columbus, Ohio 


. 
Q 


Atrial septal defect 


-(J- 


Q 


ð 


0- 


Complete transposition of the great 
vessels 



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 


. , 
, {o; . ; " 
,i
 \ 
,. 
if,
 .,,) " 
(I. , 
I 11, . 
"'.::J
 VL 
p 4 OJ" , - :b;
 
-
 . 
11 


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 


'(OS\>,) Jam J;poq!IUE UE S! ^ESSE Isaq alj.l 
'uaJpl!lj3 ^IJEIn3!l-lEd 'SIEnp!^!pu! awos U! 
^IIEWJOU IS!xa E!JapEq asalj.l - .::I L 


'asmu aljl jO alOJ IE!IUaSSa 
UE S! uaJPI!lj3 01 uO!IUa^aJd Aæwud 
5U!lj3Eal 'Snljl :a5E ^IJEa UE IE 5u!uul5aq 
a5E ljl!M a^!ssaJ50Jd S! I! - .::I 9 


'UOIIElnW!IS 
IE5E^ alq!ssod pUE 'Ia^al lO paSEaJ3U! 
'uo!suEdxa ISalj3 01 anp - .l S 


'alnOJ alEUJaliE 
UE sJaJjo snpnp lualEd aljl - .l \7 


'IEnp!^!pu! a^!I!SUas 
aljl 01 SJaljlO ^q paU!WSUEJI JO 'pamoqJElj 
aq ^EW p30ldaJIS \>' dnOJ8 - .l E 
'palEadaJ ^IIUanbaJj 
sJapJos!p asaljl aas 01 UOWW03 
IOU S! I! 'dlalj ^EW S!ljllj5noljllE - .::I l 


UO!IEln3J!3 3!waIS^S 01 
JOud ap!JIUa^ ijal aljl U! ISalj5!lj - .::I I- 
SJ8MSUY 


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 


::.:. 
.c: 
1& 
.... 
0> 
o 
Õ 
.c: 
0... 
Õ 
i: 
QJ 
E 
t: 
<1! 
Q. 
QJ 
Q 
Qj 
c: 
.2 
Q, 
<1! 
c>!c:: 
QJ 
5:2 
-J '- 
õt5 
::.,->< 

 .
 
t:CJ) 
ðl? 
0_ 
"'.!!! 

 is. 
0'" 
á:
 



 rJfJlIJ IJJIJ
 
i [Jrì[[lirì[J 
[JrìirlfJifJririrìiilJr1 
ElJlJipnfJr1i 


PJ'" 



 


- 


- 


L 


- 


.-- 
--. 
. ." 


. 


e...e 
. 


" 
-;;; 


. 


. 



 


, .... flit 


J\ 


" 


., 


"t 


...,-../'- 


, 


'-t 
... 


/ 


, 


0' a. f1 
b'/ uSe 
\Ood 
'01'1 ifl b 
tura. t \ 
a J 0-' sa. 
'""" u reS 
(fIea. S 
Gra. d '/ 
øa. ifle 
l'Iu r . Se e Wr . 
o)l.\(fI 


t 

 



 
, 


" 


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 


I , 


_\ 


.. 


- .... 
, 



 
\ 


"" 


\ 


.IICDD 
 


, "'. 
'-' 

" 1\
 



i 


"" 
'\ 
, ...........- 



_<_ t 


.. .. . 


..... 


..... 
-- 


" 
..... , 


1ft. !I'll 


I' 



 JIIa 


,.., 


r 


----. ... 


- / 
- 


... , 



 


-
- 
'- j 


,-""",'" 


I 


'" 


II.' 


st 
. 


\ 


.. 


I 
j 
. . Diaforometer, 
. - und called a e icture IS 
. men t shown in th

O:


d in the 
e
'::o


h of 
 2 intake. 
The eqUiP 0 consumptiOn. to regulate t e 
measures 2 the patient's face 
placed over 


,. 


I
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 


, 


. 


. I 


c-' 


.>. .. 


.;., 


r · 


) 


" 
... 


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 


I 


1 


Þ, 
r 


The CanadIan Nurse September 1976 


....: 


"I 
,
--
 ,.., 

 .; - ... 


, 
---, 


., 



 


. till ...... 


I 
lit 


, 



 


-4 


.. 
"', 
---..
 
.. . 
'.. 


.
 


D. 
) 


.. 


, I 


i 



 --t. 
. 
 
. ,..\.
 
. . 
 I : .

 

: . . \ 


6 
- ;;" .
. 


. 


-f, 
 
A, 
 .

 1 
'VUrse p . ... , 
Chamb at Grande # 
h ers IV. Caltbr. 
orlZO ntal . Ote the do ates the 
and It'ertical 

'::.e telelt'/
:o
ssures in the t. 
S Of the h screens . OUr heart 
eart to b Wh'ch e 
e seen S' nabl e 
ImUltaneo 
uSIy. 


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 


I 


-?' 


- 


-> 


. 



The CanadIan Nurse S.plember 1976 


37 


... 

 
 
\ 
- 
... , 
'1 .,1 
' . 
, " 
'- 
, 

 
, 


'\ A 
.,. 
l . 
j\ 
J 
- ,
 

..,. i' . 
I; -- 
. 
,", 
.) 
\- - 
f 
--... 


", 


f J 
# 


. 

 


.. 


- 
- 


- \ artef'/. 
(fIOf a 
...e fe 
10 tl, 
te r In 
a tt1e 
a C 
insertS 
d to fd 
p.a 
Oor ott1 'j 
Of. 


/ 


- 



 


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 


- 


-- 


, 
",-' 


\... 
-
 


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 


.-,
 


\ 
, 
 

 

 -' 
" 

 
 
---- -- 
..., 
 J--l \' 
-- - .. 
J - 
.......... "". 
,.. 
I ) , 
, 
....' '--" 
þ 


\ 


i d. 
pat Gran 
Nurse 
catheter, 
. rts the 
adto rd Ins e patient. 
DorothY A the young 
While Dr. d reassures 
comforts an 


'-
 


---} 
--- 
}\ 


\ 


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. ... 


, 


.. 


}&. 
:-,\, 


, 


1 


- 
. 



....,> 


.... 



, 
_if 
if. . 




 


J, -..: ' 



:-
""'---
 


.- 


c 1 " 


.....> 


... 


<c.- I 
..... 
?' ' 


. 
. ì 


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 

{\\o! 


JIIII'Þ 


t 
" 


, 
." 


J 


'" 


, 



 
,) 


) 


" 
"" 


.., 


'- 


" 


" ,. 

 " 
f 
r t 
{ I 

 



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 



 T .- I - m
 :\" li ,


 

 ' l æ 
 '.,
. / 
'" ' --
 - 


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 


At Last... 



 ' 
;. . 
... 
-< 
,Y" 


a ...-'ia. 
:.: 
 
tOl' oorses needs 
No 
 8fIour eu.aøm.- Nolilly IOI>>Y. 


R I \HIH t:\I::R1 URDFR. 
\\ hit. myl POCKET SA \ ER lor 
f I pooo. scio"".., .t.. Che.k box on 
roupoD. 


STETHOSCOPES 
" R"'Eo;STETHO.,CUPESm5 
colov.r. Exc
'Pt.iOJttJl.0II7Id 
Inmmoi..wn, odJlUlabú 
lighlu,..glal binaurnls; 
replacemenl pari, avaúabú 
in Canada. .414 Silver, 11415 
Gold, .490 Blu., .'92 
c;,-."", 11.9. Red '9.00 
.a.h. r""lvd.. .-...Iiaù 
engroved free 
Dl-\L HE-\D!I TETHUSCOPE 
Amplifle, aUfrequeRC1e,. Bouú, 
,edlO7lIta1 exlra large dlOphrugm 
Adj1Ulabú .larome b,ROUrnls .41:1 n5.95 earh. 


SPHYG
IO
IA:\'O
IETER 


Rugged mad depend4bú, WIlla 
q,"'_ 4 nerold gauge calibrated to JOO 
:' m m \'elcro 10""Ia-and-hold 

 
 -. nIl Hand.ome zippered cale 

 J _
.
 IOl/earguarantee .115 
. ,. _ S2
.95 ea.b. 
Include. "lIt.aU PlIgnlt.ed 


OTOSCOPE SET 
s::. Une ofGermanl/',ftne'l 
T - lnatru.menU. Exceptional 
f ,UIl,"rnatlon. pouerjuJ. 
, 
.._ maY' (y,nqlem. :1,laMard'lZe 
- "\-
, ,penla .31Zt' C oottene. 
rnclilded \If'tal carrying CGlt' 

 Imed" -Ila ,ofl d..th .:J09 
'56.00 .a.h. 



CISSORS & FORCEP
 
LI
TERB-\'I1-\GE"(J
"'()R"i. ' 1 
-I. mu,1 for ry "urae \. 
 
Uanufælured of f,ne,1 ,Ieel and 
"r! ;hf'd In sanitary chrl.lmE 
0699 4'.- '2.60 I 
.jOO ;; . '3.00 - 
'
02 7 . '3.75 
 
U....R-\ r"G ...n......UR
 
.'la,"
t'f;. Stef'l. strw.gltt blades 
Iri05 5 l sharp blunt 52.85 
.ch 
0706 5" sharp oharp '2.
5 .a.h 
'710 -I.'. . IRIS or ,ors '3.65 earb. 
HIR{.t-:..... 
f" sf Stam/e.. Stf?f 5 It.Jfll 
 
Ke"v Fo..epo .724 Slralghl. box IO('
 1-135 ea.b 
Ken\ For<eps .725 Cune<!. box lock 1-1.35 ea.h 
Thumh D......rn'" .741!" ralght. S<'rraled'3.35 ea.h 


:\'l"RSES WATCHES 
-I. dependable, al/ral'! 
...I Ia fuU 
nlfmber, U1I u hile face REd 5U'41ep 
II "o"d J,a"d Chrome C'aI . slamu.. 
sto I back Jeu red m< I I ack 
,. fJtAer .trop. l!/T. gK6rnnte ,,!NO 
'1
.50lpl", 93.enl, 'n Onlan 


L, 
t
) 
,1 


I'.. flTl TlU'-\L '" R......" \\ rite on \'ourtðmpan\ 
letterhead for our 2.1 pg cataloguf'. Quantity - 
discounts 3\-ailable. 50 c
nl handhng charge for 
orders I
ss than S5.00. 
----------- 
Urder '0. It
m l.ol. Quan 
iu Pric
 


--I 


C HEC" V 
FQlIn \IFIIK.\L..l P"U CU. 
P.II. BII" 726.... BRIIC"\\J I F.II'T. K6\ 5H 


I 
I ""
lId to: 
I "'rrflflt: 
I ('in: "'ro
_: 
. POlõtal C'od
: _ _ --I 
...------------- 



44 


The Canadian Nurse September 1976 


man] l3C!rgluncl: 
l3ackmood) 
nur)C! 


..
 ,- > \,: . .\'
 . \ 
I' '''"''''\ A.
 
.-.. 
 


. \,\ 
 .. 
, J "; 
1,\ . . 
. ,,

 

:..
- 
 

t.-.\..
 


It' 


." 


<I 
 -,-' l 
( ( : 1: l;'.r\ 
. .' .j ' 

 . 

(
. 
1:\ . ' "" 
f . , ' 
) . 
 

. ' 
"J . _ , > 
.:- ..A 
.- 




... 

: > 



 .
 

 .' 
.-1 


 \ 
.
. 


"," {" 

 '\....:
 . 
. . 
. , 
.". 


" 


\' 



 


, 
, ;- '. 


'i>h 
 
:\
.'" 
-> 
'\ .... . 

d .,..........J... \ 
. \. ' .' 
\ 

,-'" 

 · (1 ,
.", 


. 

 


;< 
t. 

 
./- 
'\ 

 
to '\ 
"\ 
I . " 
... 
" 
" 


,. 
. .."'\, . 
,;\ . 
 
'" . 
 
\, 
. , 


"" 


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. 



 
,s-":"I'" .... 
4.t:
.'
..':
..!il I ..' .. 
(i..1:l!l/.:.......:. ..::"":'" 



.;l;!;...... 
: ",t 
'
!:'''' .... 
f
.' III/'! .'-.; 
\\ - -- 
':
 
 '/1/ 
. I/jIatdJ 
I' .-" . 
-\.-
f/ 
I.",. 
(m
 it/I' i:ii
,:;t. 
, f j . :
r.
..: 
1!'.;i'.'.. 
 ',I" 
,.:.. / 
· ", ï;," .. 
\ 
( I f ' ;j!!
: I 
: . , ,I 
'1
 
IJ 0 1 " 
, I 

/', 


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 



Years ago, most ostomates went home with a so-called "permanent" appliance, The 
disposables available then were mainly for post-op use Now, though, there's a 
family of simple, convenient disposables your patipnt can wear home with confi- 
dence These Hollister disposables offer all you'd expect of "post-op" appliances' 
lightness, one-piece construction, ease of handling. Yet they're strong-made of a 
tough multi-layered film that holds back odor more than 200 times as effectively as 
common polyethylene plastic, Thousands of ostomates who were started with 
Hollister disposables in the hospital have gone right on using them as their full-time 
appliances. Your patients can, too. 


5 


nd them 


. 


OSTOMY PRODUC"TS 


,. 


ith 


THE DISPOSABLE OSTOMY APPLIANCES 
MADE FOR EVERYDAY WEAR 


.. 
.. 


.... 


COLOSTOMY: 
Send her home confident. 
An odl r-bsfI r Karaya Seal stoma 
bag w I pro\; e 
skin pr'Jtel.. on, 
see JI and 
simpl elf-care 
until he : 
'')Io-.
 y I 
,egula d 
 
Ho. . 
sat e 
mir' 
ComL 
ConelTl be 
Irri-- a 


o 


skin preparation. 
It fits snugly 
around the stoma, 
sealing off skin 
from potentially excoriating 
discharge, yet IS easy to put 
on, easy to empty, and easy 
) dispose of, 


1 


esta 


an easy way to 
-,g nufne, 


NO-CHARGE EVALUATION SETS AVAILABLE. 
Wflte on professlonsl or hospitalletterhesd. 


..t 11' It .. . tI IIKI r Producl to almpilly 
7" a r8 Ills!! 
H0LLlSTER
 


MERS ROAD WILLOWDALE ONTARIO M2J IP8 


o. 


... 



 


UROSTOMY: 
Spare her the faceplate-cement- 

Ivent routine. 
Requisition 
Urostomy Bag 
appliances by 
Hollister. These 
one-piece dis- 
posables have B 
convenient drain 
valve for ambula- 
tory patients, a 
snap-on tube for 
bedside drainage, 
and do away with 
the time-consuming 
ritual associated with 
most "permanent" appliances 



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 


,,--- 


---... 


'- 


SKI
 
MIL" 


I 


I 



A RlfJfJl 

 


, 


Nlazola 
CORN OIL 
100 0 PURE 
IfUILE DE MA'S 
"'r.o. 32 oz" 909,.,1 
 
-..-"...-- 


Best Foods 
Living up to our name. 


" 


I 


e 


. 


I 


I 


I 


. 


An important study of a nutritious diet 
designed to reduce serum cholesterol. 
Not long ago, an encouraging study was re- 
ported from the University of Minnesota on a 
dietary program to reduce serum cholesterol. 
The diet tested was a palatable, well-balanced 
regimen that included skim milk, poultry, 
fewer eggs, fish, lean meats, and Mazola 100% 
pure corn oil. 
Results: Serum cholesterol levels were effec- 
tively reduced by an average of 17%. 
For a detailed report of this timely study, please 
write to Nutritional Information, Best Foods 
Division, The Canada Starch Company, P.O. 
Box 129, Station A, Montreal, Quebec H3C 1Cl. 
Mazola Corn Oil contains: 
54% polyunsaturated fats and 14% saturated 
fats. 


I 






"'--- 
O V



 
G
O

 
"
ø- 


--- 


'- 


-- 



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 


, 



,\, 


The Posey Foot-Guard witb new 
"1" bar stabilizer simultaneously keeps 
weight of bedding off foot, helps pre- 
vent foot drop and foot rotation, 
6411, 


)).1- 


\ 


The Posey Houdini Security Suit, 
constructed of cool breezeline ma- 
terial, is virtually impossible for patient 
to remove yet provides security with 
comfort. There are eight safety vests 
in the complete Posey line. 3411 



 I 


-,I' 
\.",'. , 
',",. 


......... 


r, 


... 


I 



 


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 
complete Posey Line. 1731 (with 
ties), 


. 


. 

-Ý \ 


, 


The Posey Finger Control Mitts 
You can see the varied applications 
of this Posey mitt. May be used to 
prevent a patient from scratching, 
picking, pulling out catheters, I.V.'s, 
ete. One size fits all. Washable - 
2816, 


Send for the free new POSEY catalog - supersedes all previous editions. 


Please insist on Posey Quality - specify the Posey Brand name, 


Hidden Answer: Cardiac Nursing 


P 
o 
POSEY 
E 
Y 


Send your order today! 
Enns and Gilmore 
2276 Dixie Road 
Mississauga, Ontario, 
Canada L4Y 1Z5 
(416) 274-2575 



 



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 


TIMES MIRROR 


THE c. V. MOSBY COMPANY, L TO. 
B6 NORTH LINE ROAO 
TORONTO, ONTARIO 
M4B 3E5 



Tha CanadIan Nurse September 1976 


55 


MOSBY 


TIMES Mln
Dn 


every nursing 
situation they might 
encounter. . . 



 


1,. 


.. 


. 


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). 


\ 


, 


" 


. 


I 
- 


.-""""" 


ISSUES, TRENDS, ADMINISTRATION 


"-' 


...., l' 


, .--.. _' "V 

', 
 
",
, 
- 
 

----.

 
'--Q- 
-
 


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. 



. 


.. 


, 


. 


- 
1"\-1
 .-\ 
- 



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. 


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 



\"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. 



 

 

'- -*--:- \. 
,' .'

 J J 
#'.-
tl 
'


 
II..- .w 


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 


-
::,j, 
-,'-' :.,. 
-.' \. 
.'
.-. 
 
g..'> ,." 
it'" _no 


. 


 


.:-. 

--::.j : 
I':-' 
. -
 .- 


"\ 
.< 
\" 
'\::. 


\ 


/ 


,..('.; 'h "'_ 
....-ø.
 
.....:o.-'
, 


'-', ,",. 
,r 
 
.; 
I 
1)- t 
"l. ;
 

- > -< f . 
./ -. 
-<- -- 
" - 



: ....... 


....
:;. 


"....-... ".-,:.; 
 '\
 
, ...........-."'.:......., 

__. . 
 _.
..> I 


, 
< 



 
_ø.;
f..-. 
---:-::
..,'. 
-p..,. 



::

. '.'.. :,.,../ ..- 
.-{.:.-(;....- 
I'..<'i'.... 
:.-'1:/ 
::-t.- 
"'_-=:ê
. 
:.r 
.;ù--;:;....
..."-'.:.I 
iJ/i{yi 


....?ø
:::.. 


, 
-*. 


\ . 
..', ';.., 
".,:,,-. 

;f
::>. .) 
#V' 
.

 
../:. 
,. 



ti4 


. , 
" 
,

 "'
 \ 
:.} . 1&' ; 
;. 
 
..# 
 
, III' 


t
1 
.. \- \ 
.- 
,

 
..
 
can go a long way 
...to the Canadian North in fact! 



=
 

j

- 

 -:::::af-.,_ .. ;= 
.c 

 
I:-
 ,
 
- 

._. I 
.

 ' 


..... 


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 
I 
I 
I 


I 
I Name 
I Address 
I Oty 
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 


- 
NURS II'-tG l HnA
Y 
OTlAwA ONTARIU 


J( 1 Þ. óN-
 


\ 
 
< 
I 
. . ;0- . 
}t .. 
"- 
, 'l 
., 
...... 


.\ 


.......... 


, 


-'
 


, 


,. 


. 


... 


, 


\. 



SOFT 


FASHIONS 
hy

 
-- 
. \,...... - H' 
":>, 
 \j)
 \ - \ \J1 \\ \:'::,\ 1\ = 
J,' 

 
::=, 
\
.\J! ':: 
. -n;-; Ht;'
 
. it, =:: ,
= 

 
t"
H.
it 
...
\ 
 \ \\ 
 - \ 
 \ - 
 
\ \ . ;:: \'1: 
,"...- -vI'
 t \ \ .,., ..- 

.\\\
 ;:"- / ,v
. 
 l!.l

 

 \...\.! .. /, 
 / f/ 
 \ 
\ 1l 
 '!!; 
l!l );- /0 
 z I 4
 I
 
T;i UÆ 
 

 , 


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 



\ 
\ 


I,j 


I 
! l 
! II 
- 
I 


I
 I ' ""HITE 
'.Ð SISTER 
CAREER APPAREL 



\ 


"-' 
\ 


..... J 


"4 


\ 


\ 
'-- ./' "'-- 


.... 


---. 

 


- 
- 


. 


. 


\ ' 1 
,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
- 


.. 
-' t II 


P& 

eJ:'s 


" 


"\ 



 


,- 


'" 


" 



 


,\ 

---- 


'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 



- 



, J I 
'1.. _ -. -J 
. t" I . 


, 


0: 
\ --. 
1 
, 4.\., 

 -.. 


. 


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 


r-------------------------------------. 
IT'S EASY TO ORDER REEVES NAME PINS FOR YOURSELF OR FRIENDS! I 
Choose style JDU Wint shown njht Pnnt name (and 2nd bottom rtg"t At1ach eJtr sheet for ackhtlonal pins. I 
10... rt des"ed) on dotted Iones b.low. Check _, '010 on NOTE SAVIN
 ON 2 1000lCAL "IIS. .... .._.HI, I 
boxes on chlrt, clop IIIIS sect... .nd .!Ioch 10 COlI""," .... iI .... If II... I 
LmERING.______________________ 2nd LlNE.________________ 
CHOOSE. DlStIIrTIOII .Ac.GRtlUND lITTER"" ...ICES. 1 'il 
.= 
...- 


o Ouolone I 0 BIae" ] Line 
o Pol,shed 0 DIr BI.... L.tt.,.... 0 2.69 04A9 
o Satin 0 White 2lmes 
o Wh 
 'e BI.ck 1 Lette"nl.. 0 149 0579 
o Green 0 Dk Blue 3LJnes 
B :::;:." 0 Wh.te L.tte".... 0 4.29 0 6 99 
o While .0 B&aclir. lline 
B Med Green @;J Dtc. Blue Lette""1 . 0 .JAg 0 2A9 
O
;'oaBI
 DWhlte 


I 
I 
I 
I 
I 
I 
I 
I 
I 169 
I 
I 


ALL METAL.. rich, trim. tallorec:J lløhtwel.iht. 1 
. 100th ed
. rounded comers. Choose 0 Gold 
_,hshed. satm or Duotone fimsh, comblnlnl 0 Silver 
satin background with pohshed edging. 
Fr3me' 
o Gold 
0511...., 


OWM. 
ODlr.BI.... 
o DIr Gree!'.. 


SCISSORS and FORCEPS 
::':..
:
.: :.
: 
LISTER BANDAGE SCISSORS 
31'1- lIit,"'1I... Tiny, !landy, slip into 
uniform pocket Dr purse Ctloose Jewelers 
øold or gleaml. chn... plate finISh 
eL No. 3500 31'1- Mini..,. . ., . 2.75 
No. 4500 4 1J 2" size. Chrome only. . . 2.95 
No. 5500 51f:z" size. Chrom. only". 3.25 
No. 702 714" size, Chrom. only. , . 3.75 
Fo, enlraved initials add 60. per Instrument 


31'1" 
41'1" 
51'1" 
7Wi" 


KELLY FORCEPS 

 So handy tOl eY!1}' nurse1ldeal for clamplrw 
off bJbm etc Stainless steel. 5
" 
- J No. 25-72 
tn!iRIII, Box Loci< , , . . . ".69 
" @ No. 725 Curved. Box Lock. . . . . . , . 4.69 
No, 741 Tnumb Dressinl Forc.p, 
5.ml'd, 5Iro'lnl, 5'1," . .3.75 
For enloved Initi.ls add 60. þel instrument 


MEDI-CARD SET Handl.sl r.I.,. 
ence !'\Ier. 6 smooth plastiC cards C3
" J( 
5
") crammtd WJth In'ormation- Equiv. 
lone,es 01 Apothecary 10 MetrIC 10 H...s.hold 
Meas. Temp. .C to Df, Preselip_ NJbf . Urln- 
.Iysis. Body them Blood Chem. LIYer Tes", 
Bone Marrow, Dis.... InN>. P.,iods, AduH 
Wgls ..., 'n wI"'. .,nylbolder. 
No. 289 
rd 501 . . . 1 75 'a. 




-:r
s.l:':õ:
.mp'd on back ef 


'l' 




 
_ NURSES BAG Finesl hi... 

"tfuck genuine COwhide, beautifully 
cfafted. stitched and riwt construc- 
tion Water repellant Roomy inlenor, 
With snap-In washable liner and com. 
plrtments to organlIe contents. Snap 
:1
:.'1:.:';:I

:.u':;, 
.
 
" 'I x 12" Y...r ""to.ls gold embossed 
" FllEI '"' lop. An ...lst.nd"'l 
..Iu. 01 sup.rb 
1i1y. 
No. 1544-1 BII (wilh lin.r). . 42 50 ... 
Eml lin.r No. 4415. , . 8.50 


;1 


l 


14K G.F. PIERCED EARRINGS 
O.,nty, det.oIed H20 12
 Cold Filled coduceos with 14
 
!:
.; 
": 1::.
:r..
lt::...:r;nIdu
,:: :,\

' GIll 
No. J3/035... 5.95 p.r p.ir 

 . t.W".-fL
_ 


CROSS PEN 
World-famous bellpoint, with 
sculptu'ed clduc.us embl.m Full..... 
FREE engraved on berrel bnclude name with 
. 
Refills 1'4111 everywhere Lifetime RUJriJnM 
No. 3502 Chrom. 9.95 ... No. 6602 121<1. G.F. 13.95... 
PIN GUARD Sculplured CJduceus, chJlned 
 
 ' 
to your professlon.1 letters. eacl1 with Plnback{ 
safety catch Or r!þl-=e either with class pin. Gold ,.. I 
finIsh, 1111 boxed Choose RH LPN cr LYN. 
No. 3420 Pin GUlrd. . 2.95 ... 



 5-EXAMINING PENLIGHT 
White berfl
1 With ceduc.eus imprint .Iu. 
mirwm bind and clip 5" king, U S. made, batteries 
Included (repl<<ement batteries ","lable Iny store). 
No NL,10 PonliPt . , . 3.95... Inili.l. en'....d. add 60". 


8zzz MEMO-TIMER T,m. hol p.cks, 
\J 
heat lamps. palk meters Remember to check vital '" '!b 
SIgns, I'
 med;CO'IDf1, .It Lightwoljht compoet .. 
n....." dl.J, ..Is 10 bun 5 10 60 mln Key 'ing. 
S'WISS made No. M,22 Tim.r . . . 6.95 


. 
.. 



 


. 
 
.. . 


TIMEX" PulSDmeter WATCH 
D.pendabl. T,.... Hu..... Pulsome....'C.lendor W.tch 
::e:
teout,:


t

:e
;
= 
.D:ea
: 
lumll''IOUs, while strap Stainless back. water and dust. 
resistant. Glft-boXed, I )'
r warrlnte!. I.itil" elþ"IYH 
." bac.ll Free 
No. 237761 Nu....' W.'ch . . . . . 19.95 ... 


!ô BlaCk 
(Ç Dk Blue 
o White 


nones 
lette""1 .. 0 2..29 0 3.69 
3 lines 
Lette,..__ 03.19 05.29 
(1MI,,,ble 559 onl)'1 


t
 
l 


, 


Fõr 
f'kd 
fIJJ1 
-.. 


'. 


\. 


l

 
Free Initials and 
 I 
Scope Sack with your 
LittmaUD Nursescope! 


'\h. '\. 
..\........=-.... 


Famous Littmann nurses' 
diaphragm slethoscope . . . 
a fine precision instrument, 
with high sensitivity for 
blood pressures, apical pulse 
rate. Only 2 OlS.. fits in 
pocket, with gray vinyl anli. 
collapse tubing, oon-dtilling 
epl)q diaphragm 28" over. 
all. Non-rotating angled ear 
tubes and chest piece beau- 
tifully styled In choice of 5 
jewel.like colors: Goldtone, 
SI'vertone. 8/ue. Green. Pink. . 
OIIlPORTAIIl: H.w "Medallion' styling includes tubilllf '" coIOB 10 maleh 
m.,.1 parts If desIred, odd $1. eo. 10 pnc. _: odd 'II' 10 Order 
110. 2160!!J onCOlljlOfl. 


FREE I"!TIUS AND SACK! 
Your intials engraved FRU on 
chest piece; lend individual 
distinction and help prevent 
loss. FRU SCOPE SACK neally 
carries and protects Nurse- 
scope. Heavy frosted vinyl, with 
dust-proof press.type closure. 


No. 2160 Nursescope 
including Free 
Initials and Sack 
... 16.9581. "c...
_ 


LITTMANN COMBINATION STETHOSCOPE 
Maximum sensitivity from thiS fine professlONl instrument Con- 
vement 22." øwerall Itngth, weighs only 3Vr: Ol. Chlome blÐlIlf'1s 
fixed <It COllect angle Internal sprinø. sbnnless chest piece l:w." 
d,opII..p. 1 \4" b.lI. R.monbl. non-choll sl.... Gray vJllyiIubJIIg. 
Two initials engr. on ctl st piece. fREE SCOPE SACK .Hf DED. 
No. 2100 Combo St.th . .. 32 50 .a. ""'; F_ ... 
CLAYTON DUAL STETHOSCOPE 
LIKhtwoight ...., stope imported from J-,: h'Rhost 
sensltlyity for apical pulse me. Chromed bmaurals. 
chest piece with l
" bell and 1 Yt" diaphragm 
ør.y ..Io<ollops.tub;n,. 40z., 29" lone trtr. 
elr plugs and chaphragm Included T.. Inltilis 
.nK!'lved fr... FREE SCOPE !W:
 INCLUOEO. 
No. 413 Dual5/eth 17,95... ""'" F_ 


LOW-COST STETHOSCOPE 
Our lowest cost precIsion stethoscoøe
 Sing1e dqphragm (]!Ia" d.aJ 
Choose BIUt. GJeen Red. Sliver or Gokl tubing and ctlestplete. sl
er 
bolllU..ls. only 3 0' Th,.. ind,.1s .ngrilYed I,... FIIEE SCOPE SAC
 
Ne 4140 Clay. 51.lh ... 11.95 '". " - 


CAP ACCESSORIES 
 
CAP TOTE k..ps your aps crisp -.d clean 
Flexible clear plastic, white trim. zipper carrying 
strap. hanl toop Stores t1al Also lor Willets 
Qlrlefs, elc 8\.2" dll. 6" tllgh 
No. 333 TOI. . . . 2.95 'a. 
GOld in.t. .dd 60,. 


. 
 iìik 
,\ 





 


WHITE CAP CLIPS Holds cops 
firml) At p1ace l Hard-ta-find white bobb e pms, 
enamel on fine spnng steel SIX 2"" and four 
3" clips mcluded In pl
tic snaø box. 
No. 529 Cli s 85, per box 1m," 3 boxes) 


,'.; 



... 


MRS. R. F. JOHNSON 
SUPERVISOR 


.1" 



 



 


CHARLENE HAYNES 


- 




 
, . 
 I' OHN. L.P.No 


.1. 


..... 
51. 
ufatr eatdI 


AI",- 
NURSES PERSONALIZED SPHYG. 
Now in Fashion Colors! 
A superb lIIerold sphyg. especially designed 
tor nurses by Reßter, preclSIOf1 crlfMen 
m w. German)' Easr-fo.attaeh Velcro. cuff, 
IIghtweiRht. complCt, fits Into soft sim 
leaiber zipper case 2
'" J. 4'" J. 1" Dial 
callbr.ted 10 32Omm., ]O-yea, ICCIJracy 
R\II,..'eed 1o:!:3nvn Serviced by 
Reeves If eYer required Your inrtlils 
engraved on manomet.r .nd gold 
stamped on case FllEE. Choos. BlACK 
with chrome metal manometer. or 
BLUE. GREIH 0' BEIGE wit
 ploslic 
mana. houSIng, tubing. CtJtf and case 
.11 co....-coordln.1ed SpecIfy on coupon). 
No. 106 5p!ln 39.95 u. ;;; .:-_ 


4 


.... 


" 


',- 
" ./ 

 


BLOOD PRESSURE SET 
An ...Isbndlng .neroid sphyJ. ..- 
In Japan especiall)' for Reeves. Meets 
.1' U.s G<w. specs, :!:3/1111 ..curacy. 

 .......,eed 10 y.... Block -.d 
chrome manometer, ca. to mtlm 
Velcro" g,., cu1f, black IubinK. solt 
leathereite zipper case measunng 
2Vr:'" J. 4"" J. 1". ServiCed 1ft USA " 
...r ...eded. CI.yton Ho. 4140 

 
:.(=



; 

 initl.ls on case. Here IS I sensCe. 
. pr..tocal, dependabl. kd JUSI "1Ib' 
'or nery nu
! 
. , No. 41.100 B.P. 5el. . . 
". _' F.., 33.95 set complete 
5phyl. only No. 108 . 27.95 w,ln co.. 
.-----------. 
: 
AVf 
5_00 : 
: on 
ph!lg.or B.I! 
f!f! : 
I Order the No 106 Sphyg and/or No 41-100 I 
I Blood Pressure Set described above and deduct I 
S5 00 from each price * Be Sll'e tD ilclude "'is 
I spec",' Dffer coupon when ordering below I 
I OFFER EXPIRES JANUARY 15, 1977 . 
I *1:..., __Ids _. .1 III'" .. !tits s,lCiII...... . 
. TO: REEVES CO., Box 719- a. AttleborD, Mass, 02103 I 
I DRDER ND. EIml::tz:1JlmDIl 
I --- I 
--- 
. ---I 
Use e)(t,a sheet for additional items or orders. 


INITIALS.. d..irtd: _ _ _ 
TO DRDER NAME PINS, f,U oul aU inlormation In bo..lop 
left. clip out and attach to this coupon 


I Pl.... .dd 50<< h.ndlinl/poshp 
I enclose S , an orders tohUinl under $5.00 
No COO's or billong 10 ondlvidu.ls M.ss res,dents add 3% S. 1 
Master Charge and BankAmencard charges are welcomed on 
orders totaling $5. Of more. Please submit camph: e Card 












tt 
;
:nterbank ). Expiration Date. and 


Send to 


Slteel 


('itv 


z." 


c;.t:dp 



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 


SEARS 
introduces 
our new 
'WHITE SISTER' 
uniforms... 


...,. 


, 


Our fine collection features classic, 
basic and innO\ative st\ le
 in all 
size range<;..,brought to vou from the 
talented designers at 'White Sister', 
Take the smart-looking 3-piece 
ensemble photographed here...a jacket 
plus skirt plus pants that total up 
to fashion, value and practical it), 
Shown: Our finest qualit) 3-piece 
<;et made of luxurv-weight polyester 
knit. A\ .Jilable in White or Peach. 
Junior 
izes 5-13. 31 R 008 256 B, 
Sold in the uniform 
department of Sears 
retail stores $34 



 



 


} 


Sears 



 


""HITE 
SISTER 
CAREER APPAREL 


Other "\ \'h,te Si<;ter" uniform.. are a\ ailable in \ our local Sears store or catalogue. 



B 


The Canadian Nurse October 1976 


A SPECIAL OFFER OF INTEREST TO 
CANADIAN NURSES 



 
:= 

 
::.. 
.g 
.., 
=- 
fj* 
- 
- 
.. 

 
p: 
:::I 
::s 
;:;. 
" 


- 
... - ------ 

.. = 
 
 :r "" "= .. 

.. 

.! 
 r 

 :2. 1 i.,......
 
1 =_' 1 i t 1 ,, - J J j I 
50 ;* ;' - 
- = = =-..
 
g::;:1 
 
 .... 
,. 
;-. 
:I:= 
II' 
:I:I:I" 

 
:! ' :I :I 
 :0;' :- " " 
.. ;:;. :1;' " "__--- 

. II' II ___--- _ 
---- -- - 


- 
.... 
... 
;::: 
0= 
::I 
::I 
;:;. 
ID 


- 
.. 
- 


. 


. 


- 


- 


- 
- 


.. 


.::- 


-- 
.. 
- 


.. 
- 


. 


. 


y 
.::- t' 
........"iii'" 
.""".".".íiïttII 
------ ",.,."". 
,.""",,- 


,. 


II 


I 
".:ø- 


fill' 


" 


. 


.. 
\ 
\ 
\ 
;; 


TTD I i TITI II IÏ 1111 
i i f i i i I II i 1111 It II i 

 
 
 ' ' , - "11T1t 
_-- - T 1'1'1- .... 
-__-r'f,:,T, ..

=..,. 
-:: .10 - I I' 
 . .. 
 . . .jJ 
I _;;. 
 '='--, 

.... 

 ::: - . f J,-J 
.. --- 
. t. 
-- 


NOW 
30 
VOLUMES! 


THE new ENCYCLOPAEDIA BRITANNICA 
Now available at a Special Croup Offer Discount 


For over 200 years Encyclopaedia Britannica has been recognized as the reference standard of the world. Now. . . the world's 
most authoritative and complete reference work has been redesigned and totally rewritten to bring a far more readable, 
usable, informative encyclopedia than ever before, You can choose either the Heirloom or Imperial binding and select 
your choice of valuable options - included at no extra cost. All this can be yours at a Special Group Discount - a price lower 
than that available to any individual. 
More useful, in more ways, to more people- 
Now arranged for 3 reasons into 3 parts. 
In a dramatic 3-part arrangement that makes seeking, finding and knowing 
easier than ever, THE NEW ENCYCLOPAEDIA BRITANNICA provides quick facts 
clearly and concisely for the school-age child, and at the same time can moti- 
vate student and adult alike into the magical world of self-enrichment. 


1. TO GET AT THE FACTS QUICKLY 
AND EASILY. This need is served by 
the 10-\Iolume Ready Reference and 
Index which contains 102,000 right-to- 
the-point articles so readable that 
never before has Britannica been as 
useful and valuable in homework 
assignments. 


2. TO DISCOVER THE MEAN- 
ING OF THE FACTS. This 
need is served by the 19 
Knowledge In Depth volumes 
containing 4,200 articles pro- 
viding understanding and in- 
sight to make the facts come 
alive with meaning. 


3. TO EXPLORE ENTIRE 
FIELDS OF KNOWLEDGE. 
This need Is served by the 
revolutionary one-volume 
Outline and Guide which 
Is a readable gUide to the 
whole of human knowl- 
edge. 


Together, the three parts of THE NEW ENCYCLOPAEDIA BRITANNICA combine to 
achieve a breakthrough in publishing history and result in a family reference of 
extraordinary and unequalled usefulness. 


We have prepared a special, new Preview Booklet 


't:Ø'fe'i 
\0 
tÞe 


If you are interested in receiving our new preview 
booklet which pictures and describes the All-New 
Britannica 3 in detail, plus further details of this 
Special Group Discount, please fill out and mail the 
postage-paid reply card. If the card is missing, please 
write to Britannica Special Group Offer, Box 501, 
Station F, Toronto, Ontario, M4Y 2L8. 


...{t

 


YOU CAN SELECT 
YOUR CHOICE OF 
VALUABLE OPTIONS 


OPTION NO.1 


,
\ 
, 
, 


I 


15-Volume Set 
Britannica Jr. Encyclopaedia 


OPTION NO.2 


IIf' i. 
1 f ... 


Britannica World Atla. 
and Webster's Third New 
International Dictionary 



The Can..dlan Nurse October 1976 


9 


SPECIAL GROUP OFFER CERTIFICATE 


(
] 


Genllemen: Please send me. free and wlthou\ obhgatlon. your color- 
ful Preview Booklet which pictures and describes the latest edition of 
FncycJopaedia Britanmca in full de\ail - and comple\e information 
on how I may obtain this magnificent set. direct from the publisher, 
through your exci\inS sroup offer. 


11 things. In other 
want. 
h in its favor as a 
one, but 
I be carried on 
/fdensome 
Iwhile because it 
Tlan knowledge 
live long after 


Name.....,..................................,.......,....................,.............................................................,..,...... 
(PLEASE PRIST I 


I 
I Sireet Address .......................,..,..................,...............,........,.......,........ ...........,.................. 
! City......., .....,......................'...,....'............. Zone.....,...................... Prov...............,......,.............., 


If what you have. 
) with a whole 
on what is new. 
Its rust away and 
in youth is an 
Tlaturity, it is a 


Signa IU re ................ ...., ...,. ,....,........................u...... ...... ,....,...,................................ ..... ............,..... 
(VALID O!\lLY WITH YOUR fULL SICN!\TURE HERE. 


NURSES SPECIAL GROUP OFFER 


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 


- 

 - - 
.-. .-. 

 = = 

 
 
 

 
'2 
 -= 
-= ., :;: 
=- =- 
 
æ;' ;. æ;' 
- - 
- - - 
- '1 .. 
... ;:; 
 
;::: '" ;I: 
p: =' = 
=' =' 
. 
=' ;::;. ... 
;:;. '" ;I: 
ØI ---- 
r ... 
- 
... 
- . 
&I 
I ... 
".:ø- .. 

 ."""".", 


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- 
the-point articles so readable that 
never before has Britannica been as 
useful and valuable in homework 
assignments. 


Bu.ln... 
Repl, Mall 
No Posteg. Stemp 
Necessary il meiled 
in Cenede 


Postage wi II b. paid by 


SPECIAL GROUP OFFER 


Box 501 


Station F 


Toronto, Ontario 


M4 Y 9Z9 


2. TO DISCOVER THE MEAN- 
ING OF THE FACTS. This 
need is served by the 19 
Knowledge In Depth volumes 
containing 4,200 articles pro- 
viding understanding and in- 
sight to make the facts come 
alive with meaning. 


3. TO EXPLORE ENTIRE 
FIELDS OF KNOWLEDGE. 
This need is served by the 
revolutionary one-volume 
Outline and Guide which 
Is a readable guide to the 
whole of human knowl- 
edge. 


For Over 200 years Encyclopaedia Britannica has been recognized as the reference standard of the world, Now. . , the world's 
most authoritative and complete reference work has been redesigned and totally rewritten to bring a far more readable, 
usable, informative encyclopedia than ever before. You can choose either the Heirloom or Imperial binding and select 
your choice of valuable options - included at no extra cost. All this can be yours at a Special Group Discount - a price lower 
than that available to any individual. 
More useful, in more ways, to more people- 
Now arranged for 3 reasons into 3 parts. 
In a dramatic 3-part arrangement that makes seeking, finding and knowing 
easier than ever, THE NEW ENCYCLOPAEDIA BRITANNICA provides quick facts 
clearly and concisely for the school-age child, and at the same time can moti- 
vate student and adult alike into the magical world of self-enrichment. 


Together, the three parts ofTHE NEW ENCYCLOPAEDIA BRITANNICA combine to 
achieve a breakthrough in publishing history and result in a family reference of 
extraordinary and unequalled usefulness. 


We have prepared a special, new Preview Booklet 


If you are interested in receiving our new preview 
booklet which pictures and describes the All-New 
Britannica 3 in detail, plus further details of this 
Special Group Discount, please fill out and mail the 
postage-paid reply card, If the card is missing, please 
write to Britannica Special Group Offer, Box 501, 
Station F, Toronto, Ontario, M4Y 2L8. 


P'
 


. 
 
...{'{
 


YOU CAN SELECT 
YOUR CHOICE OF 
VALUABLE OPTIONS 


OPTION NO.1 


"[ 


15-Volume Set 
Britannica Jr. Encyclopaedia 


OPTION NO.2 


II' 


f 


... 


Britannica World Alias 
and Websler's Third New 
International Dictionary 



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 



 
 
\ , 
, , ... 
- n 
 

 - 
 
4;(< . . 
" ,- I 
rA1. 
-I\
 1 .., 
.. -;; ,/ .. 
, 
/ 
.. , 
. I 
;;- \ ^ 
.. 
, ">- \ 
..- 
.. "- . 
... . '. 
. 
 ...;-- I , 
.... . .... .. 

)tt .. .
 " 
.' 
f ,01' f 
. ... .. 
" . 4: ,> . -" 

"Iot r ." 
\ 
 
..... \ .. 
... " 


.:::..... 


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
 


. 
I 
,.
r . .. 

 .... 
.. 
 
 
.. 
}.. . . "'. 
".- 
,.. 
. ..f 
4 
f ... 
. 
- 
- 


r 


"to 


... 


Designs in Dacron@ 
Dupont reg. t.m 


J J1U<< X) 


The Tunic Pant Outfit: Tunic, 5593; Turtle Neck, 5564; Pant, 1562. The White Lights Dress: 1509. 
Write for your complimentary Uniform Brochure to: Barco, 350 West Rosecrans Avenue, CN-76, Gardena, Califorma 90248 
Barco, one of the finest names in Uniforms and Shoes is proud to be in Canada. 
Please look for Barco at the store nearest you. 
UNIFORM WORLD, 3 Coumbe St., Renfrew, Ontario; 226 Bank St., Ottawa, Ontario; 641 Bay St., Toronto, Ontario; 691 McCowdn Rd., 
Scarborough, Ontario flORENCE NIGHTINGALE, 156 James 51. South, Hamilton, Ontario. SALON FANTASIA, 562 St Catherine 
East, Montreal, Quebec. ROSE-LEE UNIFORMS, 837 Sherbrook, Winnipeg, Manitoba; 265 Kennedv, Wmnipeg, Manitoba. ROSE 
UNIFORMS, 10175-100A St., Edmonton, Alberta. DORIS UNIFORMS, 618 3rd St. S.w., Calgary, Alberta. VOGUE UNIFORMS, 116 8th 
Ave., Calgary, Alberta. IMAGE UNIFORMS, 734 W. Broadway, Vancouver, B.C.; Cariboo Shopping Center, Coquitlam, B.C. 



The Canadian Nurse Octobar 1976 


15 


UPSIDE-DOWN 


HOW DO YOU 
FEEL ABOUT... 


. 


. 


AW 
<' '!is 


- 


s=- 


- 
-- 


*' 
,. 


s 


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... 
 
'< . 
a Canadian supplier 1/ /' 
lex nurses needs' 
 
No worrying about CwIoms- Nocilfy 10".. 


'HrH H t:R1 ORDER. 
f R II White riayl POCKET SA" ER f.... 
pea.. ocio-.. et<. Cbrck boo Da 
COUpoD. 


STETHOSCOPES 

 l RSES STETHOSCOPES m 5 
colo.... Ezceptlorl4l.OIUOd 
'"""",ill"'''' adjulable 
Iigll/weigll/ bi1omIralI; 
rep/ace7M1l1 pari. atXJdable 
.... Canada. ".14 Silver. ".15 
Gold, "'9081"", 
492 
Green. ".94 Red. 19.00 
rach, lr&c/VIÙ' .....,ialI 
engraved fr.e. 
Dl AL HEAD STJ-:THOSl'OPE. 
A mplJjie. aU freqJU:rOJ:i... &wIe. 
.ecliOll has rzlru large diap
ru!J11l 
Adj1Uloble cllmme bmourall 
4U 515.95 each. 


SPHYG
O

'O
ETER 


R..gged mad dependßble, 1<>1111 
A RCroul gouge coblnuted 10 j()(J 
m m. Velcro 10ItCII.mod.llold 


 nff--
- 

.. 10"eoTg1U1nmlee. 
115 
" 12
.95 each. 
........... /uludes mitUJlJ f'n9nJled 


",,- 


OTOSCOPE SET 

 ()ru? (JfG"""",,,,'. /ine.t 

 lftstntmenls. Exceptitrnal 
, ,Uummatnnl. PJ1Llf'rful 
_
.-=- magnifying leR.l. J ,'anOOrd sIZe 

':-:wa' 
pecuIa. Size C boUene. 
IJJcluded Metal carrymg C'G.If' 

 lined v','11 .ofl c",III 
S09 
156.00 eorh. 
SCISSORS & FORCEPS 
L1!>TFR BA '\D.-\GF. sns<;oRS. ' 1 
A mlUtforevery l\Krl'e \... 
'tfanvfW:lv..d offine,','eel mod 
filll.-sAed m sanItary chrome. 

699 4' , . 12.60 

700 5' ,. S3.00 . 

7(),2 7'," 13.75 
UPFR.-\ T"G :"U:"!>UR<; 
Stui>tk.. Sl..
 slTtUght blader. 

705 5' ," sharp blunt S2.0!5 earh 

706 5" sharp .harp S2.85 each 

71O
' ,"IRISscl<sor. S3.65e..h. 
FORCEPS. 
Fin,,' Sla",le.. SteelS"," "mg_ 
 
Kel!> Forceps 
72t StraiKht. box lock $.1.35 neh 
Kelly Forceps 
7
5 Cuned. box-lock $.1.35 euh 
Thumb DressinK 
7tIStraiKht. serraledS3.35 each 


:\"t:RSES WATCHES 
4. dependable, ottroclwe vwell FIll} 
nI
mbers ow u Ait
 I
e Red 
'f!ep 
.e
md lunlit. CArome casf!, damle.. 
sleel bark Jev'<llkd mm'emenl, black 
leolllcT .,rap 1 !IT. !1"4runt <_ 
900. 
SI8.50 IpI... 9' eNiI. in o..tono' 



 
K,r,\1;;. 
"1 .) 
11 


"STITl-nO:\AL 
l R:"ES: Wrile on your Compan) 
lett
rhead for our 2-1 pg. catalojitue. Quantity 
discounts 3\tailable. 50 cent handling charge- (or 
orders Ie.. than S5.00. 
----------- 
Order 
o, Item Col. Qua.n. Siu Pn<< 


FQI In \\F[)\e -\L Sl PPU CO. 
P.O. BO'\ 726-S. BR(K'K\ III t',O'T. K6\ 5H 


I 
I 
""(o: 
I StrH't: 
I ('it\-: Prov.: 
I P08taJ rod...: --I 
-------------- 



þ ? 

 , 
.. 
,. --' 
.. 
-... 
--- 


, 


 
'\ 


I' 


" 


.. 
.. 

" 


T' 



. 


, 


<< 



 


The Canedlan Nurse October 1976 


Gb9D
 Q
 
w
n

. 
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? 


", 


, 
. 
.. \ 
. 
. 
" 
, 
" 
" t ..... 
.6 
\ ......... 
,. \ 
... 
".;' 
, 
r-- 
"' 
l" 
"- 
.. ., 
"' ..... 

 
. 
.. 1 'I 
, '\. i 
1 


'\ 


,A 


'- .... 


I
- 


\ 



" 



 


, 
'
 


'" 


"'\., 
;, 
7 


, 



 



. 

 "\ 
 
\ 



 


, 


- -<" 


" 



 


) 


......... 


The Cenadlan Nurse OCIODer 111'11 

(I 


, 


.." 


.. 


.. 
J J
 


" 
, 


-. 


, 


"". 



- 


.. -... 
 


.

 


.... 
- 


.. 
 


. 


... 
. 



 
....
 



 
.-., 
-_ t.r---
 


s". 
-+ 


, 


'" 


, 



 


A 


" 
.. . o
 . 

..., . 
. . . . , 
.0 ,_ '. . .... 
.. . 
.. . . 
. . t 
. . 
. 
'" , " 
. 

 . 
.' 
'" , 
.. 
" . , 
., . .,- :.. 
, 



:.tv 


The Canadian Nurae October 11176 


'_ iJ/ 
.
 

 . '
 I .
 

.. 
 


:, I. 
,
 ' 
_ f ;1,>- V. 

 p,,
 


-/
 

.
 


.. 


.".. .... 
.".. 


Penny Jessop 


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. 


, 
, 
"' 
f , 


, 

 
I 


... 


\. 
..:2 


..... 


1 Normal coronary artery 
cross section 



 


. :;,"'. 


".. i 

 <""C 
Å
b :.,..:-
..,:::: 
- . .!..-...-- 


.........- 


" 
.. 
t .:.. 
.J- 


. 

 
...... 
 


.-1.:\ -;.... 
" 

 
- -; 


:
 -:: .; - .:;:; 
. 
 , .<",..,...



. 
 

 '.,......... 
 

 c: .-" 
., 
, . 
I . 


. .; 
.... - þ . 

;"......:. 


..-:: 
-'..! 


. 
l 
1'\ 
 ,. ,....1 

 
-'í"" 
 
 - 
. JL. -. 
 _ -_, 
.. '. 
 ..' -= 
"; -=<-::'---"'- '- 
 -
 

 Ir. '\\ ". '

f _.-...: 
-
 ---


.:.-;a. "\.. 
." I. ." -. 
""';:"'"",-," -- I --- -.. :::::::
 -...--- -r 
< . ,
,.._,... 
 ..... -.... 
._- -
 -- . 
.......


 -....::."" 
 -.. - -, - -.- - 
.. 'i;.
;
 

 -
 
 


*ii
 .;,. 
..,;+:. . 
.
, ,-
,,: .. 
 -ö
 --
:-.-
 í' 
 
r 
?:a-;':
 - '- . 
 '}..: '_

 
 '" - _.of 
. C

!.::


 ....._-..-f.;-"í?"i 
 --: 
. 

0"--
 ' 


a - _" ,- 
. "
r ,",,:')f

 '":
"" 
--=:':':= ,- ._
 
. ..:.,..,. 
... s , - 
 ....;.c-;'::;
--""-"'''I;;:-'''Iw!!
 '.- ".. 
, 
oJ 
 - 
 - . -1"""---r--.:-...-.:.,.l--.... -' _' .. .,"h
: 


:; - - ...... 
 ..v.' -
 

 .,. -1 ... ____ .
 -
 
 : 
:;
_..2 Deposits form in Inner lining 


;ì:.l.Àl 
. . 
. ...... 


.
 
. 


'.
 
:,- '" 
, . 
. -.#- ..If./ 
'1
.
 :- ._ 
. 
... 



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 


23 


... 
c. 
CI) 
(.) 
C 
o 
o 


... 
C 
CI) 
... 
... 
=' 
o 
c( 


E 
f 
i 
is 


. . 
o 
.- 
>< 
c( 
C 
.- 
o 
c 
CI) 
... 
o 
.- 
m 
c 
c( 
I 
C 
.- 
C 
CI) 
a: 
CI) 
s:. 
I- 


Q. 
ED 


. 
'S 
.&l 
::I 
- 
'ii 
ø; 
=ä 
.E 
e: 
.2 
ë- 
o 
III 
.&l 

 
S 
. 
. 
Ê 
::I 
=ä 
o 
III 


+- 


tÞ 
E 
::I 
Õ 
> 
" 
'S 
-= 

 
l1li 
:ã 
ãi 
u 
l1li 

 
CD 
+- 


Ê 
::I 
=ä 4 
o 
III 
+- 


.. 
III 
e: 
CD 
" 
l1li 
'S 
tÞ W 

 E 

 .E 
:2 
. 

 1iio 
.. be 

 i
 
.. go 
u 8 is 
l1li _ 

 E .. 
= .3 
 Õ 

 
 1 
 
E III _ 
::I 'VI .!! 
'2----.5 
--+
 

 

 ;:: 

 .b i 


Q. 
CD 


.!! 
8 


-+ 



 
l1li 
'S 

 
E 
o 
ï 
)II 
3. 


'ii 

 


III 
::Ie: 
00 

;: 
CD l1li 
e:- 
::I 
.YE 
-- 
CD- 
s'" 
l1li E 
Q.CD 
E1ii 
>->- 
."." 


ÞC 
CD 
1:: 
o 
u 
'ii 
i 

 
'0 
l1li 
Õ 
e: 
o 
;; 
Þ'S4 
.5 
i1 


j 
." 
=ä 
e: 
+ 
C 
z 

 
o 
- 


CD 
e: 
o 

 
1ii 
o 
" 
iii 


1 
CI 
e: 
l1li 

 
U 
þ( 
.!.. 


+ 

 
E 
:I 
I 


/ 1 

 E f 

 
' 
i i 
CI f Ci 
e: - e: 
.E i:S ï:! 
." > III CD 
e: c: i 
 
.! 8 - 0 
t-\
 
III 
; i\ 

 
Q 
e: 
l1li 
e: 
o 
;: 
l1li 
> 
;: 
U 
l1li 
E 


-+ 


e: 

 


e: 
CD 
8' 
e: 
ii 
e: 
.! 
o 
'& 
e: 
l1li 


." 
." 
CD 

 
III ø; 
'ii 
 
>- III 
s::. 'S 
.5 Q, 
Q, 0 CD 
e 
 
 
õ.-
....-
 
U e: - 
i: CD ." 
o '0 
 
U .. Q. 


+ 

 



 
.!! 
.3 
.. 
U 
l1li 

 
CD 
s::. 
CI 
:E 


-e: 
o 
;; 

 
i 
U 
e: 
o 
U 
E 
::I 
=ä 
o 
III 



 
o 
ë.. 
CD 

 

 

 
l1li 
Õ 
ö: 
CD c: 
1:: 0 
l1li 13 
o -.: 
e: 1ii 
o e: 
;: 0 
þ 
--'
-+
 
U l1li +- 
l1li > 


... 
" 
" 
õi 



 
c: 
" 

 
ë 

 
'5 
u 



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, 


I' 
\l ... I 
" 

 
I 
-- 
\ 
, 

 . 
" 
- . ., 
, 



 

- 


i 


4 


Photo by Health and We"a,e Canada 


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- 
e;. 


I 
, 
If' '!'If
 /I, '" 
 \\\\\ \ 
j' / 

 
,
 


. I 


-, 


"'-- 


/ 


/" 


" 


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 



(\I". 
.-.el
 , c' 

 
,0 


-- 




 
!I 
\
 
.
 

 


,I"
 
". 
 

, !. 
\ .;It -. ,. 


If 'A
 { 
.if: \. 
,.-,,"-,//1 1\ 
-<


 ( 

y
 t.... 
-
\ 
þ ' I 
, A
 ':
 : 1 
", \' ,:,,: 
ìl l
: 
/ 


,.,:
 
". " 


'
 


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 


Send for free catalogue of all current nursmg publications 


From Lippincott... 


THE DYING PATIENT: 
A SUPPORTIVE APPROACH 


. 


Written specifically for the many hundreds of thou- 
sands of practicing nurses who care for critically ill and 
dying patients, this sympathetic and practical book offers 
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 
situations they face daily. Topics covered include nursing 
care of the dying child, the basic psychological needs and 
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- 
ing from her extensive experience as a practitioner, the 
author has achieved a candid and refreshingly original 
presentation of the sUbject. Content includes: relationships 
with families; nursing tips for common treatments, tests 
and medications; 
elationships with confused or disoriented 
patients; keeping patients comfortable, happy and occ- 
upied; care of stroke patients; problems with obesity and 
diabetes. There is a section on needs of younger long-term 
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- 
logical problems of the elderly. The preventive approach 
and the need for future planning as people grow old are 
stressed. The clinical aspects of disease, the difficulties of 
diagnosis and the appropriate treatment of illnesses peculiar 
to the elderly are discussed while the necessity of surveying 
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 
i.terature on the psychology of aging, Today, when this 
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 
This is the widely used book that nurses consistently 
praise for its realistic approach to the care of the long-term 
patient, Now updated in the light of advances and inno- 
vations in its field, it has also been expanded with the 
addition of a model for nursing care, comprised of eight 
key components that can be shifted and adapted as the 
needs of a specific program require. A "helpful, patient- 
oriented" case study, to quote Nursing Outlook, rounds 
out the book. 
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 


. 


Improvement of the health care of elderly people 
through the rehabilitative approach IS the principal focus of 
this book. The content is centered around concepts and 
skills fundamental to the rehabilitative process, including 
such concepts as the dynamics of independence, the haz- 
ards of immobility, the age continuum, the value system 
and life style, and the dynamics of role in the rehabilitative 
team relationship. 
By Janet M. Long, R.N., M.S. With 13 Contributors. 
Lippincott 127 Pages 1972 $3.90 


ABOUT BEDSORES 


11 


In simple language and with full color photographs 
and drawings, this unique manual effectively presents what 
the nurse needs to know to prevent and treat bedsores, one 
of the most common problems in management of the long, 
term ill. Nearly every page describes and illustrates a 
different potential problem and ItS prevention. You will 
learn which parts of the human anatomy are most subject 
to decubItus ulcers and pressure sores, and why. Photo- 
graphs taken by special techniques show exactly what 
happens to body areas that are subjected to pressure. 
By Martan E. Miller, R.N., M.S.N., and Marvin Sachs, M.D. 
Lippincott 45 Pages Illustrated 1974 $5.40 


Long-term health care. 
. 


THE PSYCHOLOGY OF DEATH, 
Concise Edition 


This book brings together what we know and can fore- 
see about our changing conceptions of death. This concise 
edition, like its highly praised parent volume, identifies, 
evaluates, and integrates the significant observations on the 
tOpiC, along with the new findings resulting from the 
authors' own research, It reflects the conviction that our 
ideas, attitudes, and actions in every sphere affect our 
relationship to death; that, moreover, we have greater 
control over the factors that determine death than we 
realize. 
By Robert Kastenbaum Ph.D., and Ruth Aisenburg, Ph.D. 
Springer 446 Pages 1976 $9.95 


CARE OF THE OLDER ADULT 


9 


I ncreased numbers of nursing homes, extended care 
facilities, and new legislation for older citizens have brought 
the needs of this age group into sharper focus, This book 
has been written to provide practical nurses, geriatric nurse 
technicians and other health workers with a useful text 
in thIs viable area of health care. Content includes the older 
person within the context of family and society, develop- 
mental tasks, community aspects - housmg, health, nutri- 
tion, recreation - normal aging processes, nursing in 
long-term facilities. 
By Joan Birchenall, R.N., /11.Ed" E. Streight, R.N., B.S.N. 
Lippincott 228 Pages 1973 $4.75 


J. B. Lippincotl Company of Canada lid: 
Please send me the books I have circled, 


1 


4 


9 10 11 


5 


6 


2 


3 


7 


8 


Position 


Name 
Address 
City Provo Postal Code 
o Payment enclosed, ship postage and handling paid 
o Charge and bill me 
r-IilChargex Acct. No 
o :;:; Master Charge Expo Date 


LIPPINCOTT'S NO-RISK GUARANTEE: 
Book. .r. .hipped to you ON APPROVAL; if you .re not entirely 
..ti.tied you m.y return them within 15 d.y. for full credit 
Price. .ubject to ch.nge without notice, 


Lippincott 


J. B. LIPPINCOTT COMPANY OF CANADA LIMITED 
Servmg the Health Professions in Canada Since 1897 
75 HORNER AVE. TORONTO, ONTARIO MIZ 4X7 (41.' 252-5277 



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. .. 




 /'"", 1 - t.
, 
pI ,-.... 
'\ - -", ÿ , 
gl !
 "=
'1 ç ,h J .L 
11 
Irr;:

! 'l l
 í , i';-- 
11 [ III
' II i I
 . 
 -. ' I 
 
,- ;
 
-
-,,
 ; I J I, 
 
., _ ?..,. " \
. :IT, . r
, 
:
 

 
/
 v 
 : , .
 ' . f ,,


):;.- 
,,/ '....
... . { . , 

 

! -,;:.r \\ 
......- 


I 


..- -.._,.., . -.- 


./ 


.,. .",--- ... 


S
lf -cOlnc
p
 


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 


'\ 


.. 


A 


. 


., 


.. 


" 


. 


. 


. 
;,J 
':t 


" 


" 


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 


- 
- 
- - 
- 
:x: 
-<
 
- :Þ 
m 
Z mOO 
00U'> 
0 -<t;; 
- 00 m-< 
m Zm 
X 
Z 
- 
:Þ 
 0-< 
- m Z 
00 
< - 
-< 
0 0 
- 
 Z 
- m 
-< :Þ 
- 
- Z .- 
(;) 
 
:Þ 
- 0 .- 
:Þ -< 
U'> 
00 - 
- 00 U'> 
:x: 
m 
:Þ 
- 
- 
- 
- 


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. 


I - , 
- -- 
- = 
-;-- 1:.-:- a 
CJ ,- '--- 
....... 
- 
. . 


1 
, 
-".. ..J -" 
.- 
- \ 
- 
I , A- " 
, \:'
A 
. la' I , 


" 

 



..--
 


- 
.- 
-
 


-- 


, 


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 
 .., 
-.. 
i 
I 
- 
'l L 


.
 



 



 


. 
,. 


t 


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 


IIIII

(


III 
'I 
1111\
 I 


The Canadian Nursa October 1976 


11111'1 


I I 

 
 
I 
I 


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. 




 


 


 
.

 
.

. 


 
.

. 


 
.

. 


 
.

. 


 
.

. 


 
.
 

 


 


. 
. .

 

 
.

 


 
.
 
U 
.
 

 


' 
.

 

V'
. 


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 



\ '. 
'

<
\ 
i ,; 
v\ 
: , ;' 
 
. I J ' 
 \ . :'\
 , \ 
l
 r

 / .:', 
\J, 
, 
t'. ,": \ß":"'
" 
,,,,, --:.....
 .
..
 ./ :.;;:;"; 


!:. 0':"'::' . ::.,: .
....:
.


 c-- 

. .;,....
. ..:...
. -- 
 


 . \ " '::"'j 
 -:. :: 

f



â!



:
,
 
 
1 . __-
U'-_ .'-
-- -' . .,.
, J.- -
.. 
, _, '. þ
;
':'


r


i
l

'
 



The CanadIan Nurse October 1976 


45 


"P 
#- 




 
I 
.1 1 


iI' 
 , 
t
t 
I
 
'U
 


,I 


Y-----:: 

 
. 


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: 


. , 


...-" 
Pediat..k 
Nursing 



-9JOC.^l 

-- 
--- 



, 



 


, -. 
- ... 
.... 
. , . 


.. 


-- 


. 521.35. Order #5805-9. 


. $9.25. Order #5717-6. 


- 512,65. Order #609&-3 


-- 
-- 


ClJ\

 
O\
 
\-\I\.
 


Order #354&-2, 
$13,90. 1976- 78 
(Includes the Handbook) 
current (}rug 


... ------- 


pr..1ÐIt 
 

 


., ... .- 


LaW 
Every 
Nurse 
Should 
}(noW 
-- 


aLUA-nD'I 
=- 


f $6.10, Order #35 67 - 9 . 


-- 


- . ... 


. $8,25. Order #4131-8, 



 
--- 
--..-- 
.- 


. 
,- 


,.. j 
. 
... 
 .. 


ø-IOIIII.... 

 e-al 
iNFECUJUS 
.
 - - 


Pa\ -n.\ t 
^ :
 --.
,\ 
::nagetnen\ 
b-y the 
Nurse 
PraC\ibO\\ØI' 


Î 55,15. Order #3545-8. 


. $10.85, Order #2752- 8 , 


#1220- 5 . 
, $12 40. order 


1 



 
- 


- 4 
O de r #4133- . 
- 9.80. r 



 



 


.. ...... 

 



 ............. 


#9649-)(, 
. $13-35. Order 


'\ 


, 56.10. order #8286- 3 . 


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 
1 



 
 
8ya
 



 
ber -------



------------ 
I 
I 
I 
I 


n ooe(I 


ntIe,. na !to DOS'.
 


!tend COD 


::; bd 't1e 


C y 


PROV 
E 


Pnces subject 10 change 
---CNI:-;S-' 
I 
I 
I 
I 
I 
I 
I 
Z E I 


FULL NAME 


POSITION & AFFILIATION (IF APPLICABLE) 


HOME ADDRESS 



- 


50 


The Canadian Nurse October 1976 


\\"']11:\( 
8 Xt>>\y 


/' \, 
, 


; 
(Ir
 
\ 


, 


,.Þ\ 
\ 


"- 


- 


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. 



 


'\ 


,. 


.... 
. . . \\ 
,....

 , 


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. 



, 
II I' t: 
.1111/ I; 
 : ,,- - tllc 
I II! I )it Ç/'
 
(" 
.' 
..a(I'latc 

, I 'I I \: 
. C" 
, I) I: " -" 
I IiI \ 
 \ I, I, 
I 
1/ I' 
I, \ I 
,/' " 
I 
I; I 
, , 
I ' 
I!"
. 
I : I 
- 
Ii 
0 


; I "Ifo,m 
I ' II 
 
78 KING ST WEST 
,III ORONTO. ONTARIO M5V lN6 
I 'TELEPHONE 364-0125 


II 


L/, 
- 


I 
'/ 
II, 
I ,I 


'i 
r 


I, 


II 

I'I 
j 


I 
I 
I 
i I \ I 
I ,II · 
II 
11 \ 
/ 


I 
I, 
, 


I! 
I 


t! 
III 
1 / ' .1: 
I J;; 11,1, 

 II 
ill : I 
'1 1 I' 
II
 I I 
:1 , ' 
, II: i 
\I I ' 
1 1\ I ' 

'I I; 
I! 
I 
I 
II' I 
, 


Style 814 PantsuIt 
Polyester Textured Warp Knit 
White Blue - Yellow - Ice Mint 
Suggested Retail $2800 


, 


iI_"d 


12 ABITIBI PLACE BONAVENTURE 
MONTREAL. QUEBEC 
TELEPHONE 8
6-5223 



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 


MOSBY 


TIMES MIRRO" 


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 
perspectives. Timely articles include discussions of how to prepare 
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 
rehabilitation. The nursing process is emphasized throughout; 
with pertinent assessment guides preceding each chapter. 
February, 1976.246 pp., 3 illus. Price, $11.05 (C); $7.90 (P). 


IVICSBV 


Tl-U: r \/ MnC:;RY rnMPANY. LTD. 86 NORTHLINE ROAD, TORONTO, ONTARIO M483E5 


TIMES MIRROR 



- 


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 


Item 
No. 


Author 


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 


Borrower. 
Registration No 
Position. 


Address 


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 


:\
Vl GENf
 
C
 [j v. 

 
 
s, -:::;.. 

 
 

 !I 
 
'Ó Ó' 

 
 
-11tl) (, ,,
 
lIAæ\
 


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 
./ 0 
J, . r .5 
Ot 1awa 


(., 


:/ 


IQ 


o 0 
c::. . 


" 


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- 
, t. ... 1 
., 
,....." , "., . " 
... " t' 
- 
.... A 1'0.' . \. 
.. 
 
, -.:'\> 

 \ ;;.
 
.r ,.; - r .1 
... ::: 
. . 
i'-' - 
" <
"'.j . 
 
.. io,c ..... f; 
V .. ..... 
... ,-:1 ,.. 
)L fs)' , -.I 
F . 
 f 
.. 
Ji. -
 ".. - 'L--- . 
ü . -- . . 
'" - ""'"-.,. - 
 . 1JIw" 
c. ., 
É 't.. .. 
0 , ;:. . 
'ë ,. \ 
" 
èij " 
>- 
D 
g 
0 
-'" 
n. 


... 


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 


TIMES MIRROR 


A TOTAL PERSPECTIVE 
OF EFFECTIVE PATIENT CARE 


. up-to-date information on 
nursing techniques 


. 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 


TIMES MIRROR 


THE C. V. MOSBY COMPANY. L TO_ . B6 NORTHLINE ROAO, TORONTO, ONTARIO M4B 3E5 



14 


The Canadian Nurse November 1976 


@ 



 


. 


) 


The first and last word 
in all-purpose 
elastic :mesh bandage. 


, 
, 


Quality and Choice 
. Comfortable, easy to use, and 
allergy-free. Widest possible choice of 
9 different sizes (0 to 8) and 4 
different lengths (3m, 5m, 25m, and 
5Om). 


f.J:-
;7" 
:FJ1 t'I k 'I 
.. . 
'r" 
( i ... 
n--
-::tIItZ.ðIIItC 
'i [,l
E
r;, 
'.f . LJ(,E;rJt:
 
--. , 
_
r't.... 
.... '
J 
.
 . ... 
5.: '11' 
-, .
.. ... 


Highly Economical Prices 
Retelast pricing isn't just competitive, 
it's flexible, and can easily be tailored 
to the needs of every hospital. 


t 


Technical training 
. Training and group demonstrations 
by our representatives 
. Full-colour demonstration folders and 
posters 
. Audio-visual projector available for 
training programmes. 
. Continuous research and development 
in cooperation with hospital nursing 
staff . 


- 


.... . 
- 


.... 
. " 
-,,
:-::; . 
.
=t1.ec"\ 
 
4.

r:;;:::=:;""
 
;.:

.....

..

.
.. 
;.:,:.:.. 

p 
"-;.''''
 JlI#Þ'.'" 


Ill. _it
t. . 
.cu.....- 
.
,,
...... 
. t Þ .. :'\õ1J 
..

#Þ.; o. .
."", 
... 


For full details and training supplies, 
contact your Nordic representative 
or write directly to us. 



@m@)o@ 


PHARMACEUTIQUES LTËE 
PHARMACEUTICALS LTD 


2775 BOVET ST., LAVAL, QUEBEC TEL: (514) 331-9220 TELEX: 05-27208 



The Canadian Nurse November 1976 


15 


/þ 

 


... 
... 


-' 


.. 


. 


'\.... 


, 


/- 


impressive, and seems to make sense. attack. These people need to know how 


, 


 
\ 


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 


... 


\ 
, 


.... .. 


'. 


r 


" 


..I 


. 
.. 
. 


, 


\. 


\' 


\ 


1 


r 



 


" 


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. 


, 


.. 


" 



 


.. 


" 
""- 


\ 


\ 



16 


The CanadIan Nur88 November 1976 


. 
r 
ones 
FRom I
EAD TO TO
 


. 


wo. . 


"'":' 


.. I 
.e' 
---...' 
þO:\ 


.. 



 
s/ 


" 
..$ 


-. 


/ 


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?" 


-III .. y' 
.., 
" 
\/' 
 " 

 -
'J 
.- " 
t 
" 


\; 


J '>1 


J. 


\ 


J 


.. 
 


I 



 


....... 


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 


---r 


The Canadian Nurse November 1976 


. 


I 
I 
a 
.. 
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 


I 
I 


I 
I 
II 

 
. 


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. 


At Last... 



 \ 

. 
'... 
-f' 
K' 


o 
a Canadian supplier 
for nurses needs ' 
No 
 about CuIbns- Noduly to,.,. 


\\ I (II n I:.R\ URUI:.R. 
f R f f "lUte ..in..1 POCKET "A' ER lor 
pene. 
ifj,
rs. ek. ("ht"Ck bol OD 
f'oupoa. 


STETHOSCOPES 
'l R!>F!> !>TETHU!>l'I)I'ES",5 
c ltnlrs. Ex. phonal sound 
lro"",...non. ooJlUlabk 
bghlwelghl b".....rolI: 
re
emenlpørl.a.
bk 
'" Cønødø. 
414 SLIver, 
415 
Gold. 
490 Blue, 
492 
Gree1l. 
494 Red 59.00 
each. l...dvde. i1Iiliall 
f:ngrnvedfref! 
Ol .\L HE.\o..n THCI..COPE. 
Amplill 
oJJfreqlU!nne. /Jull.je. 
t'chon Iuu e..rtru large dlaphruqrJI 
\dJ1','øbk chrome bmøllroll PJ,U 515.95 each. 


SPHYG '\UnIA:\"O\lFTFR 


R d and depend4bk, WlI" 
Q."'_ A'
er().d gauge calibrated to 300 
:. m m \. {'I('TO IOueA. and-AoLd 
p ..... ;_ 
 -" .Iff Handsome zippered cas 
. 
 !l.
" iii year !l""ronlee 
115 
,. 

 52495 each 

. 
 /1JdJUles mrtaals f'lIgTated 


OTOSCOPE SET 

 (hie QfGf'rmß1Iy"sfrned 
, - I rume . E pli<mal 

 ,Uumlnatl
 1'01 rfvl 
" , 

 . maqr- lymg I ..., 3 slandard "" 
-.c s".,ntla "'- :e C batlenes 
udf>d '[ptal ca"1f.no ("Q.IE 
....' I .J. Ih .oJ! Ih /I;JU9 
- 5';6.00 each 


SCISSORS &. FORCEPS 
U!> TER B.\ 'u .\Gt: ..cr....OR<;. ' 1 a.. 
-I m...1 (0.. ery \11' '_ 
 þ--' 
"'anufactu.n t ;. t steel and ' 
\ 
_'"u
^ed n smntary clJrume 
/1699 52.60 
/1.00 13.00 - 
/1.02 53.75 P 
OI'FR.\TI"; ..n....OR' 
."<itl' r rwgln olaJt' 
lfîû5 5 harp blunl S2.K) e-a('h 
N706 ã sharp harp S2.
 e'arh 
ti71O.s 1 .. [RI
.... ....or.. 13.65 e-ac:h. ......'
 
nlRn:I'''. ; 
F,. t 
tUl Ifn St

 5. lung .
 
Ke.., For<ep< /1'24 Slrai!(ht. box lock 5-1.35 each 
I\e \ l-on"'E'psIl7_
 ('uned.box lock $.j.1JeHh 
Thumh OrE Lng 117-11' r 
ht. "erratt'dS3.35 e-ach 


:\TRSES W -\ TCHES 
I d pt'nJøb'" nl/roel ....,'" Full 
"I',j R4'"f) 
t.,PI hand Claram
 ("(1,i . 
talllk.. 
.,1. I back J.II U.d "'01 rne1ll, black 
I r'^ r strel' 1 r g1taftJ,., ItQl1fl 
51
.;;OIp/ J. I (In ,r 


Ll 

f.) 
11 


"" flTl TIt".\L 'l R..t:..: Y, rile on your Company 
lettt'rhf"ad for uur 2-1 pg ("31ál {Ut". Quantity 
dl rQun'''' a' .1dable_ 50 ("("nt handhng charge for 
01 . "t.. than 55 00 
----------- 
Orde-r '0. he-m ("01 QUaD. 'ue Price 


FQl In "Hllt..\1 "l PPI \ ('(I. 
I' n IIn"\. i!fi ".IIRnl'''' III LII' T. "fi' S\' 


I 
I "'tf'nd to: 
I 'tr
t 
Ilïh: Pro," 
I Postal I"ode: 
 

----------- 



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.. ._"" 
. 
 .iI ";
" ;j
_':;': has a Master's degree in cardiovascular 
'v ' ,'" 
 (
 -, 

, -
-"',:, 
 ':::; nursing from the Catholic University of 
'l.' ,l
 'l-..I- '. ..",,- J" ,,;-..r J.'
 , .. :.o\'
 
.
. 
 'f,jr' I 
 . \j- 
 .v h
 
 r' 
, 
 . r. . . -' . 
 .' ,..1/iJ'" \ 1 America, Washington, D. C. 
þ. '" ' 
, ' 
., ø
' , '

 _.
 f n i 

,\ f 
 
i
i
i
 
 {{
' 

 '):. \. '

}:( 

 1.' o;u

HihÆ}e fi:
E1t

.::p: 
I .:' 1;:- 
 \
, ' I . \
 
 fl.. y/
). 


 t f " 'W .,j _ 
 ."lo. ""f affiliated with the Canadian Heart Foundation 
. .. f_. \j.' . 
 r - 
 '" - lt 
 ' _ n(( . was founded in 1973 to promote the quality of 

 '" " 
 '\.. 
l. 
. :.': " ','i. .
 \.
 health care as it relates to cardiovascular 
.'- 
 '
("\ j '
\ .--.!-
 '
' 


l' function. 
...................................................................................................... 


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. ' 


. .. 
--.:: ,,::, 1: ' -;:--:' I-i
' fn 
.'.' , :::: '::: I '. 1 1 \ t \ 
...:.::::::
,' :.: ::: 1 I \ 
.............. , " 1 11 
. ..:....;.:.:....... ' , , I ,II!!!!
 
. .......... ---" - 
 
 / 
0.:-::::::::::::::::::. --- -. ./ ------- 


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 
 J 

 
....-/ 
.
 
I M1étîíjtY 

 
J]t
I1S 
I 
13tb ___ 
d øJø e 
:::::-------- 
"':Ie 


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 
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 t 
tion in normal psychosocial and Ical 
the first four years of life F r hild 
month intervals f 'nf cy to g f u in natural but com- 
parable sellin . In c n on 'th an accompanying work- 
textbook, fl s co S . ute a unique and extraordinary study 
program i gr development. 


For additional audio/visual information, 
please write. 


Dependable texts and 
references that 
constitute a basis for 
superior performance. 


LIPPINCOTT'S NO-RISK GUARANTEE: 
Books are shipped to you ON APPROVAL; if you are not entire
y 
satisfied you may return them within 15 days for full credIt. 
Prices subject to change without notice. 


Lippincott 
J. B. LIPPINCOTT COMPANY OF CANADA LIMITED 
Serving the Health Professions in Canada Since 1897 
75 HORNER AVE. TORONTO, ONTARIO Nez 4X7 (416) 252-5277 



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. 


. 


\ 


# 


. 


.. 


... 


I., ". 


" .. 
-\ 
it \ 
.... 
.. ". '9 
, "':,f. 
 
"'- 
. 
,. .... 
.11 \ 
" ,t1 


, 


, 


. 



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 
(G 
soY> ,l 

 ;\ e.c- 
S 
e 
i- -('ò.'\ I)" v- 
ol( ò--4..'J 
,,0-'.\ 
 1- -{ 
'!o..,

 0 
.<; 
 s'\'\ 
1': 
Il:f' 
\.P
 t.l' 
1- 
' o {\ 

\ 
0<'( 
- ,?--'o" 


7J 
bn.ai1V 
Stann/IV 


Euclid Seeram 


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 
I 0 ' ", ,
'''.ft 
,
 " . f uð_ 

y 
 " :: ' -.... 
E ...y,,,
 .. 
.r- V " V 
-..." 
" .:. 


.... 


" 
...' 


" 
" 

, 


: / 
'1 
"II ' 

DETECTORS 


-
 


I 


.. 


'" 


- 


/ 
"'fa/ ) 
.. 
.
4 
,--- -" 
I 


", )I 


\In. 2I 1 9ì'4 


( ,'-. 
. ..:
 \ 
.

J 
\ t
' .1 


'\ 


, ' J 
\ . 
\ .1: 
., '" 


-1001 


MAn 


'51'11& . I 
226'.1- 21 
191'4 


L T....!.. ) 
 


. - Ii 


I.H '1 



4 


JI, 1Z 


" 



 
,ç- " \- 
. '\.' 
.. 


, 
;;
:}- 
)t .. ,.,. 

 


1\, 
. 


-004\ 
"4T10J14l . .4l 0 S 


A " IIDSPITiIIl'"'t_ 


JU' ta 


a;M- 410 


U1t- $A 
..,. 


II. It 


t,. 




 


"" 


. .' 


A" 
 


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. 
D
"')L \:Jon 


4ir [-S-ooJ 


e, SDO 

 
/
 
30c 

 1cd 
\ J 
,

 JP} 
,.
 J 

\ 
_ __v 
oj - ..::J 
o 
- J-I; t 
-_
L í' 
-=-41<L 
-5 0 0 woÜ.r- Tissue fat Î"IC'1ol,. 


. F t [<fO-5'O'b] 
Bone{Calc1 ICd 101'1 2'J- 3 'iS] 
con
ealeJ Blood 
lfj-13J 
6're.y Matter 
WhIte Marter (/1- IfD] 
Blood [IÞ] 
water [oj 
Fat [-5 


ft, . dblg . 


'1-...- 
y 


Figure 50 Patient's head positioned for the 
examination 


-1) 


o 
I 


23... 
I I I I I 


u 


w_ 


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. 


l 
(((I 
"",
I 
I 
L 
I 
\ 
r 
I 
r 
I. 
, 
l- 
I 
I 
.,J .. 


( 
( 
{ 


[-<'-' 
.

 
'- 
-r: 
r 
:(- 


-' 
.... 


Figure 1 


Bilateral Harrington rods are attached to the spine in the 
surgical treatment of scoliosis. 
Courtesy 01 Shirley Mohyudden 


o 
o 
c 
::t 
CD 
.. 
-< 
Q. 
!!' 
c 
n 
CD 
(J] 
íi 
:Ii 
0> 
" 
0> 
" 
" 
IÐ 
õ. 
3 
.. 
g. 
g 
o 
o 
3 
3 
c 
" 
ñ 
0> 
g 
" 
.. 
o 
.. 
"!I. 
c 
IÐ 
(") 



44 


The Canadian Nurse 


Novambar 1976 


Courtesy 01 Shlrtey MOh) udaen. 


(
1\ 
( :1 
\\ 
fir/- 
-r 


\' 


r 


J 

 _1 

 \r 

 
 

 
 
_1. 
-f/ 


\- 


{ 
1 


\ 
. . I 
.If' ... ... 

 
( t 



 )
 
ç - 
R 


Figure 2 
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 


c 
CD 
"0 
'1 
.c 
o 
,
 
.>- 
,
 

 
.w 
õ 
1>- 
,I 
r 

 
o 
I U 


..--..... 



 
/'
 
'L- 


. 


J 


-J 
t

 _) 
I) 

) 


Fig ure 3 
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 


.#' 
 
. 
. ..", 
I 
---.òio I .....( 

 '
""''\.- 
'" 
 
J \\ \ \.. ' " 
Figure 4 \ , '\ ...... 


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). 


J 


, 


....'1 
"". ì:( 
C' 
..... 
,) 
 


" 
--. 


þ- 



 


" 


i 


.... 
... 


.' 


.. 


,,--- ,- "':-- 
'---r:
) 


,. 
...... 


Figure 5 


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 


"j t>>
1 
t' -oJ 
.... 
,.c 
 
..-. -'1 
,. ....... -... 
-, 

.. 


"'- 
- 


"-- 


" 


- 



:: 

 
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 



 


.11 f J: 1 
 
J 
"I \; .. -'f
 t 
' 
..J H:\ 
,_' 
:, 
 .....1
 
..i;,' 
. 
' 
lft. ;
 
 . ,.:. 

}7' '-li
 ;,:
;] ,
 .
>_ Jl; 
-j- i '$ 
. *... I'
?' r 
. t, :1 L 
 
' 
 J!Ut
 
t'
 f 
t
 

iz
tI


 
 
:1 '--.fè^t.,
' . 
 .' 
'" 

*1L' 
, . 'í l : < '. 
 
 _tl . :
 
 ' 
..?;
tT 

 :J:. 
 
 
 . J t 
'!!

'!
' 
'
:";
il': . 
.., - -. I 1íl I 
 .... I - A. \ { j " 
"v .0' '"". 
 
 ""- I' , ,
 ' , 
::1 j. I _
 

 
 '.;.' ,".
'! 
: v I,f';þ!ji - , íÜJ.... P --:, 
 '. 
, _ \
 

 r _f. \ .;: 

 ' , ,
, "
f . "-. . 
;;: 
,_..=J.,' 
 .....
 =.
 '- '. -../' 
.,.......... "'""-'. 
 .... 
 -:::;.I, 'I. -,........;; ->J ...- 
" - \. I ,)4 r - 
 
 
 
---, 
 ',{ 
 ' .
 ,'}..- 
 '\ :j C 


o <
... 'i " 
 
. , > . 
 - 

 
 
- ' 'J 5 ':, " .... ,.::tJ 4(;!!,j 

 '.. -'
' 
 ,,' 6: t 



 ,,

,; 
 f" ,:r. .".. . .," " . ' 11' ^' c\w: t ' 



 I ;
, 
,
, " - 
,

 

 "-.
. 
'
-

 ", 
 ' 

., r 
' 
,
-'-
 
-

 
. ". 'i:i ' 
, (' \!I' 
:f ., f: \ 
( 
ì I.. 'I. 
1
 
 


;:: 


, 
.. 
',. 


I 


-1976 


4
 


bß_\ ef... rr, ' 
y 
l

 

1 t ç ,ý{P', i
 . ft.
 ... , 
. 
'l( I' . '1 < .l,,'; 
,JI . 
 J 
1 
 -:1 
. t .c\ \' }
 ,., f "t'ì.. 


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 


-, 
:b:.

 .... 
::. )

 
.,5, 
., 
ii' 1
 

X-... 
j};;...." 

 . ç. 
'1
 
 I' :;.
 ;'.. 
\t .., 

; 
'= 
. 
) 
> 
-
 :::, 
, -. 

 '::; \ 
l .- .:
 
,0 :

i 
J ':'11 

\i1 ! 
:;.: 
1. 
4< 
 Jj; U,.f.
 
j=- '[-n-- T 
.
 
-..15i 
 
 I 
d..
 - 
-;fl : 1 :1' 

- 
":i' 
, .: f
1 
 ""f 
'
 ,," 

 Le 
 . . 

 '""II 
'

 
 '_ .)
: ,. 
, (l 
'It
 
 
" {GI
' 1 A 

(

 .t 
. '1 !-.! 

& 
\ i,t
 f ) 
 


 . :>.. J ., 
...
 -'" ( 
-
.. ....). 
-J- 2:'" 
 
"t'
'.. 


49 


r 
 , 
t . , 

 r, .. 

: ' \ '. 
' . t - 
 tÙ 

- 
i...
 "
" 

 ''-\
''_'f tJW 
f\?

-:
 /!. -" 
. 
 _ .,'. \', .'.
\.... i' .*---. I. 1. .' , 
::to' '011011 ',. ' . " 
 · t 
 

 .
" _
 4"' ";"'..
 clt,} ;'.r :f!{; ,. '-
:
r 
 . I 
1:"'. vt...
. . " -. · '1"1, if::.:1t
 . 
.- I ; 11 ) 
. 
'_ .I.

r :-.. -". \ ,l I ffm-:l
!g
tid{ti1 ;l
' l ' it"l j 
,_ ,1', I ... ''"j -1:"-= ":; J. .
 ,ff't<'-
I---"'"=",.2 
)
1tl 
11- ,
.' , . f ' ........:::
.:. .j t "-!
K.@ 
 
Ü.l1X.L 
fi -,i\ 
 1
-.
 'f 
 
'" 
 
. 'I'
-\' 7':' .j!....,
 !1'" 
 ..... 
.
. ..:
:i ',-!.. _ :
: :;1I'i'. I '. 
 -.'.;j. ,'!' " 


, 
j( -., .. .;: 
 ::(
 -

ì\íit 
:. 
 
 
".". 



.. 'J, - 1 - .t. f :: M
tt ... - .... 
. .-:

 ( ......:':- .-#t" I/b>-' 
 
"' . \,/....., ;,; 
f ,. - 
, '
";{;'.. . 

1t 
- ...-t ...... -- - 
1 


 - - 
· '1 'It", ! 1 I Jt . 
 ,0 , - 

-k r.JM1 If' 
 .Þ ,- . 
 
'
::;:';;i. '
'. .t :'...t.

' :%:-1:"["'" ;
 t',.! 


 ia,
tt;;.'i\lIJJ',' 
 . "t
 '.' "1ii,it .::t 
 
. "U 

 , <.<

1
 
;.

\:
t" I ' [ ".I
)(".'J' ": I 
:
 
 
., , .' \, 
\ - - 
')I
'; . 
 {I:.' '
'1 /'loç
 . I l Jl' 
1 
., tf I {
 

 . I \; 
 _-' ,j 
A P"I!
 , 
 .. '..1{ : ' 
 ] 

, tj. 
\. - }. "'I .- 
 
" ,.,i
.J'1

 )
',I J ;;' " 
 J 
o/!) 
\-
! '\
".'
Y't.. (.,
 ...
;< 
\
\ L \ .,--- 
( -
,.(
 " 
_J 
 ' _'''
' ' \ ' " 
 . I, . 
. 
S 'ì r
 

 ;;-O::j 
'1 
 'I'
' : \ 
. - 

 
 (/ (J -:Z .:
 . 
 -" . 
 \' - \.. 'þ-
 

 
 .. 
 ' 
', '
' - ,
 

. 
 
. .:;io 
.:; '-,)
 .. I '"'1 

 )
. --' .' 
,J 
\ 


I 
, 



 


-- 


"'- 


. 


.- 


I I 
-- r :...., 


;:
f


.: íf'ì. Y' 
, 
 
. k.. " 'Ý 
.t(" !
. j: ' 
, 


J"....!".l,! 

 '. 
 
\: . 
l(
t'

'
1. -
'\Sf:to'f
l::- 
oi. 
i" i
n
I
2
..
 tJ\ '-: :\
:
:
- 
,. f f' _ ,. " 
,,"'. . 
 
 r-' '" 
::; · 'I 
; 
 li,t\d\ 'i
 1 '\-, 
., J ,(:I..U_U.II.I4. 


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..... 



.,;:ft 

\
 
1"""0., p "" 

' ., 



so 


The Canadian Nurse November 1976 


j. \11(1 iOyiSllil,1 


,./- 


.."",,- 


I 
,(- 
 


: . 


'. 
- 
,.. 


. 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 
Institute, 303 Richmond Rd., Ottawa, 
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 
help arrives. 
The film may be obtained from 
Pyramid Films, Box 1048, Santa 
Monica, California, 90406. Price $300 
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 
Health and Welfare Canada helps 
Canadians to discover the benefits of 
physical activity in the form of simple 
calisthenics, walking, jogging, cycling, 
swimming, skiing, etc. Exercise is the 
great conditioner, according to this 
film; it builds a reserve of strength, 
reduces stress and is nature's great 
tranquilizer. It takes only a few 
minutes a day to keep in trim. 
Available from the Canadian Film 
Institute, 303 Richmond Rd., Ottawa, 
Ontario KIZ 6X3. 



-..,.I 


\ 


"I 


.... 


'-. 


" 


.,.., 


.... 


J 


'4 


......... 
""'- 


'Or 


. 


n 

 1
 


. 


...... 
- 


\. 


The 'Littmann' Series Portfolio of 
Ä. Y. Jackson drawings 
Free with your order 


Reproduction of 
A. Y Jackson 
drawings by 
special permission 
of the McMichael 
collectIOn. 


Littmann 
STETHOSCOPES 
. . . tru Iy the fi nest 
stethoscope a 
nurse can own 
The Medallion 
Combination Stethoscope 
The highest quality bell and diaphragm 
chest piece, the stethoscope for nurses who 
practice in critical care areas. Choice of five 
tubing colours - goldtone, silver tone, blue, 
) T;;; ;;:d
lIion Nursescope 
Colour co-ordinated in five jewellike 
colours. This stethoscope was especially 
designed for the nurse. Weighs only 2 oz. 
and fits neatly into uniform pocket. 


Group Purchase Package 
Your local selected surgical supply dealer 
handles the complete line of , Littmann' 
stethoscopes and will offer discounts on 
group purchases of five or more. 


Write us today! 
for complete details on: 
D The 'Littmann' stethoscope line 
D The Group Purchase Package 
D The 'Littmann' Series portfolio 
D A list of selected 'Littmann' 
dealers 


3m [ANAD
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 


-- -- 
The Canadian Nurse 


::
7502q6P915 
("nv! 
qTY rF rTTðlr.A 
Nl'1spr II 
ARY 
CTT^

 Cl\TðrtIO 


121 


. 


Klf\ 6N 


u 


1 
. 


Ir' 


. t' 


." 


H..:.' 
., fI- '''{;;j. 



..... - 
..
t14::;..' . 
.

'"-- 
, 


, 
. 
<-,. :. -
- 

 ij .,.
 .
' - . 
..... 
, .\.....',.. "':-'-'1- -- 
,: ;
 
 .. 
-
 " 
-- 
. '" "',.." 
'. ..:.:' ,. 


- "" 


, . r; 
 
( - 
.
 --
.... 
...... 


 ,. 
.,. :.it
 

 " "",,'-' . 
'!. I
i :'. . 

.9 .., }," 
-,;"
 I 
\" \ 
-' 'f . 
f) 


\' 


,. 


.... , 
:," ., ,'" 


, 


-..... 


... y 
'.. ...., 



 


; " I 


, 


;v 


t 


'-0 



 


..... 
 .......... 
. 


r.: 
. . 
-. 


.
_ t 


, 


_\- 


It 


""\U"" 
11' 


. 


.. 
.. 
. 



. 
. ':. :; \ 



i"fjc" 
"t 
.. \' 
,_, n þ.. 
\ '.J \" 


.- 



.. 



 


.... 
'1IÞ 
-- 


, 


. 


/r 

 


, . 


.. 


:I 



 


" 
 


rhe season s best wishes to uou and uour entire staff who give 
patience and understanding all u ear JrountÍ 




 


. _,}' V r Shoem
ker 




 
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 
statement and return address should 
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 
fi: I I , L.-. 
i. .. , " , ":'. ( 
Ii f )11 
 e 
f 
: !
 -, 8 
s.:( ...., -< 
J 
ways- J -! I 
that Saunders helped nurses this year. 


111:;1- 
Þ CD 

 
 

 
 

 
 
o 52 
C) 8 
- -< 
 

 'II 
I I" 
I 


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 
: I I : 
: I I AUTHOR : 
I AUTHOR I 
I :J check enclosed-Saunder. pay. pOllage 0 aend C.O.D. 0 bill me I 
I I 
I 
I 
I 


I FUll NAME (PI...e PrInt} 
I HOME ADDRESS 
I 
I CITY PROVINCE ZONE I 
L__________________
 


Pnces sUb,eclto change 





 
.O
dar 

 '.en 



 .ndaul
 -


 
: 1 I : 
: I I AUTHOR : 
I AUTHOR I 
I 0 check anclo..d-Saundero pay. postage :; .end C.O.D. bill me J 
I I 
I 
I 
I 


I FUll NAME (PI.ase Print) 
I HOME ADDRESS 
I 


-------


---

--
 



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 


..
tf 


r----- ----------- -. 
I IT'S EASY TO ORDER REEVES NAME PINS FOR YOURSELF OR FRIENDS! 
I Choose style JOlI want, sho'l'fn nlM Pont name (and 2nd bottom fight Ahacl1 extra sheet for add.llonal pms 
I :::f!
t ::S

::t
cI:r::S"

t

O:
C

:c
t
:r 
:


 
p


 
:


S.

.
s
DENTICAl PINS... ..vre cillyen.,... 


, LETTERING.______________________ 2nd LlNE:________________ 
I DESCRIPTION BACKGROUND UTTERING PRIUS. 1 Pill 
!: 
1 name) 


.I 
I 


All METAL... rich. trim, tadored l,ghtwereht. 
noath edges. rounded corners. Choose 
hshed saUo or Duclcne 'Inlsh, combmlne 
satin background with polished edgme. 
II METAL FRAMED Smooth plastIC back- 
. . ound with classIc. distinctive polished metal 
ame. Beveled and founded edges and corners 
Smart professional appearance. 
II PLASTIC LAMINATE. Slim. broad. yet IIght- 
.. eight Engra\led through $ur1ace mto 
ntrastmg core color Be\leled border 
matches lettering Excellent V.,h ø 
D MOLDED PLASTIC . Simple IS smart Smooth 
. ean plastic deeply engraved. lacQuer.fllled 
t.dges and corners gently rounded The 
ongwnal nurse style. . always correct. 
........... 
SCISSORS and FORCEPS 

::,In
:

e: :''::'1.- 

 LISTER BANDAGE SCISSDRS 

 3h" Mini scissar. Tmy, hendy. shp into 
uniform pOcket or purse Choose Jewelers 
gold or eleamlng chrome plate finish. 
No. 3500 3V," Mini. . .. . . . . 2.75 
No. 4500 4'/2" size, Chrome only. . . 2.95 
No. 5500 5' 2" size, Chrome only. . . 3.25 
No. 702 71J.... size, Chrome only. ..3.75 
For engraved initials add 60, per instrument 


o Gold g 




 
OSllver DSabn 


Fr3me: 
o Gold 
o Silver 



, 


3V:t" 
4'/1" 
5'/1" 
71,,.,, 


KELLY FORCEPS 
SO handy for every nurse! Ideal for clamping 
NO.o;5

b
ntt;
i
::'


sL


'. 

:'" 4.69 
No. 725 Curved, Box Lock. . . _ . . . . 4.69 
No. 741 fhumb Dressing Forcep, 
Serrated, StraiEht, 51/1" . .3.75 
For eneraved initials add 60, per Instrument 


MEDI-CARD SET Handiest refer- 
enCe ever
 6 smooth plashc cards f31í ' I' 
5Y.1:") crammed with information: Equiva- 
lencies of Apothecary to Metric to Household 
Meas., Temp. <>C to of, Prescnp. Abbr.. Urin- 
alysIs. Body Chern., Blood Chern . liver Tests, 
Sane Marrow. Disease Incub. Periods. Adult 
Wgts.. etC. In white vmyl holder 
No. 289 Card set . . . 1.75 ea. 
Initials Eold-stamped on back of 
holder, add 6Oc. 
f) ,
 
NURSES BAG FInest black 
....'1 thick genuine cowhide. beautifully 
crafted, stitched and rivet construc- 
I tion. Water repellant. Roomy interior, 
. with snap-in washab'
 I;ner and com. 

 . r partments to organize contents. Snap 
strap holds top open during use. Name 
- card. holder. Carrying straps. 6" x 8" 
x 12". Your mitials gold embossed 
F
EE 01\ top Iv1 ootstandmg 
value of superb quality. 
No. 1544.1 Bag (with Imer). _ 42.50 ea. 
Extr. liner No 4415." 8 50 


14K G.F. PIERCED EARRINGS 
 -".", 
Oomty, detaoled 1/20 12K Gold F,lled caduceus wIth 14K > iJff" 
posts, for on or oft duty wear. Shown actual size. Gift '1 
boxed for fnends. too. Ideal group I graduation elftl 
No. J3/035. . . 5.95 per pair 
c__._ _
 'ahlr..dl.1f..-.. 


CROSS PEN 
World famous ballpoint, with 
sculptured caduceus emblem. fun name 
FREE engraved on berrellinclude name with couponl. 
Refills avail everywhere. lifetime guarantee 
No. 3502 Chrome 9.95 ea. No. 6602 12Kt. G.F. 13.95 ea. 
PIN GUARD Sculptured caduceus. Chained'-
 
 
' 
to YOUr profesSional letters, each with plObackl --, 
safety catch Dr replace either with class pin Gold ,.. 
finish, eift box-d Choose RN. LPN or LVN ... 7Ji1. 
No. 3420 Pm Guard. . 2.95 ea. 



\'--:_EXAMINING PENLIGHT 
White barrel With ca4Jceus imprint, alu- 
minum bend and clip 5" long. U S. made. batteries 
Included (replacement batteries available any store). 
No. NL-I0 PenliEnt . . . 3.95 ea. Initials enEraved. add 601_ 
BZll MEMO-TIMER Time hot packs. 
\I 
, 
heat lamps þark meters. Remember to check \'Ital 
 . Fr 
!ugns, give medication, ete. lightweight. compact Q, 
 . 
f1 M!" dla J, sets to bUll 5 to 60 mm. Key rlne. .. 
SWISS made. No. M-22 Timer. . . 6.95 I. .... ." 

 


r 


TIMEX Pulsometer WATCH 
Oependable T Imel Nurses Pulsometer ICalendar Watch 
Moveable outer rme computes pulse rate Date caler. 
dar, wtll1e numerals. sweep-second hand, blue dial. 
luminous. white strap. Stamless back water and dust- 
resistant Gilt bOled. 1 year warrantee. Initials enlrJVed 
on back free. 
No. 237761 Nurses' Watch.. ., 19.95 ea. 


o Black 1 line 
o Ok Blue lettenMI. 02690 4 _.9 
o White 2 Lines 
Letterlne. 03A905.79 
3 Lines 
letteru1g 0. 2 90 6 . 9 9 


I Line 
lettering . 0 1..9 0249 
2 Lines 
lettefiMe 


o 2.29 0 3.69 


3 Lines 
Lettering 03.19 05.29 
("YIII
ble 559 oroly) 
- 


__0 




 
( 


, 


, 


" 


... 


f 
I 
.


 f
L 
Free Initials and I 
Scope Sack with your 
Littmag"tj Nursescope! 
Famous LIttmann nurses' FREE INITIALS ANO SACK! 
diaphragm stethoscope . .. Your intials engraved FREE on 
a fine precision instrument. chest piece; lend individual 
with high sensitivity lor distinction and help prevent 
blood pressures, apical pulse loss. FREE SCOPE SACK neatly 
rate. Only 2 OlS., lits in carries an
 protects Nurse- 
pocket, with gray vinyl anti- scope. Heavy frostedvioyl, with 
collapse IUbing, non chilling dust proof press-type closure 
epQxy diaphragm. 28" over- 
all. Non-rotating angled ear 
tubes and chest piece beau- No: 2160. Nursescope 
lifully styled in choice of 5 m
ludmg Free 
jewel-like colors, Goldtone, Imtlals and Sack 
Silvertone, Blue, Green, Pink' ... 16.95811. DUTY FREE 
.IMPORTANT: New "Medalhon" styling includes tubing In colors to maten 
metal parts. If desired. add $1. ea. to price above; add "N" to Order 
No. 2160!!!1 01\ coupon, 


YJtU 
- 
oIHæ... 


LITTMANN COMBINATION STETHDSCOPE 
Mallmum sensitl1/1ty from this fine professional Instrument. Con. 
venient 22" overall length, welgÞs only 3M! 01. Chrome blnaurals 
filed at correct angle. Internal spring. stainless chest piece, 1 Y4" 
diaphragm. 1 %" bell. Removable non-chlll sleeve. Gray vinyl tubing. 
Two initials engr on chest piece. fREE SCOPE SACK INCll lnC {) 
No. 2100 Combo Steth . ,. 32.50 ea. DUTY FREE 


CLAYTON DUAL STETHDSCOPE 
L.ghtwelght dual scope Imported from Japan: highest 
sensitivity for apical pulse rate. Chromed bmaurals. 
chest piece with 1..... 1 bell and 1 7 /.'1 diaphragm, 
grey antl-collapse tubing. 4 01 , 29" long ú:tra 
ear plugs and dlaphrilgm Included TWI IRltia'- 
engr..ed Iree fREE SCOPE SACK INCLUOEO 
No. 413 DuOI Steth 17.95 ea. 



' 
, C. 
Du'TY FREE 


LOW-COST STETHOSCOPE 
Our lowest cost preCISion stethoscope I Singte diaphragm Ii 7/." dia J. 
Choose Blue. Green. Red. S"\,er or Gold tub"'R and chestplece silver 
bmaurals. nnly 3 01 Three imtlals engraved free. fREE SCOPE ACK 
No. 4140 Clay. Steth ... 11.95 ea. DUTY FREE 
'cAP AC
SSORIES 
"""",'P
,, 
I CAP TOTE keeps your caps cusp and cleon. 
 --" ]I 
flexible clear plastic. white trim. Ilpper. ca.rYlng 
 .... - 
 II 
strap, hang loop Stores flat Also for wiglets. 
 
curlers, etc 8 1 2" dia. 6" high 
 

 No. 333 Tote... 2_95 ea. , 
Gold init. add 60... I 
...
... i> WHITE CAP CLIPS Holds caps I 
., 
 fJrm'y In place' Hard to.fmd white bobb,e pfßS. 
"... '". enamel on fine spring sttel Sur; 2" and four 
".... 
.. J" clips mcluded In plashc snaþ box I 

 No. 529 Clips 85<< per box (min. 3 boxes) 


. 


.../u- t'.m 


L 


MRS. R. F. JOHNSON 
SUPERVISOR 


f 


1. 


- 


CHARLENE HAYNES 


. 


1. 


..... 
11. 
AI ...... .. ....., ..... 
NURSES PERSONALIZED SPHYG. 
 
Now in Fashion Colors! 
 
:o
':fu


:

r


s

I?:r:




a

a
t


ed 
 ì 
In W. Germany Easy-to.attach Velcro<< cuff t; 
lightweIght. compact. firs mto soft s,m 
leather Ilpper clse 2V:t" I' 4"' x 7". Dial. ;... fJ 
calibrated to 320mm, ]().year accuracy fib 
guaranteed to :!::3mm. Servlc.ed by - 
 
Reeves if ever required. Your mitlals 
engraved on manometer and gold 






o
 



R

n
C::
:. 

CK /: 
BLUE, GREEN or BEIGE wdh plastIc 
mano housing. tubing, cuff and case 
all co'or-coofdinated (specify on coupon). ?y 
No.I06Sp h n 39.95"-DUTY FREE 


BLOOD PRESSURE SET 
An outstanding aneroid sphys:. made 

 In Japan tsÞecially for Reeves. Meets 
all US. GoY. specs, ::!:.3mm accuracy. 
") guarilnteed 10 years Black and 
chrome manometer. ca' to 3QOmm. 
Velcro. grey Q1tf, bla
 tubinl, soft 
lealherette Ilpper case measuring 
2112" J( 4'1 I 7". Serviced In USA If 
,- e.er needed. Clayton No 4140 

 
 Stethescoøe (s,lvtr) an" Scope Sack 
included (see photo left). FREE gold 

J .._--_..- 
ø -
 
 practical, dependable kit lust npt 
for every nurse l 
, No. 41.100 B.P. Sel.. . 
33.95 set complete DUTY FREE 
Sphy only NÐ. 108 . 27.95 wIth case 
.--..--------. 
: 
AVf 
5.00 : 
: on gphyg.or B.l! gOf! : 
I Order the No, 106 Sphyg aliff/Of No, 41-100 . 
I Blood Pressure Set described above and deduct . 
$5.00 from each price! Be sure to mclude this 
I - special offer coupon when ordering below. . 
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 
I enclose $ , on orders totaninE under $5.00 
No COO"s or billing to individuals Mass residents add 3% S. T 
Mastpr Charge and Ban
Amencard charges are welcomed on 
orders totaline $5. or mOre. Please submit complete Card 
Number (Includmg M.L Interbank .1. Explratl n Date, and 
your Signature with order 


Send 10 


Street 


City 


State 


lop 



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. 


, 


.. 


) 


- 


.... 


...:,> 


f .. ': 
-----!.. 


--- 
........... 


., 


..., 


- 


----4 

 ,ß 
C'\ J' 

 


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 



 
I' . 
1 - ill 
. . 
- ... , 


.) j 


.. ... - ....f 


..- 


. 


-. 
. . Ie 



 
:;þ 


r1 

 


;- 



 



 . " 
,V,! 


, . 


\ 


.... 



' 
...-:I 


'1" 
, .;f' 


, . 
,J It- 


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. 


, ..'....
4IIIt." ",......, " 


 1J\. l. 
.... I 
, \
;;.
- 
 
tt:- 4 
.......:=: - 


o 


-"II' 
.. 
t.. . 11'" 


I - 


... ..... 


-L. 


ð -- II
 
-.. --ã 
"- , 
,.... _.- . - - 
... 
 - 
"" ....... 
.'-' ..... ..... "" ... 


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 


"
I-=al "'I-
' '-"'1-. 


I 
.l, 
\ 


...-. 


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?" 


rr 


).<f 


ì 


.., 


..1. 


!- 
.. 


". 
" .. 
 


" 


f... .. 


4 


.:,. .. 
.. \.r 
I. _if, 
. .W'.,. 
.
.,...:.... 
.,,. -.-.. 
- 
"",'.' 


-
 
.:::.::a- 


'" 


... 

 
" 


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, 


..... 



 


,... 


--- 


1 



 


.......; 
\ 

..
 


'" 


.. 


--.J 


) 



 
. 



 



 
" 



 


/ 


4 


.... 


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
 ....1 
sciences ed, -- -'-'jilr 
by a small gr.:>up.' 
that there still - b
M 
decision from the Or. ",,- 
Health concernIng the future of 
nurse-practitioners. 
Both the plenary sessions and the 
workshoPs prompted lively discussion 
frr"
 "
'--'ites and served tc provide 
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 


" .. ...- 
'\ 
".J,' 

 " 


't 


.
.. Early Signs of Disruption in 
. 
· Parent-Infant Attachment Bonds 


John A.B. Allan 


II 
t 


" 


, 
. 


. 
· t.a 


. 


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 


l 


. . . . . . . . . . . . . . . . . .0. . . . . . 
. . . . . . . . . . . . . . a I 
i l 


"'---" - 0' 
., 
4 
 
.- 
-- þ"y=:...
",. \ 

 Ìf!
 - . ... 
 
 
, \ 
,'" 
. 
 . '" 

 
......
 

 I ,I

\ . - T
" __
- ,,'" 
...... ,....
 

, 
- 

,ø n 
\.. \ 

 E-
 
'J',
t\ i

 
 \\ \,,
:\
,\
t

 \ ,If 

. 
. . . . . . . . . . . . . . . . . . . . . . . . . . .'. . . . . . . . . . . . . . 


.. 


-...r 
aî
\\\ - 
\ 


...'...... 



 


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. 


. . 


........ 


.. Þ\ 


þ 


./......... 
6. 
'.., 

 


.....................................................................................1 


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: 


. . . . . .>. . . . .'. . . . . . . . . . . . . . . . . . . .. . . . . . 
, . 


-- ...... 
".
. .. 
.... 
... 
 
 " 
 '"à.1Io. 
 
...... ,....-
-
 
 

\ ," ,- 
-
 ' 




 
.. L

 

 

 -- 
,.

- 
 -J '1h
 

 
- ..
 fi';
 --- 
 

 
____.
 I" 
 
....,,
 
. , ":''''''- \ 
 _ -A. ..' :--:::: 
...r ,. ,
'" "'. - 
. . . . . . . . . .... . . . . . . .. . . . >. . . . . . . . . . . . . . . . . . 


-
 



 


-4 


- 


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 


-- 
,. 


- 
- 


-. ... 


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. 


. . . . 
, 


"9 


/ 


, 
- 
......
, '-
-.... 
,
..'-:''''
 

 

\

 
'\ 
 
-
 

- 
.... . 
 
 f ;

 
. 
 " , 
"- - 
'\,
 

 


.... 



 
} 


- 


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 


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 


Z- 
"- -<.," " 
, ,," 



 
 


.. 



 ; 
'" '/ 
." 
" 
J .. , 

 '- . 
," r 




 

. 


,. 
...-,
 
.Io\t.: c - 
 '-. ,," ", 
- ::= t\',

 ," ,
 ...... i 
 ...... 
} iJJ.(. · : \þ /I ...' 
: (
 
 \\
' 
 111 --;i 
 ' 
 \\ 
 
"\\ 
 S
 
';
-
 -- , \ d' ),\
'
 I!!.,; \ '
,;( 
;: 
it..:: ::::::....-......
 \) \ \\,l\
 
 " 1. _ r-_ 
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 


,.-- 


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 


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 


'" . '- 
._.:;. ( 
 .. .
 _;;;: --( " ït;; " 
. 
 )- -=r ,.- - _ ... . 
 
 1 , 
'. ._-'
', 
 
, )- 
, -::....: ,,

'"- r 

.... 
..' 
_"'t.. \. ...... ,y 
 "\'i/ 
 
<.... ,. , . --"""
 '\\=;:' ... 
,
 .: 
"" 
 ::..-....: . ........ 
\ 
 
 -
 
-; / 
 t
'
 ... 
", 

- I l
" 
 o/@
 
-:- 
\ 
 Ul,'
)!- -,,\ \ 
;, 
..:- . 
 .


 
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 



 
-\ 


\.' 


4 
. 



 


, 


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. 


t. 


\.. 


'\ 
1 


L. 


...................................................................................... 


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 
-- 
-<I 
- 
---- 
} 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. 


, 


" '- 
"! . 
. 
(. 1 
" 


- 



 
,,

 
/" 
 r I \\ '- \ \'
'. \ 
 
/ ill , \ \
 \ ,'\ 1- 
' \ 
 \ \ 

 -,," -. 
" '\' \," 
 
.........,. 
---
 , 
 
--- 

,- 
 
 
- 

 
 . : '- 
-- ------ 
\.;

 
 
,.

 
--- --=-- --. - 

 - 
....._
 
'-
..... 


-
 
-- 


.... 



 

 



 


..... 


... 


--- 



 
:;?' 

 

 


-- 


\: 


- 


i
 


.. 
t,. 


"",.... 



 

Ç;, 


.. 


) 


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. 


-- 


"" 



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 


. 


Q 


.... 


....
 


......... 


1 


.,.<. 


.. ""...... 


\ 



 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 



 


........... 
j,.-". 
\ \.. \. 
\... 
"",. 


'\" 
..... 

 


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. 


G 


, 



 



,. 
 



 


" 


ì 
 


J 


./"",-;.. .. .--:-:' 



. J 

--;;:.. . 
- 


?
'"'--: 


\ 



 
....;,; 



 


.. 
.. 


" 


. - 


'- , 



 Sweet taste of success 
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... 


" 
a Canadian supplier 
for nurses needs - 
ONo

eu.aø.m.- NodutitoPIIY. 


. \\ IIH 
.\ nn IIKII..K. 
fR EE \\hiteviDyIPOfKFTS<\\FRfor 
II pen!t. !llC:ihfOOr8. rtc. ("heck bo. OD 
t=oupon. 


STETHOSCOPES 
,. K...... "'U: I HO
I.OPE" II! 5 
r"l"ur
 E.rceptlonal SQu1Il.1 
tnJ1iSmiUIOJJ, adjustable 
lightweight bmauraú. 
repÚJcement parts aVailable 
in ('anada. .
1
 S,lver, .
15 
Gold. N
90 HI.e, 

92 
CrT"", N
9
 Red 19.00 
ea.b. [..<:IVAi.. 17!l/iaú 
eJ.graved free. 
m AI. HFAr) 0; r.-THII..n)p.-. 
4. mp/,./It's all (rt:fIUt I" In Bord. " 

f f tlml has extrQ larqf> tilOphraqm 
.4.fl}u<i:'ablt'rhrurn' hmaurals 11'11 515.95 ..ath 


SPHYGMO'\1A!\"O\IETER 
,.. RU'N' ,I ami depeniJable, ...,. 
-tlt
rf"d qali.qe calibrated to JOO 
" rn rn L ftlcro tllU( h-anfl-hold 
A ;-:- 
 ' r"t, HmulsfJrnf> zlp1'If'red ca.y 

 1l
._ IOv.'a''llUlnmlee. MI15 
" 
3J...c 524.95 ea.h. 

 
 /71c/udt:.s 11i,hab t'ngrot "d 


OTOSC(WE SET 

 - --- 
I1J lii!.- 
1ß \ .-
' 

 


(hit' "l Germa1iY's (mest- 
rn
lrurnf nls f':rC'f'ptlOnol. 
r/JummatllJl1. PU1J f rfu/ 
rn"tllllfljl1lq It'n
. j 1ìta1iflard Silt' 
.p" "ia S'Zl r hattenf'5 
./udf"/ \It 'al (nrr"rnq ('asf' 
''''''/'ilth 
flft .lllth 1I:I"q 
55b.lMJeuh. 


SCISSORS &. FORCEPS 
'1 
1 
VI' 


US I.-K II \ '1),\"'- ""'ISSlIlt.. 
\ m t fur f f r" \ r 
'1tI1l1ltilt lun,/ "' ,Ú/f'd stet'l and 
'flush../ Pi 
"m",rl/ ( hrume 


#b9!J 
N7()() 
#7112 


12.60 
13.00 
53.75 


III'.-H \ ,,,,; '" '....ilK.. 
.',;'"ml. Sit '. I Tfllqht blllllt'
 
1170:):) . ..harp htunl Sl.X5..a("h 
,,706?) ..harp ..hdrp S2.'6..a("h 
11710 -II 
.. IHI
...( I....nr... SJ.651"&ch. 


.-cIKITI'
 
F,"nt ...;tnmln
 oSt",.1 5 lunq 
 
K..lh Fnrn'p..#72-1 Slral
ht. bu}{;.loc.:k S-I.35each 
Kelh .")f( ('P" "7
;) fur". (I. box lock 5-1.35 rach 
Thumh Un 
 inK 117-11 
I r uKhl. ....rrdl(>oS3.35 "ach 


:\CRSES WAT<.'HES 



} 
,1 


-t "f'p
'",I,ch/t,. ullmet.. uJtJtC'h. Full 
"hf:'r " u IUlt' fal f Ri J SI . tOp 
'", ("t,ml hfUld l"hr"mt.' cast'. slarnlf'Si 
..If' / hack JelndJ.:'rl mr'Lf"mt.nl. hl&-k 
I. fllh, r simp I",. 'I.mra"''''f "lJ'l{) 
Sl
.5fIInllJ 
 t !OofJ/f)ntanol 


"
IIT\ TII"",I "l K........: \\rit
onyourComp.n\ 
1(>( t..rhead for our :!.J p'R'. (".:Ualo
Uf'. Quantity 
rh
("ounl<i 3" allable. =)() ('enl handhnK ("hil.rge for 
ordt'r
 It".... Ihan 15.00 
----------- 
Ordrr '0. It..m -"':01. Quan. 
ue PrlU' 


nIl II 
 \U11I(. \1 .... PPI.1 1'11. 
P.II. /111'\ 7!b-
. RKlln\\ III'" "'T. K6\ 5H 


I 
I "\t"nd 1.0: 
I 
Ir"
l: 
I nt' .I ro ,. 
. Postal cod.: ;;I 
------------- 




 


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. 


,v 
,<<. 
V 

 
(t 


c
þ.N 
o 


N 
& 
\
E 
S 


\ 


;J 

I . - ) 
'
/ 
w 


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 


". ...
 ... '. 

 '- 
l'. 
 
'" ... 'I" 
 
. . 
. 
. ..t 

 
Ì'I 
 
C" 
. 
 -- 
:t" 
-- 


'""" 


.. 


. 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. 


1 
.. 


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 


" 



 


" 



 


../ 


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 


"- 
 - .
 
tJ 
". - 
.:41 J 
. 
I \
 '\ . 
.. 
I . ,. 
.
 , 


. t .,<1 
. -'It .. 
I .. . ' 
. . 


.Q 
,.. - .... 
. .- -'" . 


-:. 
 "'.II . 
:-- .. ". ., 
..


 
 if 
..

:. 
.. 



 


. \, . 
.()
0 (>. 
_,-
"f<" 
..-- ' ... (j-. - 
1(' ..,' 
., 
\ .4 


..... 



 


.... 


'\ 


c:;:> 


\, 


.... 


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 


--:Þ, 


'- 


. 
" 


\. 


{ 


\ 


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. 


y 


.. 


... 


lEAT<fÝ ló p
 )év
 
]}f,IIG ']ói/f THE BOWl 
,I1Qý/#JF!fr _ 

 OJ ì 


 I 
r 
 
.Vt 
1 
 
. - ...."- 
... 
f 

-t:.. 

 1- 
----r- 



 


.:::.> 


'" 
. 


.' 
- 


.. 



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 
"'-, 


._

 


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 


.f' 


\. 


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. 



.l-'\. II 

 .... .- 


,.. 


. 



. 


.."', ,H 


. 


( 


"" 


... 


... 


, 
,. 


o II' , 
.." \' 


.... 



tta 1 8 97 cJcf3. hippiniotv , 
Q 
I I 'Compal\" # Cana!(t) htl has , 
blen hlpil
! (ana!iaJt) (1tU J:5{S 
. pt,O\*ft '
kïfki paticlft caJ't.' , 
cJt has been oUJ' pkas UJ '( w be I 

seJ't'ia W out' t1 tan týu t úJS, 
, . 
[.fJ'in
qht past "eaJ' an! 1\'t 
, 
. , 
. '. , roJ
"u'aJ'i w 
 cOiflinuei 
, : pkas ant a5S ociilÍ01 " 
, 
I 
\ cJcf3.1il'piniotv h 
- 
- COIttpant # CanJv tl 
, 1 . 
I .- 
 , 
. 
I .... 
 
- .. I .I
 4'
 
.... . _.


 -., 
.... 
.... "'I ,,".' 
... 
". ') 
0 



. 


.. . 
. \... 
) \ .
 . 
.
. 
H L DAYSE'SON 
, SUCCESSFUL 
& ULFILL G 1977. 
, 
a l 
II 


&) 


. 


, 


'- 
. -- 


* '" ,I 
... '... 
Q ' i, ... 
- 
. . 
.. ... 
 l' 


o 


, . ,'" 
-. - ..... " 
... .... 


f 


... 

 /"
 
/ 
.1 . '- 
 
\ :- lib - 
 
I ß .

'--' c= . 
\ 
., 
..- 
\ 
\
\ 
 '.'- -;
 
 ! ';'- ' 
, 

 /A ," 
 . 
I 
 -...... . . \ 
. - 
- -- 
 

 .>0," . ____ 
 
(. ...... 
 
 
 - 
, . - 

- . 

 . -'. 
 --.-. 

.J.. 
 


.- 


, . 



30- 


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, 


, . 
I 


I' 



 ' 
-\ 


. 


, 


. 


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 



 -- '\. 

 

 
, 
J .... 
\ " - 
L! II a"" 

''- ".. 
::a- I 
tt 



 


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 


n 
":i 

I 

, 

I 
&1 
> 
., 
. 
. 
;:1 
< 
c 
ë 
.11 
I 


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 




 : 
-c:- 
 r
 ?
 


" ----
 II 
At('- r-td
, 
,
-
 
 
. _.- 
i>, 1 ,/l o#..
 ft.", 
-b
'.:\,. í.
r =- ". 
; - r
 ,rV.- 

1-4 . ":4 

? dE'*
) _
 
 -
.: '-
; 
' 
;J'
 j
 -- -- 
 '-'^A- J
 
. . ,.. ì . .. 3J_ /. _; 


 ,"1. .. - 
.v ...=-/". 1'.: i:? (.

 ( 
.<'''N.
- ./-. ...._ -....1. 
. \", . 
 _ 

". '..-1, -'
.. ..'j., 
.' -." - 
-
 .

, (''''
', --... 0/" AIIiIiII
 -, ' 
\,."'-
..,.;; 

;..:.. 
 
,f4Iq.'4,
' ---:. _-, ;.,- / -'1.: '. 


,'
- JJ; , ..>' . .
/ . <"
 -1f'" :- . j ' 
) >-' jit
,
 ./ V i'. ' . ... 
 . t<;' -
A6 . ' . _': 
_ ." ').of"':' .
. ._ ..... .". 
... i-.. _. t 

 .. .., 
-- 

"',<'"I< 
-'" f" ::- - "'''''.. -- \ >', f I' 1J ! ir--" '--.-. l
 . ... 
';' - -$ --.1.,:1 , 1 f} :: j 
. ,- 
. '-i'...) /l,.,'

" .
 -. 

J l\ 
- . J 'I 
- .... 
- \ 
- , - '---- 
..... - 
\
 r 


I 
I 
I .. 
I 
::.: 


#
.:
 
-,;".".,,& 


r-- 


f' 
I 1., I: . 
J 
' ., ..J
 
!, I'
 
} . 
' m \
 l;
 t ' ',\ : \ i'

 p l ' . , ' :: 'r. 'f 

AvA:IIC"'\
l.l' 

f/}'--I I
\', 
, ,; r\' 
-ß
(..\\
' 
.
.;1' V lli._.r,
 (
 f 
' t , I '. .; Ý ,,!,-=aï
 
'. '::,.. L - _ --:- 
 ..." -{
 
 .;1-' 


.... 


.... 


.
 
------ 


J IJ 




I 

 


--- 


=--- 


- ./ 



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 


:1\\" 
\., \ .c.. 
,,,\\\CY. 
e

 
,,; . \Cl
/ 
'-S\
,' 

 CO .
\\ 
. 

 \ \)
" 
, .
\

 
S 
.J
 à'-O 
\\'-'" 
 



 '( '
 j 
· - - :. I - J , 
-<I 
O;O,," Slf7jN.
' 
l]yO ""<tE'/J,t 1I1fJd 
; 
1 ::
 è) I] l1e 
 o .o"'og"O''J] Zift1/ , . 
\,....\ ....."-t,; 9 0 
\'\\'\\\\"".$,,


 ...el f!J 
 o
 " 
\,\Ù ,......:i
...

?;.
 lJ ,L e,. 
""
.... 
,,'..:i.
"'...," 
.
... ......... SF] 
 
....
..."
.:-
..
.. .:
..

:.;......
....... Ols -. 
.,ø ,-:;:.. ........"':......... 
. .
 .::;,
 ;;:;; ..

 -J' 
..
1 ..
 ..:
"'
'ò
 -. ./_.... :; ,
4 ..
....;:... 
4 

 
':
 ;,

:..
 ...1...( 
.
:! ..:z,..;......
.,:
": 
c,'3.uJ 
.,.' 
..........,.:::: ....
 -..;
., - 
 
'3.{{\ 1...".,..
;: 

 

4"
"'
 '" "/' 0 1. at 1\11\
 

 
.,
..",

...... _1 . 
 \,1. ....
,....
.,...."'". 

Þ

'-


.",8 r- 14(\\\0 
(\. -:;:\
.:-;$
" 



 :;--


 
 , basiS . ... 
ocu """..- do'" ...::;. t:"";;,, -:.... ...... 
 
/"1t
':. ,olu tl1an \\u \\' 

.;::"..\.......- .:.......
''''
...j:;::;, 


...:.Otl S \1\c, '" 
",
........... . ..,,::.

,.
.,, 



4li
, 
 d\\\ ,"01' \:' " ...ø
\,,,,
\ 1I'\..
.
.fI. \:\\
4\
-d
\Dt<<O 


 s
 1'-1"'.ø fP Of" 01" \& ..C'lC at ......
..
 

':'4

--"
 
""'--::.o ":ø"
 "
\

\


'Otl '''ø"ø .""
d tfo*Ø' 

1


":;...;tA :1o.-O\


\\:,,&d1""- "'-rÇØ',.d
 .....1C
 

\* 
. 
'4r.


 "tOtl
:vØ'-



\I\a\'O
\ ":;::'"P' 

jØ)'--



 wP , 

;uðl!lll
p-.. .p ...,.
:: ....fIC ,.ð.16flU
 tt'\\\.otI"ø1ll
1l 
 
ø..
"\D,,.
 
.tJ"alI1
_-n::.. .'
 I 
 
 _ 
",.
,:,\..& '
ø
\


 "'
\QI"4110
 \\,& .
.,-:Irl 
1trnt1leMtlnJ.
 -:1 
 'f'" ..- 

1.
 
 '" rØ'".:: F" l"
 CIiI 
U.ltwydoddQ.. 
"C;
""'\\"'d
\\b....."ørO 

 ...Itr....',..."'''''. 
.;: r..:.
J,::: 

\IÞ .ø k .. ,-.c '" ..;..". fJ. '.'':1'': 
6:0-.!"
 II "
ø\ .,ø. 

 
 ø ",,-,1"'1 I., I..- 
".,....
nqg....ttne 
 '-' __'" --I."
"W. f,.
 r/e f: '!'"...... 
.....r_t'..tmrifert ........
 ø
 ",,"h..
J.... 0 b ,.. . 
..cI JIr Miller -.l1w _ill l' 
.,.,.. 
 1ID',,&f tA.\'P' 'J!!o1W' 14.'
3"J11iot.t .co . 

Ie.
rt 
 C 
 
'- \) ,. .. 


"''i:
 
 ...- f-eS.l. 

\
-=-:rn;:. 0>'" . 
heoJ S . 
..,.


 ;,r

'--C" reel 
- .. . ..., ." . . '" '-' .. '.. , W' ll '" rl ....
 :;:..,...., ... t Of) U -......... 
"'.. _"'0_' 
"
 \ 
 ....." ...- TlIJ -........"'.,.... %"", S " -......... 
ho.....hDam.u...._,......-.. 
 ' .'9'8_19,'1.,.... vaCC. c.;..'4
':
 . h 



..= J" 
-' 
"h Ð1}"e,.. .. :':""'U:'::' 0... .... IOati'on ÞJrt If.....
 
 . c 'lc 
......... oriD br ..._ e " 
 .. 0{ fAr 
 h... lillI" ':,.rllp r.c:
... ... -"tI"- I;:"
 III pro grð ....... 
1""..I1'01
..'" .. '-' 
 bee 1111 C1So_ llJal1h.ir let ølll.-..... ",'" m I...u- d 
rnr6I
mI\I'IlIltJ<'ft ,,"- -#ð- \;,.;.l'jd
:..rrpo,.,;:JJI)
..,..-"II'...
IIp.... ::;-..:::.. 11.-,,. 
11J ::. efl7Jp, 
I eo ed 
_Jlr....:
aiIIlhf-:--=: (,._""
 rpc 
 .L .......00' '" "'r.,..., '::"
Il"-IbI/'" ""-':: 'IIaIo.I,......
I'

".':: 
i; ,..,:-;:...... 
_1d
mI_nu_1r ",,'" 4'(1""'J
' jl'ler.rl . 
J!"'n ...__
r,.rtvd 111
J;f''''' ...IJderJ""()[!he Jb,.iPi''*r1" 
'.. "'::;"'<ll7lto. 
;W

..II'oI"MI:"""" '"\, "'" 0 rOl nt "'-:':""''''
 '''W1'Ij ;,,'::;:'..-.--:.;hf'T,::::-': .....
.:z"'
'

 
,;":

':
: 
'ltleGo'flrf1lmalll(inl__ ) dl'" T".
"'."G _,...le....,..-..tIJ... Q.,efrr.e 

fIwIj
.Ie!I-w;,._
"""'1II 




-""I (I s dO< 
 \ '
I I
Oi..""'''.,f:::dr:'':'::
'DIIø:::':; 
"<lSlb.o

.. r.c:::
-:::'<IIJd':-.r:' 


if

.'''''' 
.."..,fI:I....IIC.';:;:'" . r" --- Itq"" ...d..."...."tIenJ."..,1ea...a.u...,,,. ,__.-./
hp

 .,.Iir "1u.,
null1ll"'l. hftI.:t.:

. 
.- nu ____ l1li: Mr 
 . SC e ., .
":><J.. 

'VIteí". ,.,...
 :::- 
";>' ...;:: 
 .ir:....,.. ....., 
 5:'
rls.t 1'DIrJ
."Ir"
 
Ifilla' 
 h. mild t"""1 \ .,...... 
12Io'
q -III..;.""".."..... 
J
 .,.
 Ib..ln'-.I 
""""'..øl ""JbI. ',....rhe.fj"'V
 
::".

r= ..
C y,,, .. ..::,,",:::.

.,::.
 :::"
J..


 ':

,'
;:'0IIJd


 .IC
.':::"
I
" 



"Ihf
= l)' '-
 .. ......., 





 ':::
'
J

Z ::-E
..III:::
 
:,=:..::w,-::Q'- 
_trarl"IIIt:re
.,
 \ ts 'I .
CClol' ..;;.,.AW_.....IItIJ
b,.,
" -"
;'
f""1.:: 'tI_:'C:Vklre
1II' ::
....",&o,:.d..r... 
.

-=,lør
L "' () '-':1-0:,".1.1. "-'h.
 ef1J.,.
 J:;'br":,,,Oy
__,
...: L.I
.l:' """Iy",,",,* 
(:I
"SI}t'f

If .. '" 
\, ' ..
.... .'-Je., . __--blot: r1>rct. ,..<111ft"'....... ""
 '.r.1r.J . 

 .,...,. ......... 
"'IJerØrp.......J: .,1b1lrr.....
A:.,..r _"':..
r.c:
aqrllp 
t T' ( 61 . JI ..
 
, .
 ':;:.r ...:-:-: 

J' . 
 
 
\--"'0'-' t:1,
cS of II ur .. '-::
"'
'::
 r
r..
::::r:.:E 

 U but he. J J u " gea oy rntr;l', '''
'''J;:,
.::: 
0 ..'" <l t I oFf;"' ...., ':''' 0",..., - to. . ___ 
( o t lSél\ïlO{" 1('lal!! 
::;,.::- 1\,\e . .....-: .. 
\ ,...,....';.
..
.f PldcoJÎ(' \ 
Ä:" 
",,:,
"#-s""
.:,.;;.:-..... \ 
L edO
\.'
:: \
"':.
:-::::,,

':::,h """lit. 'UJ .. ef ';:

7':" t K :
.:;

.

r
:
'ot;::;;. \ 

 5a1'lf('i.tI ,,
{j II'J:-''''''to''''''' "'b.a....:t,.", 'l..

p "illu.lt/II) f/Irt1 
. 
 ".oTf.
,.! ...a ",..tIO

'SfI_""""'-- 
\
I\"'(f'I1. .. ::'ttJ'..r:-", "
.I .'",';"t'
.,1' ::-,__JlrflrrIJJ ..,..,. .... i:'.\1I
\b' lot ..........eSf!: 
'Ûla 1\ .I',,"" <4-,. 'II 11>......... I,. 
"'D'. '-1þ....oIdA/.,...... í.....
 ...... ".oTf.
b.' 
 
'I(II) 
{\Uas

.,,..&".:--.
4'
"-:
,,, ..,'.;... u.:...;: """':
:"'t1 """'''
'JI'.tc

;-i 

.. F 'rlSL
/ o.r/d .".. 
.. 
 
_ l,.lJ,. "4::.. ". '"..111.:: ....., 
 ----,.. 11
.. . "41,( 1 IInø . ........J '( fOr 
s" 


; ;,:::
::'

I \"" .II
:";:L.:
.'."J
 
 ;;:i.-:::.:r.....
 
"'b.,.:;:;.ilrlo. .... '1'1\O
 
Pb,. o:':;:'f
'!1jc al 
""'''7,;,4.'' .Þ'
,.."
 
/J :It' .JJ
:.f3' IfI;,L.,s.. 
__.... ,;:;:::..
"..
 ."'rr.e.-ll:û.,.....,. ..., 
 \.,...._
 Iller;:" lo"r",'laá-:::o{...
 


.. '
"'I,r"!tr."'
 I.JIII 
f.r.<<':U,!,r..'
Io/._,..
.._. 
 .c.(\O". _.... ....-:
rø ,"-',,,,
"'..,!::-I'j 
';':CIa :..
.... 71).... . ara .......... ",..,.., w.a ,. ,,
 
 .'a.....
-
 

 :tr.lJ:Il_
'" 
6e"-.,,.
'''' io...
:r ,,,........1- J .J/C8oI IAI1 .-q,. If""-er--"Qa' 
 \. b\
 ..,ø

 
..,IIb...q,
....r,11rPc 
4.,:.I'pI:....?+.f/Z"'
: Da
fJjJ
 LlQ)" ::
Fr- e .._'
 0" 
dI

-,II



: 
("Ie:.. :..,
,....tð... .rc... I "h__,,:;I1;u,. ,"Co. 
t.'>.-.
 
-\\ ,.ø
" 
..
I'j.lJ"t:Jr.".IJ"lriIr"lJ 
....' So;,.... 'i'""'l.. 
 J!p J .tt.e.!lllll... "'I O I\"
. 
\r'j 1ID'Ib:':':

\ 
_ \l.ø:
'o
 l.\
:
""4r..'IJc,I'
""'b
j 

 '.ö..
,. "u .... 
\\,: ...\.......
 ov6.
 
 ."'. cP:- 6Ø n ø- "" .
 'IOf' P"ðI
 10 i;;;' 
') S$-:.t:'",

" '-0 ,,' -C\\1. 
 ...;:"'


 
;'
 
.;;:......
..
...::.::::-.
 
1.1..i
"'

,
.ö..f . 
 
 "\:I&"
"____ 
lIot
'fII""'


 "'CI'
 
 
 
O/",,,,,,,,,,,-

"It 



':
ð


oIJ SCIence ..,Øl C :__ _to ':
 r
o
';-. '
.:::s
. ,...;1
a\
 



 '-'eð1er,,;:r 
:


.. '(,.;;. . 1
Cl
'
 ø
o-';
,:. 0- m' 
 '" "'"".. 

C"9,6c-iw? 
.............. .,..",1 stra ln <-"
....
:;:. ,."....,.;....... \'\..
\- .' f .......;..
'.:. 

....:: 



:

þ I
i_ 


OD

 




 -,* 
 . '
. 
;
:. 


4J'
-

4t.J,. II ,'\-ø"\
'O "111'0. "01. 

;"'.
I\.
 ....



_. 

-
 \Þ
 
....,.
..:., ..-" "'" ''''
 ....., """..
::- 

ø<',...."'" Vl ruS a l 
".--,,;.,,
-::...
 

(!."t." .
' e 
.fI'.,.,... I 


 
......,.N: 


 \
 
 
rCV";;'

\J'So
. 
1.

40"'''J:tr. 
-a ... 
"'I":: f('
"..n:'., ':::
..u1
<"-;' 
_""",,,



ðG ðJ1
r.
.'I1'
",
 ' n S1 - 
. ko."1r;'- W "'.... þðe plð \\SI:IrJr, 

 "\'II"___
""'
" tat 1'
.,þ1P-;ø.e.1,GI" tt. :rr. .. 01 ,,,. '
øø-
.'''''' 
'r,,
.""..:t. 
JI 1Iar'I'CI ace1\eC I.t. '1Irt .",Þ,s' .
..o#.. 
_",a.I.
'-' I -
 Ho._

.......-...a'fII 
'"4

 .,
,,


:. .,
.c ..n...... 
,.:-


-o:c
 





 _. ...,"'.:}.... .f'I
tII
-.e.c.
.o
..tI 



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. 


THE CANADIAN NURSE'S CAP REG'D 
P.O. BOX 634 
ST. THERESE, QUE. J7E 4K3 
-; 


NURSES CAPS 


<0Þb 


{ 


MAIL THIS COUPON TODAY FOR FURTHER INFORMATION AND ORDER FORMS 
-----------------------------------ì 
OUR PERMA-ST ARCH CAP 
"NEEDS NO STARCH" 
WASHABLE, NO IRON 
Students & Graduates 
We duplicate your cap in our special fabric. 
Also standard styles available 
Single or Group Purchase - Volume Discount 
Name 


Address 


Cil}' 


------------------------------______1 


Postal Code 



38 


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 
: :::::::::::
:::
:::::::
:
:::
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
: 


mrmmmnmmm
t
W
mm=mt
@j{( 
.................. ..... .... ... ................................................-.-.-. 


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%

!j!j!j!j!
jj

jj! ::::::::::::::::::.
 
r 3 0 - .!!!!!!
!!I!
!!!!!
 J ' !!!!!
j!i!!!I!!
i! !!!!

!!i!l!i!i!!r!!
li!j!
!!li!!I!! I :
iiIIIiii 
 
.:.:.:.:.:.:.:.:.: .:.:.:.:.:.:.:.:.: .:.:.:.:.:.:.:.:.:..:.:.:.:.:.:.:.:.::.:.:.:.:.:.:.:.:.:. 
.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:. :.:.:.:.:.:.:.:.:.::.:.:.:.:.:.:.:.:..:.:.:.:.:.:.:.:.:.: 

 ......... 1 ......... . ..... r ........ ........::r........

I
:.......J......... ........ ......... . 
.:.:.:.:.:.:.:.:.: :.:.:.:.:.:.:.:.:.. ..: .:...:: .":.:'::.'.: :..-:.: :.:.:.:.: :.:.:.:.:.:.:.)r:.:.:.:.:.:.:

J
.:.:.:':.:':.:':':I:.:.:.:.:.:.:.:.:. ................. ........ ...... . ....... 
o 1963 1964 1965 1966 1967 1968 1968 1970 1971 18?2 187;) 1874 1875 


\
{(:{ 


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 


-"- ..... ...... 
.. 
 
. 


.... 


J- 
 _ 
-...". 
 --'- 

 
=;.- '-- 


.... 


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. 



\
 
,. 


 
. (, '<l' 
..
 "i< i 
.). j
 . 
 ....... - ( 

 
I , 
 


") 
/ 



 


p 


/
 


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 


., 
. a"-. 
---
_2- ;. 


. JlJ 


,.4J '1 
,.r 
 
.. 
.

 


I 
, 
.. 
f
 


. 
_i 
.
 


-,
 .. 
- 12: 
-fíL'6 ... 
- 2"'. '- 
 . 


""'" 
...... 


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 


I 

 ....-:.. 
.

 " þ, , 
.,; :
 

.
. 
\. \ , 
j 


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. 


'. .. 


-'"' 


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: 


. . Health and Welfare 
Canada 


Sante el Bien-ëlre social 
Canada 


Director of Nursing 
Montreal Children's Hospital 
2300 Tupper Street 
Montreal, Quebec, H3H 1P3. 


.. 



S2 


The Canadian Nurse December 1976 


.. 
. . 
. . .. 
I 
. t . I 
. . 
. . ' . . 
I 
. I I I J . 
 
I It 
I I I 
r . . . 
ç, I . -, 
.... '. I I 
- 1__ 
 
- 
. 
.If 

 
-.... 
"- 
--.L 


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. 


!i3 


Come 
grow 
with us 


" 
 


.1!. 
.....') 


; - 'I 
l 



 .. 



 


\": 


'. 


'
 
. 


,";- 
\...... 


- 


Î 


" 


Þ< 


1. 


" -oj'l 


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 


'. 


 

, 
('. 
. .c- 


 
" 
, 


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 


Wish 
ere 


,,_ 
 f"' 

 
t; JJ 'x. ' 
- . \
.. 
< r'},t - 
., ,,- 
, . 


r 


.,.I . 


,..". 
- . 


...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 


.\BR.\H.\\I. P.\. 
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- 


.\()OUSC"-'CE 
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
e 
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 
39003008724477